India's first centre for interdisciplinary study of medicine to come up in Kochi under Amrita University

India's first centre for interdisciplinary study of medicine to come up in Kochi under Amrita University

The first centre for integrated study, research and patient care in Allopathy, Ayurveda and Yoga will come up in Kochi, Kerala under the Amrita University.

The Amrita Institute of Integrated Medicine and Research Centre is planned as a centre to integrate the holistic vision and therapeutic range of Indian systems of healthcare with the analytical, diagnostic and prognostic proficiency of modern medical sciences.

Amrita School of Ayurveda and Hospital, Amrita School of Biotechnology both in Kollam, Amrita Institute of Medical Sciences and Research Centre, Amrita Centre for Nanosciences and Molecular Medicine and Amrita School of Pharmacy - all under the Amrita University will be part of the integrated Centre, which will come up in Kochi.

"There is considerable room for studying interdisciplinary avenues between the modern and ayurvedic treatment strategies, which will help the common man in India to seek a better and more holistic approach to health," explained Dr. Prem Nair, Medical Director of Amrita Institute of Medical Sciences, Kochi.

He further stated, "The purpose is to bring Ayurveda and Yoga into the mainstream healthcare in India."

The Centre will bring out replicable guidelines for introducing and practicing integrated healthcare at various levels besides facilities for study and research. It will utilise non-pharmacological and non-technological healing spectrum, including psycho-physiological interventions, behavioural therapeutic measures and spiritual inputs to improve well-being; record and present the experimental knowledge in scientific forums to create awareness and network with physicians from Modern Medicine, Ayurveda, Yoga and other systems of Indian medicines, who are in alignment with the concept.

"We have already set up an integrated clinical programme at the Amrita Institute of Medical Sciences that combines Ayurvedic and Allopathic care with some cross-referral system in place," said Dr. Prem Nair

The research areas will mainly focus on validation and development of formulations for diseases and clinical conditions known to have effective treatments in Indian systems of medicine, medicinal plant research, drug standardisation research, pharmacology research - pre-clinical safety, toxicity and biological activity studies, literary research and documentation, nanotechnology and Ayurveda research, tribal healthcare research, healthcare services, information, education and communication, and clinical research.

The Centre will also have facilities for pharmacognosy of raw drugs, phytochemical studies of drugs, physic-chemical constants of single drugs and formulations. It will also endeavour to revive and retrieve texts from ancient manuscripts/rare books, collection and compilation of references relating to drugs and diseases from classical treatises, lexicographic work, contemporary literature and publications related to Ayurveda and other medical systems.

It also seeks to develop appropriate training modules and guidelines and research on integrative oncology.

The Centre envisages introducing modules or short courses on principles of Ayurveda into MBBS, MSc Biotech, MTech (Nanomedical Science), MTech (Molecular Medicine), offering PhD programme in Ayurveda and interdisciplinary PhD programmes; international training and teaching programme in Ayurveda, etc.

The Centre has a component to make available ayurvedic medicines at low cost. It will also contribute to enhancing the Ayurvedic Biodiversity of India through farming of rare species, organic farming to improve the quality of ayurvedic plants, encourage farmers to cultivate ayurvedic plants; training villagers to manufacture Ayurvedic formulations through low-cost pharmaceutical engineering in a small-scale set up.

MSK Plays Critical Role in FDA Approval of New Melanoma Drug

MSK Plays Critical Role in FDA Approval of New Melanoma Drug

On December 22, the US Food and Drug Administration approved a new treatment for people with melanoma that cannot be surgically removed or has metastasized, or spread, and no longer responds to other therapies. After the drug, nivolumab (Opdivo™), was shown to shrink tumors in a clinical trial, it received accelerated approval, which allows patients earlier access to promising therapies that show effectiveness during a study.

Memorial Sloan Kettering physicians helped spearhead clinical trials testing nivolumab’s safety and effectiveness and continue to conduct studies using the drug to treat melanoma and other cancers. In particular, MSK was one of the primary sites for the multi-center phase III trial that directly led to the FDA approval, enrolling a large number of patients in the study.

