Cutting Edge Cancer Treatment in Vietnam
Written by Dr. Kelly M. Smith
Cancer is a global health issue which affects over 18 million people worldwide every year. Cancer is becoming an increasing public health issue for the Vietnamese people. Due to multiple factors including changes in diet, lifestyle habits, better medical testing and increased life expectancy, the number of cancer diagnoses and deaths have tripled in the last 30 years.
Cancer treatment is evolving rapidly due to advances in in cancer genetics, molecular biology and immunology. While Vietnam is a developing country with a health care system that lags behind developed nations, patients may still benefit from access to treatments which are revolutionizing cancer care. Immunotherapy and targeted therapies are two new treatment approaches that are more effective and less toxic than chemotherapy. Both of these strategies are part of treatment options currently available in Vietnam.
Immunotherapy harnesses the body’s immune system to treat cancer. The immune system plays an important role in recognizing and attacking foreign invaders such as viruses and bacteria. The immune system is also important in destroying cancerous tumors. Checkpoint inhibitors are a new class of medication which disable the “brakes” of the immune system so it can more effectively identify and eliminate cancer cells. Checkpoint inhibitors are used in many common cancers such as lung cancer, colon cancer, liver cancer and melanoma. Response rates are only 20% but patients who respond to treatment may have their disease controlled for many months or years. In fact, a small percentage of patients with metastatic cancer are now being cured with immunotherapy. In addition to the potential for long-term disease control, immunotherapy does not cause many of the side effects (such as hair loss, nausea, vomiting and infection) that are seen with chemotherapy. Pembrolizumab (Keytruda) and atezolizumab (Tecentriq) are two types of checkpoint inhibitors currently available in Vietnam.
Targeted therapies are used in other clinical scenarios. Many tumors have a mutation which drives its growth and spread. Tyrosine kinase inhibitors (TKIs) block pathways which are activated by these mutations. These drugs tend to work better and cause less side effects than chemotherapy. New techniques to sequence DNA faster and cheaper are helping us identify patients who may benefit from these agents. TKIs have dramatically altered our approach to treating advanced non-small cell lung cancer. In Asia, approximately 50% of patients with lung adenocarcinoma have tumors which have an epidermal growth factor receptor (EGFR) mutation. Osimertinib (Igresso), an oral medication that blocks EGFR, is very effective in treating metastatic EGFR mutated non-small cell lung cancer. Response rates are high at 80% and average survival is over 3 years compared to less than one year with chemotherapy alone. In addition to being used for lung cancer, TKIs are used in many other types of cancer including chronic myeloid leukemia, breast cancer, kidney cancer, liver cancer and thyroid cancer. Examples of other TKIs available in Vietnam include erlotinib (Tarceva), gefitinib (Iressa), and sorafenib (Nexavar).
There are several shortcomings to these novel medications. Immunotherapy and targeted therapies are expensive so they are unaffordable for many Vietnamese. These medications can cost many thousands of dollars each month. In addition, only a limited number of the agents approved in the U.S. and Europe are available here. Regardless of these shortcomings, these advances in cancer treatment are helping some Vietnamese patients live longer with a better quality of life. With Vietnam’s rapid economic growth and development, hopefully there will be improved access to more of these promising cancer drugs in the near future.
Dr. Kelly M. Smith is the Chief of Clinical Oncology at Vinmec Times City International Hospital and a Clinical Assistant Professor at University of Pennsylvania. As a member of the Vingroup-Penn Alliance she is in Hanoi to develop a Cancer Center of Excellence while treating adults with solid tumors and lymphoma. Dr. Kelly M. Smith can be contacted at [email protected]