Standardizing cancer treatment

Dr Advani confers with Ian Magrath at the INCTR annual meeting.

Suresh Advani, the man who pioneered bone marrow treatment for leukemia in India, is one of the most highly-decorated physicians in the country. Last year, in recognition of his significant achievements in medical research and education, he received both the Padmashree Award, a civilian honor for lifetime achievements, and then, in early November, the Dhanvantri Award, India’s highest recognition in the field of medicine.

The former Chief of Medical Oncology at Tata Memorial Hospital, Advani also helped to establish the Oncology Department at Jaslok Hospital, Mumbai, where he is now the Chief Oncologist. He is working with the faculty at Mumbai University to standardize the oncology syllabi used in its medical colleges. And he has established the Asian Institute of Oncology at Bombay, providing cancer treatment at affordable cost.

Dr Advani, 56, trained in general medicine and in hematology at JJ Hospital at Grant Medical College in Mumbai, and studied oncology in the United States. He joined the Oncology Department of Tata Memorial Center and Research Institute in 1974. Here, he undertook clinical work along with research in hematology and medical oncology. He devoted the next 28 years to developing a modern oncology center and operating India’s most advanced hematology laboratory. He established the first bone marrow transplantation unit in 1983.

Among his research projects were cytogenetic studies in chronic myeloid leukemia (CML) and myeloblastic leukemia (AML); the cytochemistry of leukemias; enzymatic patterns in leukemias; cell-mediated immunity in CML; cell-mediated immunity in Hodgkin’s disease and myelomas; and polyamines in Hodgkin’s disease. Advani has published more than 500 papers in international medical journals.

Advani began practicing medicine when oncology was an emerging field in India—and when survival rates for acute lymphoblastic leukemia (ALL), for instance, were less than 25%. During the past 15 years, long-term survival rates for ALL have risen to nearly 60% at the Tata Memorial Hospital. Early on, he recognized the importance of international cooperation, particularly for workforce training and the transfer of technology. The success in treating leukemia is due in large part to hospitals across the country adopting uniform procedures for diagnosis and treatment (recorded in a “protocol” document) developed by Advani and his colleagues at other major centers, in collaboration with cancer experts from the National Cancer Institute (now with INCTR).

Advani believes standardization is critical in the fight against cancer. The treatment protocol outlines how specific drugs should be administered, what side effects might be anticipated, and how those side effects should be treated. The ALL protocol calls for drugs in their generic form, which are more cost-effective than new drugs coming to the market.

“Being a cancer institute in a developing country, we have a tremendous responsibility not only to deliver treatment, but also to promote education and research,” Advani says. “All of us need to work together, and INCTR has been really helpful in this area. With assistance from INCTR, we have been able to do more research that helps us advance the understanding of the biology of these diseases. In certain areas where we lack expertise we need to send people out for training; we also are looking for a reverse flow of knowledge-to have experts come to our center to look at our work, to help us upgrade local facilities and to make sure our data are absolutely reliable. The quality of our work output should meet international standards.”

Under his guidance, Jaslok Hospital now offers bone marrow and stem cell transplantation therapies in addition to routine chemotherapy and other standard treatments. As a medical researcher, Advani looks forward to moving into DNA microarray —a technology that allows biological information to be stored, integrated, searched, retrieved and analyzed—which is reshaping molecular biology and bioinformatics.

“Everyone is very keen to get into new technology,” he says. “Everyone wants to learn how to do things in a better way, but the opportunities are limited and it will take time. The most important thing we need to develop are our human resources—with properly trained doctors and technologists, everyone benefits.”