Nivolumab inhibits the PD-1 protein, a molecule on the surface of immune cells that acts as a brake to prevent the immune system from attacking tumors. Blocking PD-1 takes the brakes off and allows the immune cells to destroy the cancer.

A Striking Result

Metastatic melanoma is the deadliest form of skin cancer, and until recently treatment options had been very limited for those whose cancer progressed after initial treatment. In the phase III trial, nivolumab shrank tumors in 32 percent of patients — an effect that lasted for more than six months in approximately one-third of those who experienced the reduction.

“This type of dramatic benefit is not typically seen in cancer patients. These are patients who did not respond to other standard therapies, so these drugs are really practice-changing,” says medical oncologist Sandra D’Angelo, who led the MSK portion of the trial along with medical oncologist and immunologist Jedd Wolchok.

The FDA approved nivolumab for patients whose melanoma has progressed after previously being treated with ipilimumab (Yervoy™) — another drug that harnesses the immune system — and also for patients whose tumors express a gene mutation called BRAF V600 and who have already received ipilimumab and a BRAF inhibitor.

Dr. Wolchok and MSK medical oncologist Michael Postow are now leading clinical studies testing nivolumab as an initial frontline therapy in melanoma patients.

Immunotherapy: The New Paradigm

Nivolumab is the latest in a new generation of cancer therapies that unleash the immune system to destroy cancer cells. This approach, which MSK physician-scientists played a major role in developing, is producing stunning results when combined with standard anticancer therapies.

The first such immunotherapy drug, ipilimumab, was approved in 2011 and acts on a different immune cell protein called CTLA-4 to achieve a similar effect.  Much of the basic research identifying CTLA-4 as a critical target was done by immunologist James Allison, who spent nearly a decade of his career at MSK before leaving in 2012 for MD Anderson Cancer Center in Houston. Ipilimumab has already produced impressive results in some melanoma patients, dramatically extending life expectancy.

In September 2014, another drug, pembrolizumab (Keytruda™), became the first anti-PD-1 therapy to be approved by the FDA, also for the treatment of advanced melanoma. Dr. Wolchok helped guide both ipilimumab and pembrolizumab through late-stage clinical trials.

“Our approach to melanoma has really been transformed over the last three years, beginning with the approval of ipilimumab,” Dr. D’Angelo says. “Patients are now living with a disease for which there had been no effective options. It’s a testament to our involvement and commitment to immunotherapy and Dr. Wolchok’s ability to make this happen here at our institution.”

The impact of nivolumab and similar immunotherapy drugs extends well beyond melanoma. Dr. D’Angelo says her main interest now lies in using immunotherapy to treat sarcoma, a type of cancer which, like melanoma, also has had limited treatment options. She will be leading a phase II clinical trial opening in the spring of 2015 testing nivolumab alone or in combination with ipilimumab in sarcoma patients. The national study will be conducted through the Alliance for Clinical Trials in Oncology, a network sponsored by the National Cancer Institute.

cCAM Biotherapeutics Receives FDA Approval to Initiate Phase 1 Trial for CM-24, a Novel Immune Checkpoint Inhibitor for Cancer Immunotherapy

cCAM Biotherapeutics Receives FDA Approval to Initiate Phase 1 Trial for CM-24, a Novel Immune Checkpoint Inhibitor for Cancer Immunotherapy

cCAM Biotherapeutics, a biopharmaceutical company focused on the discovery and development of novel cancer immunotherapies, announced today that it has received approval form the US Food and Drug Administration to commence a Phase 1 trial for CM-24, a first-in-class immunomodulatory monoclonal antibody (mAb) for the treatment of various types of cancers. The study is expected to commence during the first quarter of 2015.

CM-24 is directed against CEACAM1, a novel immune checkpoint protein that is expressed on activated effector lymphocytes and a variety of cancer cells. CEACAM1 belongs to the Human CEA protein family, and preclinical data show that inhibition of CEACAM1-CEACAM1 homophilic interactions by CM-24 leads to enhanced activation of tumor specific immune cells.

