Mumbai: The Most cancers Genome Atlas (TCGA) didn’t simply increase most cancers analysis it has rewrote the rulebook. It proved that tumours in several organs can share extra in widespread than tumours throughout the similar breast or lung. With medicine following knowledge, classifications developed, and survival curves has shifted. However the precision oncology nonetheless has a blind spot as extra South Asians largely lacking from TCGA, India faces a stark alternative create its personal genomic proof or depend on imported insights that won’t totally serve its sufferers.
At a latest ETHealthworld’s India Oncology Management summit panel specialists Dr. Shantanu Chowdhury, Professor at CSIR–Institute of Genomics and Integrative Biology (IGIB); Dr. Sanjeeva Srivastava, Professor at IIT Bombay and Founding father of Proteomica Worldwide; and Dr. Muzammil Shaikh, Principal Director – Medical Oncology at Nanavati Max Institute of Most cancers Care. Moderated by Prathiba Raju, Senior Assistant Editor debated whether or not TCGA has taken India far sufficient, and what the subsequent section of Indian most cancers genomics should appear to be.
TCGA has basically reshaped how the world understands most cancers. By decoding the molecular underpinnings of tumours throughout 33 most cancers sorts, the panel mentioned about on TCGA shifted oncology from an organ-centric self-discipline to 1 pushed by genetic pathways. The larger query on how far this landmark world initiative has taken India from discovery to real-world most cancers care.
Opening the dialogue, Dr. Chowdhury mirrored on TCGA’s lasting scientific influence, mentioned, “TCGA basically modified how we perceive most cancers by exhibiting that genetics—and the individual’s genetics—matter greater than organ labels.”
Drawing from over twenty years of analysis expertise, he emphasised that most cancers biology can not be approached as a one-size-fits-all drawback. “When you don’t perceive the demon, you don’t know the place the Achilles’ heel is—the purpose the place you wish to intervene.”
Earlier than the TCGA period, he famous, chemotherapy regimens comparable to platinum-based therapies have been administered broadly, typically with extreme toxicity. “Over time, TCGA confirmed us that genetics issues,” he mentioned, including that the undertaking additionally revealed its personal limitations. “TCGA is closely underrepresented within the South Asian and Indian context. If most cancers is intrinsically genetic, then what we study from Western cohorts can’t be blindly utilized right here.”
One in all TCGA’s most profound contributions has been the pan-cancer perception that shared molecular circuitry can malfunction throughout completely different organs. “What TCGA has taught us is {that a} related genetic circuitry can go fallacious throughout completely different tissues,” Dr. Chowdhury defined. “The circuit doesn’t care which organ it belongs to.” Whereas organ-specific components stay related, focusing on shared pathways throughout tissues is more and more changing into a therapeutic actuality.
As analysis has grown extra granular, so has the complexity. “Increasingly, most cancers is about understanding the genetics of every tumour, and every tumour may be very completely different,” he mentioned. “The truth is, a tumour is a galaxy of tumours.” This, he argued, is why deep analysis underpins the idea of personalised oncology and why new drug discovery should proceed past recognized pathways.
Whereas TCGA delivered a genomic blueprint, translating genes into perform requires one other layer of biology. Addressing this hole, Dr.Srivastava highlighted the position of proteomics. “Genomics offers us the blueprint, however proteins inform us what is definitely occurring within the cell,” he mentioned. “That’s the place proteomics goes past TCGA.”
Referring to TCGA’s early glioblastoma research, Dr. Srivastava defined how the Scientific Proteomic Tumor Evaluation Consortium (CPTAC) developed so as to add useful perception. “In gliomas, genomics alone couldn’t accurately classify almost 30 per cent of sufferers,” he famous.
“Proteomics revealed clear patterns, significantly in recurrent tumours, together with kinase exercise and post-translational modifications.” Genomics, he mentioned, maps the panorama, whereas proteomics reveals which pathways are energetic, and subsequently actionable.
Importantly, Dr. Srivastava sees India at a strategic inflection level. “India has a chance to keep away from the error the US made—ready a decade so as to add proteomics after genomics,” he mentioned. “If we combine genomics and proteomics from the start on the identical samples, the worth of the info multiplies.”
From the clinic, Dr. Shaikh described TCGA as nothing in need of transformative. “From a clinician’s perspective, TCGA has been a sport changer,” he mentioned. “Our understanding of most cancers biology has deepened enormously—we now know that lung most cancers or breast most cancers just isn’t one illness.”
Molecular stratification has already translated into tangible affected person advantages. “TCGA has enabled drug growth that has modified affected person outcomes,” Dr. Shaikh famous. “Stage-four ALK-positive lung most cancers now has a five-year survival of almost 75 %.” Nevertheless, he cautioned that knowledge interpretation stays a problem, particularly for South Asian populations which are underrepresented in world datasets.
That hole is exactly what the Indian Breast Most cancers Genome Atlas (IBGCA), launched in 2022, seeks to handle. Explaining the initiative, Dr. Chowdhury mentioned, “Some checks developed utilizing TCGA knowledge work spectacularly within the US and UK, however they aren’t as environment friendly in Indian sufferers. That was a key motivation behind launching this undertaking.”
The consortium, involving ten hospitals throughout India, has already sequenced round 800 matched tumour–regular genomes with full scientific follow-up. “We’re sequencing Indian sufferers, analysing Indian knowledge, and doing the computation right here in India—finish to finish,” he mentioned. Early outcomes counsel that recurrence and metastasis signatures reported in Western cohorts don’t totally apply to Indian sufferers.
The last word objective, he pressured, is scientific influence at scale. “On the finish of the day, you don’t give an NGS take a look at to a affected person,” Dr. Chowdhury mentioned. “You give a small, reasonably priced biomarker take a look at—and that’s what this analysis is in the end about.” By narrowing findings down to twenty–25 gene panels and validating them utilizing patient-derived organoids, the workforce goals to foretell remedy response, together with immunotherapy, in a cheap method.
Whereas these efforts mark an necessary step ahead, the panel agreed that India’s most cancers genomics journey is simply starting. TCGA, Dr. Chowdhury reminded the viewers, didn’t ship in a single day breakthroughs. “TCGA didn’t grow to be a drug in 5 years,” he mentioned. “It took years of laborious work, scientific trials, and validation. India should take the identical laborious steps there aren’t any shortcuts.”
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