Technology Vs. Cancer. Pound for Pound!

‘Children with cancer have higher cure rates than adults with cancer, and I wonder if the reason is their natural, unthinking bravery. Sometimes little kids seem better equipped to deal with cancer than grown-ups are. They’re very determined little characters and you don’t have to give them big pep talks. Adults know too much about failure; they’re more cynical and resigned and fearful. Kids say “I want to play. Hurry up, and make me better.” That’s all they want.’

In his book ‘It’s not about the bike’ Lance Armstrong also quotes Dr. Nicholas, the oncologist in his story – “In a way, cancer is the Tour De France of illnesses.”

It shouldn’t be. But it is. Slippery. Stealthy. Silent. Sisyphean. Always just that tad inch beyond one’s grasp. Making people fight an enemy they can’t even see. A battle they don’t know they have won for sure when it feels like winning. An adversary that can be a nightmarish Hydra- rising from somewhere else when one thinks that its head has been cut off.

Tumors are mosaics that adapt under therapy pressure. And microenviroments like Hypoxia, fibrosis, myeloid suppression, and T-cell exhaustion block attacks. Late detection & sanctuary sites are also a challenge as many cancers present late; brain/bone cores are hard to reach.

- Prof. Peter Yingxiao Wang, Dwight C. and Hildagarde E. Baum Professor, Department Chair of Biomedical Engineering, University of Southern California.

That’s exactly why we need technology. Both as Iolaus to cauterise the fresh wounds so that new ones do not arise; and as Heracles to cut off the main head and bury it under some solid rock. Can technology stand up to the task? Has it? Perhaps. Almost. Right now, in 2025, it looks like we are caught up between the ‘Tour De France’ and ‘Hurry up’ here. And here’s why.

What are we fighting exactly?

First- Why is the battle against cancer still so tough? This big question haunts humanity and specially those donning lab coats and white coats as they wrestle against this cryptic nemesis.

It has to do with a number of factors, chiefly evolution & heterogeneity as well as hostile microenvironments, captures Prof. Peter Yingxiao Wang, Department Chair, Dwight C. and Hildagarde E. Baum Professor, Alfred E. Mann Department of Biomedical Engineering, Department of Molecular Microbiology and Immunology, Department of Stem Cell Biology and Regenerative Medicine, Department of Quantitative and Computational Biology and Norris Cancer Center, University of Southern California. “Tumors are mosaics that adapt under therapy pressure. And microenviroments like Hypoxia, fibrosis, myeloid suppression, and T-cell exhaustion block attacks. Late detection & sanctuary sites are also a challenge as many cancers present late; brain/bone cores are hard to reach.” To top that there is the aspect of human systems because trial access, cost, and variable care dilute the impact of breakthroughs, he adds.

The Battles Won

As hard as it is to wrap our heads around this idea, we do have stuff now that has taken us way ahead than where we were some years back in this war between humanity and cancer. Today we have camera robots as pills to be swallowed- investigational medical devices that can navigate inside human body in a non-invasive way for faster and easier diagnosis as well as treatment. Many Micro-robotics innovations are currently under evaluation and not available for commercial use- but they are exciting new steps in this long journey.

For instance - Consider what Endiatx envisions after integrating AI to enhance PillBot’s against stomach cancer, - it would autonomously scan the stomach, analyse data, and provide precise diagnostics. Similarly, there are super-charged immune cells – for focused attacks on stubborn solid tumors — tools that can destroy cancer cells without getting exhausted. USC biomedical engineers are working on what they call “EchoBack CAR T-cell,” – which is expected to be a leap in the field of cancer immunotherapy.

They are strapped with ultrasound technology that works as an ‘on switch’ for the CAR T-cells, engineered to respond to a short 10-minute pulse of ultrasound. This can trigger the cells to sense cancer cells in their surroundings.

There is also something happening in the same atmosphere that cracked the Gods’ particle. At the European Laboratory for Particle Physics (CERN), where researchers are working on radiotherapy treatment breakthroughs – with Flash (radiation at ultra-high dose rates, with exposures of less than a second, to destroy tumours in rodents while sparing healthy tissue). This could bring in unthinkable precision in attacking tumors and without any scattering effect. Sub-atomic particles like photons, or protons can be handy in treating deeper tumours, and carbon ions and helium particles can be sent for very specialised cases.

If I had to name one breakthrough that best illustrates how science is changing cancer outcomes, I would pick CAR-T and engineered cell therapies. They show us that by combining biopsy insights with genetic engineering, we can sometimes achieve complete remission in patients where nothing else worked.

- Dr. Hridaya Khatri, Medical professional and health entrepreneur

These examples may sound experimentative and explorative but we have, indeed, come a long way from the struggle to spot tumours and from the slippery uphill walk of wiping it away at the right spot.

