When Kamini Pradhan faced cancer recurrence a second time and chemotherapy with strong after effects could not be considered an option for treatment, the doctors decided to put her on Targeted Therapy with a rare drug which worked miracles!
I was detected with a second recurrence of Ovarian Cancer in December 2015 and as always went to Tata Hospital in Bombay for treatment. I could feel no symptoms but the disease was so visible in the scans that malignancy did not even require a test. Yet, a biopsy was done to confirm the disease.
That meant another round of treacherous treatment with chemotherapy. Radiotherapy was ruled out as there was growth in more than one place. Surgery was not possible as I had already undergone two surgeries and since the location of the growth was tricky, there was serious risk of damage to the main blood vessel supplying blood to the lower limbs as the growth was sticking close to the blood vessel. Therefore, there was this apprehension that any disruption in blood supply could lead to paralysis of the lower limbs.
In the past, I had taken several rounds (many cycles in each round) of chemotherapy. The last two rounds of chemotherapy had such critical adverse effects that putting me on further chemotherapy became a very debatable issue. The doctor in Lucknow (where I was undergoing the chemotherapy) had suspended it midway because he felt that the extremely low platelet count, caused by the chemo, could be life-threatening. I rushed back to Tata Hospital, Bombay, where the oncologist eventually decided to try out some Hormonal therapy, which, despite not being the conventional treatment, had been found to be successful with some patients. However, I proved to be unlucky as the hormonal treatment also failed to work.
Kamini Pradhan: Be a crusader, not a martyr
Dr Sudeep Gupta, the senior medical oncologist at Tata Hospital did not give up and decided to now try me out with Targeted Therapy, a completely new line of treatment. But that could be given only to patients with cancer of genetic origin. After I told the doctor that my maternal grandmother was suspected to have died of some cancer in the abdominal region way back in 1971, he felt that a BRCA test could establish the genetic origin of my ovarian cancer. The test was very crucial in my case as that alone could entitle me for Targeted Therapy (oral chemotherapy with little or no side-effects) – the only major option left for me.
Even though the test was a bit too expensive, I chose to get my blood sample sent to Bangalore - based Strand Life Sciences lab, which confirmed my BRCA-2 mutation.
I fulfilled the protocol to get entitled to Targeted Therapy. The particular drug – Olaparib – was yet to be launched in India, even as it was in full circulation in at least 40 countries. The drug was exorbitantly expensive. But the silver lining was that Tata Hospital had an arrangement with the manufacturer to provide the same free of cost to its initial set of patients who fulfilled the strictly laid down protocol.
There was jubilation in my family because of the sudden hope that came with the news of my entitlement to get Targeted Therapy. But my worries were different. Confirmation of the genetic origin of my cancer meant that now my entire family (my mother’s side), my siblings as also my children were exposed to the threat of this deadly disease.
What got me worried was the apprehension that members of my family would already be carriers of the disease. Initially, I did not know how to react. But I soon realised that it was not this test that had made them prone to cancer. The disease was already there. And my report would, in fact, help them as a warning to facilitate their preventive treatment even before the disease actually manifested itself. It was this afterthought that gave me an entirely new perspective and gave me the strength to fight.
Now came the time for understanding the prerequisites for this treatment . The strict protocol laid down for making a cancer patient eligible for Targeted Therapy went as follows :-
- It should be a case of Ovarian Cancer.
- A patient required to be tested positive for the genetic mutation (BRCA 1 or 2). I was BRCA 2 positive.
- It should be a case of recurrence (I had two recurrences).
Another important pre-requisite is to have taken at least three cycles of chemotherapy, just before being considered for Targeted Therapy. And these three cycles ought to have affected at least 30 per cent reduction in the size of the tumour growth.
While I fulfilled the other criteria, I had to undergo at least three more cycles of chemotherapy and hope to see a minimum of 30 per cent reduction in the growth. My medical oncologist was keen to ascertain whether I would be able to tolerate the chemotherapy. As the last two experiences were not encouraging at all, he had to give it serious thought before embarking on it.
As if still in a dilemma, the doctor, somewhat apologetically, told me, “You are looking fit and fine, but with fresh chemotherapy, I am going to make you ill again”. He, however, went on to add, “But don’t worry, this is going to be only temporary.”
I, on the other hand, sought to reassure the doctor that I was confident that I would be able to bear the chemotherapy this time. What gave me the strength to say so affirmatively was the care, prayers and support of my family and friends, who always stood by me in the worst of times.
Sure enough, I could tolerate the three cycles of chemotherapy, but what left everyone, including my doctor, disappointed was the fact that the much-awaited reduction in the growth did not happen at all. I still did not lose heart and readily agreed to the doctor’s advice to try three more cycles of chemo. He felt that the chemo failed to have any effect, because the dose of the medicine had been reduced in order to make it less toxic for me. I clearly understood that I must take these chemos without misgivings as, in any case, not many options were left for me . My family too was not willing to give up.
Finally, I could muster up sufficient strength to withstand all the discomfort and brave it out to tolerate three more cycles of chemo.
The good news came at long last. After the last cycle of chemotherapy, the CT scan and PET scan showed that the growth actually stood reduced by 38 per cent. I now fulfilled each and every eligibility criteria for the new Targeted Therapy.
Eventually, Dr Sudeep Gupta, the Medical Oncologist at the Tata Memorial Hospital, arranged for the supply of the new drug, that came in a capsule form. But the dose sounded scary – 16 capsules in a day (8 in the morning and 8 at night).
To be imported from UK, the procurement involves a long procedure:
Permit from the Drug Controller-General of India, Import permit from Customs, Certificate from Treating Doctor/Hospital, plus several other affidavits and undertakings.
The cost of the medicine is prohibitive and unaffordable – works out to about Rs. 2.25 lakhs per month. As its job is to arrest the growth of cancer cells, which get numbed with the medicine, it has to be taken lifelong. But the silver lining was that since the medicine is yet to be launched in India , Tata Hospital has entered into an agreement with the manufacturing company to provide the same free of cost to its initial set of patients.
The first consignment of Olaparib – with brand name of Lynparza, was released in November, 2016 for three months and delivered to the Tata Hospital, from where I got it collected and couriered to me in Lucknow. I started taking the medicine which has side effects, that are much milder than the usual chemo, and does not cause hair loss. I could easily bear the nausea , dizziness and fatigue that it caused and to which I have now got quite used to.
It is the beginning of June and I have already undergone this new therapy for six months during which I have received and consumed two consignments . The third consignment is about to reach anytime. And the good news has come once again with my latest PET Scan, that was seen by my Medical Oncologist last month. The size of the growth has not increased at all , which clearly means that the medicine is doing its job.
And that is truly heartening.