The Phase 1 trial is a first-in-human, open-label, multicenter, dose escalation study assessing the effect of the CM-24 mAb in cancer patients with selected advanced or recurrent malignancies, including melanoma, non-small cell lung adenocarcinoma (NSCLC) and bladder, gastric, colorectal or ovarian cancer. Primary objectives of the study are to assess the safety and tolerability of escalating multiple doses of CM-24 and to determine the recommended dose for Phase 2 trials with CM-24. Secondary objectives include characterization of the pharmacokinetic profile and immunogenicity of CM-24, and the evaluation of the preliminary efficacy of the drug on the basis of objective tumor response and duration of response in subjects treated with CM-24. The trial will be conducted at four sites including Yale and UCLA, and will be composed of a dose escalation stage and an expansion stage. The expansion stage will focus on subjects with cutaneous melanoma or additional malignancies that responded to treatment in the first stage of the study.

Pini Orbach, Ph.D., Chairman of the Board, cCAM Biotherapeutics, stated: “Antibodies blocking immune checkpoints are emerging as a breakthrough treatment that can, in some cases, lead to a cure even in advanced stage cancer. Unfortunately, a large proportion of patients do not respond to these drugs. Currently approved immune checkpoint inhibitors are based on protein targets from the B7-CD28 family, and therefore novel immune checkpoint targets from different protein families may increase the response rate to treatment. cCAM is developing a first-in-class cancer immunotherapy that is directed against a novel immune checkpoint from the CEA protein family using a different mechanism of action than the current immune checkpoint inhibitors on the market. We therefore hope that our drug will increase the percentage of cancer patients responding to treatment. This is a very exciting era in oncology, and we look forward to launching the first-in-human clinical trial with CM-24.”

Professor Antoni Ribas, M.D., Ph.D., Department of Medicine, Hematology/Oncology at the Jonsson Comprehensive Cancer Center, UCLA, commented, “We are impressed by the preclinical data to date, and are excited to take part in this trial, assessing the safety and tolerability of a new, first-in-class immune checkpoint inhibitor. Unlike current immune checkpoints isolated to date, CEACAM1 acts both as the receptor and the ligand. CEACAM1 on a tumor cell binds to another CEACAM1 molecule on an immune cell in order to inhibit an immune attack on the tumor. Therefore, it is possible that the CM-24 antibodies blocking the activity of CEACAM1 will have a strong effect in inhibiting this particular immune-modulating pathway.”

Tehila Ben-Moshe, Ph.D., VP R&D, cCAM Biotherapeutics, noted, “Preclinical data demonstrate synergistic activity of various immune checkpoint blockers, findings which encourage us to study the potential synergy of CM-24 with other existing immune checkpoint blockers. We thus have high hopes that patients that do not respond to current immune checkpoint blockers could be treated with CM-24, as a standalone or combination therapy.”

EASHNO 2015 - A deliberation into Tobacco Control, Head & Neck Cancer

EASHNO 2015 - A deliberation into Tobacco Control, Head & Neck Cancer

If I had been given the awareness about tobacco like this years ago, I would have protected myself from the devastating effects of tobacco". These were the words of a victim of tobacco named Shankar Narayanan from Chennai at the EASHNO 2015 forum held at Tamil Nadu Government Multi Super Specialty Hospital.

Due to his tobacco consumption he developed mouth cancer and had to undergo tongue surgery which resulted in difficulty in speaking. Eminent National and International Doctors, Speakers and Activists working for tobacco control gathered in Chennai yesterday (04 January 2015) at the EASHNO 2015 to deliberate on Tobacco Control and Head & Neck Cancer.

The fourth edition of the Eurasian Head & Neck Cancer Forum (EASHNO 2015) was conducted in conjunction with the XIX EAFO Oncopathology Seminar 'Head & Neck Tumors' and IV Kocher's Symposium on Thyroid Cancer. The events concluded with a Special Session on Tobacco Control and Press Meet.