As Dr Rohit Pai, Consultant Medical Oncology, Bombay Hospital, Mumbai weighs in, there is a lot of help gained with next-gen sequencing. “Molecular diagnosis of mutations in tumors is an area where technology has played a significant role. In various cancer treatments, precision oncology and targeted therapy are based on this. This bolsters a lot of efforts- like in lung cancer targeted treatments.”

Molecular diagnosis of mutations in tumors is an area where technology has played a significant role.

- Dr Rohit Pai Consultant Medical Oncology

Ask a young doctor who is fluent in both medical science and technology and knows exactly where they cross paths- and we see that the future is not too far off. Dr. Hridaya Khatri reminds us of advancements like liquid biopsy and multi-cancer blood tests. “These blood tests detect cancer DNA signals and hold the promise of catching cancers early. The sensitivity, of course, varies with type and stage, but the direction is hopeful. AI is another powerful tool. It can help to spot suspicious regions on scans, prioritise pathology slides, and reduce human error.” Sometimes a tumor can be right in front of the eyes but missed due to exhaustion or human limitation. This is where AI brings value—speeding up diagnosis and improving accuracy. Advanced scans, genetic testing, and even simple AI-based apps are helping doctors identify patterns that were previously hard to detect. We now have targeted medicine and immunotherapy that attack cancer cells more directly instead of affecting the whole body. CAR-T (Chimeric Antigen Receptor) is one example.”

The most convincing glimpse of technology’s help is precision oncology, the combination of diagnostics with targeted therapy, opines Dr. Neeraj Lal, Regional Director-Maharashtra and Karnataka Region, Medicover Hospitals. “I’ve seen patients who were failing multiple lines of chemotherapy respond beautifully when we discovered a genetic mutation and prescribed the right drug. It shows how powerful personalised treatment can be when backed by the right technology.” He also notes CAR-T cell therapy as another striking example. “Although it’s still in its early days in India and costs are very high, the results in certain blood cancers are remarkable. It gives us a glimpse of what the future of cancer treatment could look like , where therapy is designed around each patient’s unique biology.”

Prof. Wang picks out some more achievements that can be credited to technology. Immunotherapy refinements (peri-operative use, TIL therapy) and targeted drugs, e.g. KRAS(G12C). “Also, Single-cell/spatial omics and AI pathology for better patient selection and resistance tracking.”

If there is a poster-boy here though, it is Remotely/locally controlled immunotherapy Prof. Wang indicates. “Technology like ultrasound- or promoter-gated gene/cell therapy; synNotch/logic CARs - that marries precision with safety and repeat dosing. Also Antibody Drug Conjugates or ADCs—they are scalable, repeatable, and rapidly expanding across solid tumors; turning modest targets into effective therapies.”

If we invest more in awareness, screening, and creating regional cancer centres, we can shift the fight earlier – where outcomes are far better.

- Dr. Neeraj Lal, Regional Director-Maharashtra and Karnataka Region, Medicover Hospitals

Dr. Lal reckons advancements beyond the labs too- like Digital tumour boards (by connecting doctors across cities through virtual platforms, families can get world-class advice without travelling long distances) and Robotic surgery (to perform highly-precise operations, which means less pain, quicker recovery, and better functional outcomes for patients). He also calls Immunotherapy a game-changer. “I recall a patient with advanced lung cancer who had exhausted options, and immunotherapy helped him live a meaningful, active life again. Radiation, too, has advanced — with tools like MR-Linac and CyberKnife, we can target tumours with remarkable accuracy.”.

While treatment is still something where technology has to get better and faster, a lot of technology’s scope today is in the area of pathology and radiology, as Dr. Pai observes. “In pathology, automated interpretation of slides is a good step. It saves from the fatigue that humans go through. 3D reconstruction of cells also helps in better drug design. Machine Learning is a big answer for helping with scans in radiology and studying inflammation- with speed and with training data making a machine precise and accurate about the scans.”

Technologies like Artificial Intelligence (AI) and Machine Learning (ML) can actually equip humans with more accuracy, less errors and less exhaustion. Sometimes a tumor can be right in front of the eyes but missed due to exhaustion or human limitation, seconds Dr. Khatri. “This is where AI brings value—speeding up diagnosis and improving accuracy. Advanced scans, genetic testing, and even simple AI-based apps are helping doctors identify patterns that were previously hard to detect.”

In the resilient fight against cancer, radiation oncology has long been the cornerstone of cancer treatment, offering hope and healing to millions globally, as shared by Dr. Kinjal Jani, Director & Head- Radiation Oncology, HCG Cancer Centre, Ahmedabad with Dataquest earlier. “The advancements in technology have transformed radiation oncology over the years, making the treatment process precise, effective, and even more customised for each patient’s needs.”

