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Trials using cannabis to cut risk of cancer metastasis all set to begin


Being the world’s pharmacy is perhaps India’s best-known contribution to the medical field, but cancer surgeons from Tata Memorial Hospital in Parel may soon add another. Last fortnight, they unveiled a homegrown technique of injecting an inexpensive anaesthetic compound into and around tumours just before they are surgically removed.
The first proof these injections reduced recurrence of solid tumours by a third was presented at the European Society for Medical Oncology meeting held in Paris on September 9, but more trials to indisputably prove the point are underway or scheduled to begin. The brainchild of breast cancer surgeon Dr Rajendra Badwe, also the director of the entire Tata Memorial Centre that now manages nine hospitals across the country, the trial was extended to 10 other hospitals across the country.
Three developments have taken place in the fortnight since the research was publicised. Firstly, the use of lidocaine is now a part of the standard operating procedures for breast cancer surgeries at least in Tata hospitals. Secondly, a trial among oral cancer patients has begun at Tata Memorial and the BALCO centre in Raipur. Thirdly, permissions have arrived for using cannabis, the active ingredient in ‘bhang’, for cancer patients whose tumour would not be easy to inject in a 360° manner.
Surgery-metastasis link
The idea to use lidocaine comes from a long-standing theory that surgery itself in some ways alters the environment around the cancer site and, unfortunately, increases the risk of cancer recurrence or metastasis.
“Dr Badwe has spoken for over three decades about the need to control the environment during surgery,” said breast cancer surgeon Dr Vinay Deshmane from Hinduja and Breach Candy Hospitals. Dr Badwe has previously studied the effect of giving patients a single injection of hormone progesterone just before surgery; the study proved that in certain breast cancer patients, this injection reduced the chances of cancer cells migrating to other parts of the body, thereby reducing chances of a relapse.
Knocking out cancer cells
The first task was to get the biological processes right. “Towards this, for the first time in the world, we decided to take three biopsies during surgery to study the cells in circulation,” Dr Badwe told TOI.
Usually, surgeons take a biopsy before and after the surgery is done. The expression of about 50 to 100 genes would differ between the two biopsies. But the in-between biopsy of these researchers turned out to be an eye-opener: 800 genes had altered their expression. “To put it simply, we found 800 genes going up and down,” said Dr Badwe. Using an analogy of a person under attack, he explained that the first reaction of the cancer cells under attack from the scalpel would be to run.
The second task was to identify an agent or method that could reduce this hyperactivity among cancer cells.
Local anaesthetic agent lidocaine, which has also been previously used, seemed to be the answer. As Dr Badwe said during his Paris presentation, lidocaine “knocks out” the cancer cells and prevents them from migrating to other parts of the body. “It thus reduces the risk of metastasis.” His team also became the first in the world to use lidocaine in a unique way — into and around the tumour.

Cell-speak
Most cells communicate with each other using voltageregulated ion channels. These channels are proteins that play an important role in the electrical signaling of cells. But the lidocaine injection blocks this electrical signaling network, and prevents cancer cells from migrating to other areas. The randomised control trial of 1,600 patients at Tata Memorial Hospital and 10 other hospitals showed that sixyear disease-free survival was 86.1% and 81.7% in the lidocaine group and no-lidocaine group respectively.
Cheap and safe
The use of an anaesthetic agent has two additional benefits in terms of safety and costs. Associate professor Shalaka Joshi from Tata Memorial Centre said the technique at last offered surgeons a way of comforting patients. “We often get patients with metastasis lamenting that their cancer has returned despite surgery. Now we can tell them we are giving them an injection that could reduce chances of recurrence,” she said, adding that it’s such a safe compound that no one could have a side-effect due to lidocaine.
Dr Bhawna Sirohi from the BALCO Cancer Centre in Raipur said lidocaine injection costs Rs 30 to Rs 40 while patients usually need advanced chemotherapy in cases of recurrence that runs into lakhs.





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