The special session on tobacco control was handled by Dr. Subramania Iyer, President, EASHNO, India; Dr. Pankaj Chaturvedi, Professor, Head and Neck Surgeon, Tata Memorial Hospital, Mumbai; Dr. Arvind Krishnamurthy, Chair, Organizing Committee, India; Dr. Somasundaram Subramanian, Director, Eurasian Federation of Oncology, Moscow, Russian Federation; Dr. Robert J. Baatenburg, Head and Neck Surgery Erasmus Medical Centre, Rotterdam, The Netherlands; Dr. Jan B. Vermorken, Antwerp University Hospital, Antwerp, Belgium; S. Cyril Alexander, Executive Director of MACT; Dr. Jeyakumar Duraikannu, Professor, Consultant, Surgical Oncology, Tamil Nadu Government Multi Super Specialty Hospital, India and Dr. Ramesh Mahalingam, RMO, Tamil Nadu Government Multi Super Specialty Hospital, India

Director, Eurasian Federation of Oncology, Moscow, Russian Federation Dr. Somasundaram Subramanian in his speech mentioned that physicians have an important role to play in tobacco control and applauded the initiatives taken so far. Dr. Pankaj Chaturvedi focused on the challenges that are being faced in the strategies related to tobacco control at the national level.

He was also appreciated for receiving the "Sushrutha Award 2015" for successful campaign to control oral cancer in India by Dr. APJ Abdul Kalam. Dr. Jan B. Vermorken stressed that it is the need of the hour to combat and control head & neck cancer among us.

While at the state level, Organizing Committee Arvind Krishnamurthy mentioned that there has been any increase in the number of people affected with tobacco related diseases. Dr. Jeyakumar Duraikannu appreciated the Tamil Nadu Government for their support towards tobacco control and mentioned that the Multi Super Specialty Hospital is giving inputs on tobacco control which the Government of Tamil Nadu are receptive about.

The session ended with an embarrassing note, when the International Guests shared that they had seen tobacco control violations in presence in the form of smoking in public places, chewing tobacco and so on. They believed that implementation of tobacco control rules was effective in India and they were quite saddened to see such violations taking place in front of them.

It leaves a question in people's mind as to when will all the stake holders of tobacco control come together to eradicate tobacco and its consequences. 

Most cases of cancer caused by 'bad luck'

Most cases of cancer caused by 'bad luck'

Two thirds of the world's cancer cases are a direct result of bad luck rather than faulty lifestyle or defective DNA.

In a first such analysis, scientists say that cancers are driven by random mistakes in cell division which are completely outside human control.

Scientists from the Johns Hopkins Kimmel Cancer Centre have created a statistical model that measures the proportion of cancer incidence, across many tissue types, caused mainly by random mutations that occur when stem cells divide.

They came to their conclusions by searching the scientific literature for information on the cumulative total number of divisions of stem cells among 31 tissue types during an average individual's lifetime.

By their measure, two-thirds of adult cancer incidence across tissues can be explained primarily by "bad luck" when these random mutations occur in genes that can drive cancer growth, while the remaining third are due to environmental factors and inherited genes.

"All cancers are caused by a combination of bad luck, the environment and heredity, and we've created a model that may help quantify how much of these three factors contribute to cancer development," says Bert Vogelstein, the Clayton Professor of Oncology at the Johns Hopkins University School of Medicine.

They found that 22 cancer types could be largely explained by the "bad luck" factor of random DNA mutations during cell division. The other nine cancer types had incidences higher than predicted by "bad luck" and were presumably due to a combination of bad luck plus environmental or inherited factors.

"We found that the types of cancer that had higher risk than predicted by the number of stem cell divisions were precisely the ones you'd expect, including lung cancer, which is linked to smoking; skin cancer, linked to sun exposure and forms of cancers associated with hereditary syndromes," says Vogelstein.

"This study shows that you can add to your risk of getting cancers by smoking or other poor lifestyle factors. However, many forms of cancer are due largely to the bad luck of acquiring a mutation in a cancer driver gene regardless of lifestyle and heredity factors. The best way to eradicate these cancers will be through early detection, when they are still curable by surgery," adds Vogelstein.

Cancer kills around six lakh people in India with 71% of these deaths occurring in people aged 30-69 years. A Lancet study earlier had said that cancer deaths accounted for 6% of deaths across all ages, but among the 30-69 years age group, this rose to 8%.