IMRT uses computer-controlled linear accelerators to deliver varying radiation doses to different areas of the tumor.

- Dr. Kinjal Jani, Director & Head- Radiation Oncology, HCG Cancer Centre

Enhanced imaging technology is something that Dr. Jani highlights particularly here. “With these techniques, oncologists are able to precisely delineate tumor boundaries while sparing surrounding healthy tissues from trauma or hemorrhage by obtaining detailed anatomical and functional information. Integrating advanced molecular imaging into the treatment planning process further helps clinicians in identifying right patients for radiation therapy, guiding radiation treatment decisions and planning, and ultimately keeping patients’ cancer under control.”

Dr. Lal echoes that – marking an area that has benefitted the most as precision treatment. “With genetic testing and molecular diagnostics, we now have the ability to identify which therapy will work best for a particular patient. This spares patients from unnecessary chemotherapy and directs them toward targeted drugs that have a much higher chance of success. I’ve seen breast cancer patients avoid the toxicities of chemo because a simple test showed a better option. That is a huge shift in practice.”

Intensity-Modulated Radiation Therapy or IMRT is what Dr. Jani cites as a major stepping stone too. “It helps in delivering highly conformal doses of radiation to tumors while sparing adjacent healthy tissues. In contrast to conventional radiotherapy techniques, which deliver uniform radiation doses, IMRT dynamically adjusts the intensity and shape of radiation beams to conform to the tumor’s shape. It uses computer-controlled linear accelerators to deliver varying radiation doses to different areas of the tumor.”

The Battles That Remain

Despite the big list we have just covered, why is the fight against cancer so long-drawn and so tough? Because cancer isn’t one disease, it’s hundreds, captures Madhuram Khatri, Founder & CEO - Writelyf (AI-first Health OS), and a Biomedical Engineering student based in Chicago. Tumors mutate, resist, and adapt quickly, and by the time most are diagnosed, iit’s already too late to intervene easily, he underlines. “In Fall ’24, we worked on an Ingestible Biopsy Device for Digestive Tract Cancers - a capsule-based diagnostic tool for early detection. I focused on CAD modeling, mechanical design, and biocompatibility research. Interestingly, by January-February this year, scientists had already developed similar prototypes.” This semester, he is diving into brain and neuroscience projects and he knows where to head next. “Early diagnosis is where I see the biggest leap, whether it’s AI-supported imaging or capsule devices like ours. Detecting at Stage I instead of Stage 3 makes all the difference.”

Drug discovery tooling (structure prediction, generative chemistry, CRISPR screens) is transformative but clinical payoff trails the tooling, as Prof. Wang assesses the progress-curve. “Precision treatment shows the most clinical wins (Antibody Drug Conjugates or ADCs). Early diagnosis is rising fast. But prevention remains under-instrumented beyond HPV/HBV vaccination and risk programs.”

If doctors, oncologists, patients, nurses, support-fighters and patients are asked for a Christmas wish-list from technology- the conversation usually hovers around speed and clarity.

Dr. Pai hopes that we get to a stage where subjectivity about treatment-response assessment can be replaced with objectivity. “Some tumors shrink. Some don’t. Some are hard to figure out. Some respond better. AI can be of a good use here in helping with precise and accurate visualisation and assessments.”

As pointed out by Girish Raghavan, CTO – Women’s Health & X-Ray and VP – Engineering at GE HealthCare Technology Centre India in an interview earlier with Cybermedia’s Shrikanth G- One of the biggest challenges in AI adoption in Indian healthcare is the complexity and fragmentation of data—much of it is unstructured, like clinical notes, images, wearables, and behavioural data. Traditional AI models struggle here, as they often require retraining for specific diseases, slowing adoption and scalability.

Dr. Lal suggests how data and tele-healthcare can help with the much-needed scale and equity in this area. “India needs a strong national cancer registry to track outcomes and learn what really works in our population. Without reliable data, we are often borrowing Western protocols that don’t always translate to Indian patients. If we measure better and link treatment with outcomes, we will make more informed decisions and improve survival across the board.”

Solid-tumor cell therapy (trafficking/antigen escape), CNS disease, durable resistance control, equitable access/cost are gaps that Prof. Wang points out too.

CAR-T and immunotherapy are powerful, but my choice is liquid biopsy and ingestible devices. They make early detection painless, scalable, and accessible and that saves the most lives.

- Madhuram Khatri, Founder & CEO - Writelyf

Winning The Battle – For Everyone

There is a lot, a lot, I repeat, a lot that we have to add in our ammunition.

