The first evidence that these injections reduced the recurrence of solid tumors by a third was presented to European Society of Medical Oncology meeting held in Paris on 9 September, but other trials to unquestionably prove the point are underway or should begin. The brainchild of breast cancer surgeon Dr Rajendra Badwe, also director of the entire Tata Memorial Center which now runs nine hospitals across the country, the process has been extended to another 10 hospitals across the country.
Three developments occurred in the two weeks following the publication of the research. First, the use of lidocaine is now part of the standard operating procedures for breast cancer surgeries at least in Tata hospitals. Secondly, a trial has begun among oral cancer patients at the Tata Memorial and BALCO center in Raipur. Thirdly, the authorizations have arrived for the use of cannabis, the active ingredient of ‘bhang’, for cancer patients whose cancer would not be easy to inject at 360 °.
Surgery-metastasis link
The idea of using lidocaine stems from a long-standing theory that the surgery itself somehow alters the environment around the cancer site and, unfortunately, increases the risk of cancer recurrence or metastasis.
“Dr. Badwe has talked for over three decades about the need to control the environment during surgery,” said the breast cancer surgeon. Dr. Vinay Deshmane from Hinduja and Breach Candy hospitals. Dr. Badwe previously studied the effect of giving patients a single injection of the hormone progesterone just before surgery; the study showed that in some breast cancer patients, this injection reduces the chances of cancer cells migrating to other parts of the body, thus reducing the chances of a relapse.
Eliminate cancer cells
The first task was to correct biological processes. “For this reason, for the first time in the world, we decided to perform three biopsies during the surgery to study the cells in circulation,” Dr. Badwe told TOI.
Usually, surgeons do a biopsy before and after surgery. The expression of approximately 50-100 genes would differ between the two biopsies. But these researchers’ intermediate biopsy turned out to be a revelation: 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 attacked by the scalpel would be to run.
The second task was to identify an agent or method capable of reducing this hyperactivity among cancer cells.
The local anesthetic agent lidocaine, also used previously, seemed to be the answer. As Dr. Badwe during his presentation in Paris, lidocaine “kills” 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: in and around the tumor.
Cell talk
Most cells communicate with each other using voltage-regulated ion channels. These channels are proteins that play an important role in the electrical signaling of cells. But the injection of lidocaine blocks this electrical signaling network and prevents cancer cells from migrating to other areas. The randomized control study of 1,600 patients at Tata Memorial Hospital and 10 other hospitals showed that six-year disease-free survival was 86.1% and 81.7% in the lidocaine and non-lidocaine groups, respectively. lidocaine.
Economical and safe
The use of an anesthetic agent has two further advantages in terms of safety and cost. Associate Professor Shalaka Joshi of the Tata Memorial Center said the technique has finally offered surgeons a way to comfort patients. “We often get patients with metastases who complain that their cancer has returned despite surgery. Now we can tell them that we are giving them an injection that could reduce the chances of recurrence, “she said, adding that it is such a safe compound that no one could have side effects from lidocaine.
Dr. Bhawna Sirohi of BALCO Cancer Center in Raipur said that lidocaine injection costs Rs 30 to Rs 40 while patients usually need advanced chemotherapy in cases of relapse that runs into hundreds of thousands of euros. .