Tobacco-related cancers represented 42% of male and 18.3% of female cancer deaths at ages 30-69 years. A 30-year old man in north-eastern India had the highest chance (11·2%) of dying from cancer before 70 years of age.

"Cancer-free longevity in people exposed to cancer-causing agents, such as tobacco, is often attributed to their 'good genes,' but the truth is that most of them simply had good luck," said Vogelstein, who cautions that poor lifestyles can add to the bad luck factor in the development of cancer.

The implications of their model range from altering public perception about cancer risk factors to the funding of cancer research, they say.

"If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others," says bio mathematician Cristian Tomasetti, an assistant professor of oncology at the Johns Hopkins.

"We should focus more resources on finding ways to detect such cancers at early, curable stages," he adds.

It was well-known, Vogelstein notes that cancer arises when tissue-specific stem cells make random mistakes, or mutations, when one chemical letter in DNA is incorrectly swapped for another during the replication process in cell division. The more these mutations accumulate, the higher the risk that cells will grow unchecked, a hallmark of cancer.

To sort out the role of such random mutations in cancer risk, the Johns Hopkins scientists charted the number of stem cell divisions in 31 tissues and compared these rates with the lifetime risks of cancer in the same tissues among Americans. From this so-called data scatterplot, Vogelstein determined the correlation between the total number of stem cell divisions and cancer risk to be 0.804. Mathematically, the closer this value is to one, the more stem cell divisions and cancer risk are correlated.

"Our study shows, in general, that a change in the number of stem cell divisions in a tissue type is highly correlated with a change in the incidence of cancer in that same tissue," says Vogelstein. One example, he says, is in colon tissue, which undergoes four times more stem cell divisions than small intestine tissue in humans. Likewise, colon cancer is much more prevalent than small intestinal cancer.

Doctors at Aster Medcity performs series of 30 successful robotic surgeries

Doctors at Aster Medcity performs series of 30 successful robotic surgeries

Aster Medcity, the first and the only hospital in Kerala to have robotic surgery unit and a specialised Minimal Access Robotic Surgery (MARS) team, comprising six doctors has recently conducted a series of 30 robotic surgeries. Doctors from each of Aster Medcity’s Centre of Excellence (CoE) conducted surgeries for the specialties - Gynecology, Bariatric surgery, Oncology, Urology and Surgical Gastroenterology.

Dr. Harish Pillai, chief executive officer, Aster Medcity, says “Aster Medcity keeps up with its commitment of pioneering advanced healthcare technology with unmatched medical expertise by introducing and successfully conducting the first series of robot-assisted surgeries in Kerala. Hence, Aster Medcity proves to be a world class quaternary healthcare destination in South Asia.”

Dr. Kishore T A, Consultant Urologist and Transplant surgeon and his team conducted Kerala’s first robotic surgery in Urology on a 61 year old male from Kerala suffering from prostate cancer. Post the surgery, the patient recovered completely in two weeks. Speaking on the benefits of the surgery, Dr. Kishore said, “The technique is extremely valuable in radical prostatectomy (for prostate cancer) and certain major urological surgeries such as bladder and kidney cancer cases. Owing to the technique, there is lesser chance of urine leak and more chances of serving potency after the surgery.”

More than 30 surgeries successful robotic surgeries have been done at Aster Medcity till date.

Dr. Mayadevi Kurup, Senior Consultant, Women’s Health and her team performed Kerala’s first robot assisted gynecological surgery on a 30 year old woman from Kerala for a benign ovarian tumour. Commenting on this feat, Dr. Mayadevi says, “Robotic surgery is being increasingly preferred to open surgery or laparoscopic surgery for most gynecology related operations including benign ovarian tumor, complex hysterectomy, fibroids in the uterus, lymph node dissection for uterine cancer& cervical cancer and severe endometriosis.” Dr. Mayadevi and her team conducted a total of 5 robot assisted surgery most of them being complex hysterectomies.

