Free treatment for cancer?

The tremendous expense of developing cancer drugs would be worth it if the drugs promised cure or even lasting remission of the disease. <br>BUDDHA BASNYAT, MD

April 23, 2012, 5:45 p.m. Published in Magazine Issue: Vol. : 05 No.-19 Apr. 20-2012 (Baishakh 08,2069)<br>

Cancer is a feared illness not only because it may potentially kill the person but also because it may be financially draining for the family. In a country like Nepal where any kind of catastrophic illness will cause significant financial problems for most families, it is clear that when someone is afflicted by life-threatening forms of cancer, it affects not only one individual but the entire family. Certainly emotionally.But perhaps more practically, financially too. In many instances chemotherapy may only prolong life for a short period of time, but at an enormous cost to the family. Because the state does not pay for expensive medical bills ( unless you are a top politician), for most people, to opt for treatment or not is a wrenching decision. That is the reason why having a universal health coverage provided by the state and the public at large is what is essential for Nepal. But we will save that topic for another day and for now talk about a success story.

Forty year old Krishna Prasad ( name changed) who was suffering from chronic myeloid leukemia ( CML), a form of blood cancer, told Dr Mark Zimmerman an amazing story. Mark was the director of Patan Hospital then( 2001), and Krishna told him that free treatment for his condition was available.The treatment involved using a drug called glivec( imatinib) which has revolutionized the treatment of this dreaded disease. But Mark was puzzled because this drug, although stunningly successful against CML, easily cost $ 30 to 40,000 per year; and it needed to be taken year after year. But Krishna, the patient, was telling him it was available for free.

Incredibly what Krishna had researched on the internet was true. Novartis, a Swiss drug company working together with the Max Foundation were providing this drug pro bono to poor patients with CML in the developing world.  In Nepal, now in 2012 there are over 500 patientslike Krishna with CML being treated with glivec.In Kathmandu  DrGyanKayastha  helps run the programme from Patan Hospital.Bharatpur also has a similar set up. For the oncologist ( cancer doctor), this drug has turned out to be a poster boy in the treatment of cancer.

Unlike many other cancer drugs which kill cells indiscriminately in the human body, glivec treatment is based on geneticsand targets specific cells and genes. The target in this case is the Philadelphia chromosome which characterizes and helps diagnose CML. The activity of this chromosome is detrimental to the body and triggers among other things the growth of a massive spleen. 

The tremendous expense of developing cancer drugs would be worth it if the drugs promised cure or even lasting remission of the disease. But the vast majority of new cancer drugs achieve very modest results. Hence the excitement generated when aanti cancer drug like glivec is found to be so exceptionally effective. Unlike glivec, consider a drug called Tarceva for pancreatic cancer which  extends the life of the patient for 12 days at a cost of twenty six thousand dollars. 

Unfortunately as often happens with drug therapy, resistance to this wonderful drug has developed,but thankfully new drugs to overcome this resistance are available. The good news is that the generous people who are supplying free glivec for patients from Nepal  have also committed themselves to supply the new drugs too.

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