What we have been doing is trying to use the best drugs possible for our patients so for this we have developed a method of drug testing which is very similar to the antibiotic testing that we do for bacterial infections. So we’re trying to do this with the patient tissue, trying to simulate the microenvironment outside the host and do the drug testing so that we can use the best drug combination for our patients. Our initial validation paper was published in Nature Communications in 2015 and it’s a large study of over 110 patients involving several centres in India.

This is one of the important things that we have done and today with the available therapies that we have we’re getting patients to live longer and they are able to get second line, third line, fourth line, fifth line, sixth line, several lines of therapies. That again shows that we are effective in controlling the disease for these patients but invariably they do get it back. So it’s important that we understand why this disease comes back. For this we have to do biopsies at recurrence and look at the resistance mechanisms. Many times doing these biopsies is not possible because, if I can give you an example of lung cancer, when the lung cancer comes back we may not be able to repeat a biopsy from the primary site where the recurrence has occurred because of several issues of technicalities and the disease being in a situation or a position where it can be risky to repeat a biopsy. So for this we are working on what is called liquid biopsy, we’re looking at the peripheral blood, taking the peripheral blood out because these tumours shed circulating cancer cells and circulating tumour DNA. So we’re able to isolate this and look at this and identify the resistance mechanisms and thereby use again specific drugs to target these resistance mechanisms.

We’ve just published our data on circulating tumour cells, again to assess the correlation with response. We’ve just published this on 28th May and this is in Science Reports which is a part of the Nature publications. So we’ve actually shown that this could be an effective method of monitoring patients on therapy and trying to see when they’re becoming resistant and this can be seen even before the imaging shows the increase in the disease. So this is an easy way of looking at recurrences and, again, we can get material from the blood to look at the resistance mechanisms. So this is a less invasive way of trying to look at the various possibilities that we can do for our patients.

Similarly we are studying the circulating tumour DNA which again can be picked up from the peripheral blood. Today we have a lot of next generation sequencing labs in India and much more affordable so we are able to use this again to help our patients get the best treatment possible. So these are cutting edge things that we’ve been able to do. Although we talk about resource restrictions in the country we’re able to do this because we do have good labs and good basic science workers in my city so I am able to collaborate with them and get all these out possible for our patients.