South Asia

INCTR reaches out to Pakistan

INCTR is exploring ways to focus on the priority areas of cancer treatment in Pakistan. In February, Dr Ian Magrath and Dr Anslim Narinesing visited cancer facilities in Lahore and attended the 5th Symposium of the Shauhat Khanum Memorial Cancer Hospital & Research Center.

Facilities there are comparable to well-run hospitals in developed countries. Patients referred there from throughout the country have access to clinical services in medicine, surgery, medical oncology, pediatric oncology, radiation oncology, nuclear medicine, radiology, and pathology. Dr Narinesingh also visited other state-run hospitals in Lahore, including the Jinnah Hospital and the Mayo Hospital.

Among the important cancers affecting the population in Pakistan are female breast, leukaemias, lymphomas, and lung cancer (primarily in men). As in most developing countries, the majority of cases present at a late stage, leaving limited scope for effective treatment. Both the public at large and the primary health care workers would benefit from community programs encouraging early detection.

Indian Oncologists Create Cooperative Group to Study Leukemia

During a recent visit to Hyderabad, India, to discuss progress in protocols MCP 841 and MCP943 for the treatment of acute lymphoblastic leukemia (ALL), leading Indian oncologists decided to form a cooperative group for the study of leukemia. Protocol MCP 841 has been used for many years in India with good results. Within a few years of its introduction, and with collaboration between present staff members of the INCTR then working at the National Cancer Institute in the USA and Indian cancer centers, survival rates in ALL patients treated with this protocol had more than doubled.

The success of the protocol led to its use in many smaller Indian centers. To assist these less experienced centers to use the protocol effectively, the major centers, including the Cancer Institute, Chennai (Madras), Tata Memorial Hospital and the All India Institute of Medical Sciences, decided to form a cooperative group to include smaller institutions, some of which are now staffed by oncologists trained at the premier cancer centers. This group will greatly assist in the dissemination of information regarding the use of reasonably intensive, standardized chemotherapy regimens and supportive care in Indian medical colleges and larger hospitals. This should result in better care of patients, even those unable to reach the larger cancer centers or to undergo the necessary two-year period of treatment far from home. In addition, it is hoped that more data will be collected regarding the clinical patterns, prognostic patterns and biology of ALL in India so that treatment can be better tailored to risk groups identified in Indian populations. Eventually, studies will be expanded to other types of leukemia as well as leukemia in older adults.

At the Hyderabad meeting it was agreed to undertake an analysis of approximately 1,000 patients treated with protocol MCP 841 in India between 1990 and 1997. The results will be used to develop risk-based stratification of ALL patients in Indian centers using this or successor protocols. A meeting of the INCTR's leukemia strategy group, which will initially be formed around institutions with experience in the use of protocol MCP 841, will take place in Brussels after the INCTR's Annual Meeting. Results of a successor protocol to MCP 841, MCP 943, which has been piloted in several Indian cancer centers, will also be discussed, along with future plans for ALL studies in India. At the same meeting, a proposal developed by INCTR collaborators from the King Fahd Children's Medical Center in Riyadh, Saudi Arabia, for the molecular characterization of ALL in South Asian and Middle Eastern countries will also be presented.