Madhuram stresses that Cancer tech needs to move beyond elite hospitals and reach Tier-2/Tier-3 cities. “Affordable genomics, AI-driven drug trials, and point-of-care diagnostics should be the focus.”

He urges us to face some real questions too. “The real question is: Are these solutions equitable and affordable? Big Pharma can both accelerate and block progress, but tech has the power to democratise access if used wisely.”

Is Big Pharma an accelerator or a speed-bump? Prof. Wang opines it’s both. “It brings CMC, capital, and global trials (essential), but portfolio inertia can slow disruption.” But there are solutions too, as he suggests-like pre-competitive consortia, shared manufacturing, outcomes-based funding, and faster tech-transfer from academia/startups.

There are other gaps that remain, sighs Dr. Hridaya as she brings in the big question about democratisation of cure. “And that’s what makes me sad—because many people in India and other parts of the world don’t have access to these advanced tools. Sometimes it’s cost, sometimes lack of awareness, or sometimes just distance from a facility. What truly hurts me is that even though these advances exist, a person’s inability to pay for them is costing lives. That just shouldn’t happen.”

We do struggle with the cost and accessibility of advanced treatments, Dr. Lal points that out too. “A patient in a metro city may get cutting-edge therapies, but someone in a tier-2 city might not even have access to a proper oncology set-up. So, the battle is tough because of biology, late diagnosis, cost, and uneven infrastructure.”

Dr. Lal affirms that technology has made a visible difference in the last decade. “However, these benefits are not evenly distributed. Most of this technology is available only in a handful of premium centres. For the average patient in a smaller city, these remain out of reach, both geographically and financially. Promising tools like liquid biopsies, which could make early detection much easier, are still too costly to be scaled up widely.”

Have we achieved enough democracy & affordability? Not yet, Prof. Wang avers. But Tech can help via Platformisation (reusable vectors, CAR backbones, ADC scaffolds) and Automation/standardisation (closed-system cell therapy; continuous bioprocessing). There is also a lot of help that technology can give through AI-enabled, decentralised trials to broaden access and cut waste. And through Data commons & value-based contracts, as Prof. Wang espouses.

There are many challenges that are far far beyond the labs where breakthroughs are being worked upon. “Each patient’s cancer behaves differently, even if it’s in the same organ. That makes treatment complicated. Another big challenge is that many patients in India still come late, often when the disease is already advanced. By then, even the best technology or drugs cannot achieve the same results as early detection.” Dr. Lal argues.

For India, I still believe the biggest opportunity lies in early diagnosis and prevention, Dr. Lal emphasises. “HPV vaccination is one shining example — wherever it has been introduced, cervical cancer rates have dropped dramatically. Similarly, organised breast screening programs, if scaled up, could save thousands of lives. Precision treatment may be where technology has delivered most so far, but prevention and screening are where the real population-level impact will come.”

Stronger than the Enemy or Braver?

In the next five years, we should be aiming to close in on new milestones, like these that Prof. Wang underlines: “Programmable, locally activated immunotherapies (logic-gated/energy-gated cells or genes) to confine potency to tumors. ADCs with smarter linkers, new targets, and brain-penetrant designs. And AI-native, adaptive trials with decentralised participation to cut time/cost and improve diversity. Along with industrialised manufacturing (closed-system cell/vector/ADC lines) to lower COGS and expand access.”

There are questions that we should be asking as well – he adds. “How do we confine potent biology in space/time to boost efficacy and safety? Can we automate manufacturing and trials as aggressively as discovery?”

Each patient’s cancer behaves differently, even if it’s in the same organ. That makes treatment complicated. Another big challenge is that many patients in India still come late, often when the disease is already advanced. By then, even the best technology or drugs cannot achieve the same results as early detection.

The bigger challenge is that no two cancers are the same, Dr. Hridaya reminds. “What works for one person may not work for another. Sometimes cancer hides, sometimes it returns even after treatment. That’s what makes it feel like such a long, unpredictable fight—for patients, for families, and for doctors.”

The odds may be against us now but losing hope is the first step to losing this war- and something we just cannot afford to do. Armstrong also says in that book – ‘If children have the ability to ignore the odds and percentages, then maybe we can all learn from them. When you think about it, what other chance is there but to hope? We have two options, medically and emotionally: Give up, or fight like hell.’

This warrants repeating – Fight. Like. Hell.

(Dedicated to all the survivors and fighters of Cancer – on both sides of the Doctor’s table. And to a special warrior who started on another journey last month - our beloved Sunil Rajguru Sir who fought bravely, cheerfully and un-whiningly – with the same childlike spirit of ‘I have got work to do, life to live. Hurry up.’)

pratimah@cybermedia.co.in