Dr. Prasad Krishnan, Consultant, Surgical Gastroenterology and his team conducted the first robotic bariatric surgery in Kerala on a 35 year old woman from Kerala weighing 136.7 kg. Commenting on the surgery, Dr. Krishnan says, “The morbidly obese lady with a high BMI and a history of hypothyroidism and hypertension was first evaluated by Aster Medcity’s Obesity care team. She lost about 10 kgs in a week after the surgery.”

Dr. Syam Vikram, Consultant Surgical Oncologist, and his team conducted the first colo-rectal surgery (large intestinal surgery) in Kerala and became the third surgical oncology department in South India to perform robotic surgery in Oncology. Commenting on the surgery, Dr. Vikram says, “The surgery was conducted on a 62-year-old patient from Kovalam diagnosed with bowel cancer. The patient had a history of passing blood in stool. This achievement has taken cancer care system in Kerala to international standards.”

Dr. Iyoob V A, Consultant in Surgical Gastroenterology operated on a 50 year old male Omani patient; Robotic Thoraco Laparoscopic Esophagectomy was done to remove his food pipe from the chest cavity. Commenting on the new technology, Dr Iyoob says, “Robotic surgery is a new developing technology in surgery which is extremely useful in the challenging Esophagectomy operation.”

Dr. Shameema Anvar Sadath, Consultant in Women's Health and her team successfully conducted total robotic hysterectomy for a patient with multiple fibroids and abnormal, heavy, prolonged bleeding. She also used robotic assisted surgery to surgically remove fibroids from the uterus of a woman who has never given birth. Speaking on the benefits of the surgery, Dr. Sadath says, “Robotic assisted surgery while retaining all advantages of minimally invasive surgery, overcomes its disadvantages. The surgical technique provides better precision, is lesser painful and requires shorter hospital stay.”

Robot assisted or computer assisted surgery is conducted using the da Vinci Surgical System (Intuitive Surgical Inc.), a state-of-the-art telesurgical, master-slave robotic system which replicates the surgeon’s exact movements on the master controls onto robotic instruments in the patient using their EndoWrist technology. Instead of using the surgery instruments by hand, robotic arms are used which are controlled by efficient surgeons with the help of advanced computers. Robotic surgery has opened up new avenues in the near future in surgical practice.

Trichy hospital gets infra development funds

Trichy hospital gets infra development funds

The super-speciality and trauma care block of the Mahatma Gandhi Memorial Government Hospital (MGMGH) here is set to receive medical equipment worth Rs 22 crore after the state government sanctioned more than half of the allotted funds.

The block was inaugurated almost a year ago, but it lacked equipment. Out of the total allotted funds of Rs 35 crore, Rs 21, 78, 66,400 was sanctioned for buying equipment.

"The director of medical education (DME) will deposit the amount to the personal deposit account of the Tamil Nadu medical service corporation (TNMSC). The fund will be utilised to equip the super-specialty hospital with the latest equipment," Dr P Karkuzhali, dean of MGMGH, told reporters here on Tuesday.

"The purchase of equipment will be completed in a phased manner, and it would take a couple of months to complete the process. The rest of the amount for the equipment will be sanctioned later," she added.

The six-storey super specialty block was one of the major projects under former chief minister J Jayalalithaa. However, the much-needed hospital was unable to serve the patients due to lack of equipment.

Interestingly, the fund for equipment was brought down to Rs 35 crore from the previously allotted amount of Rs 45 crore, after the cost of construction of the building escalated to Rs 65 crore from the estimated Rs 55 crore.

Specialty departments like neurosurgery, neurology, cardiology, cardiothoracic surgery, medical gastroenterology, surgical gastroenterology, pediatric surgery, plastic surgery, urology, nephrology, medical oncology and surgical oncology will get essential medical equipment. Besides these, anesthesia, radiology, pathology, biochemistry, microbiology, blood bank, telemedicine, medical education, modular operation theatre (trauma block) and steam laundry departments will also be equipped.

Anaesthesia department will receive equipment worth Rs 3.98 crore, the highest, while urology will receive Rs 2.98 crore. In addition, four aneasthesia work stations will be supplied. A modular operation theatre (OT) in the trauma block will receive equipment worth Rs 1.50 crore. The block has six OTs, but at present, only one is functional. The dean said the rest of the OTs would start functioning soon.