30 minute interview

'We found ways to bring cost down'

OncQuest molecular diagnostic laboratory is an effort by the Dabur group to provide cost-effective molecular diagnostic services in India. Vivek Trikha, Head, Diagnostics, talks to Sonal Shukla about the upcoming molecular diagnostic technologies and the laboratory offerings in cancer research

What are your initiatives towards Dabur OncQuest, molecular diagnostics reference laboratory?

Dabur pharma has been present in the oncology space for about 15 years now. We have been coming out with oncology drugs, specifically in the area of breast cancer. We have a strong R&D function in Dabur pharma and diagnostics is an offshoot of the same wherein we look at tests that could be made more cost-effective. Since high-end technology is always considered expensive, especially in the Indian context, we found ways to bring the cost down by almost 50 percent in the couple of tests that were done in 2001. We wanted to make this feature available to more patients through OncQuest, which began its operations in 2003.

Cancer patient management involves more than managing patients with infectious diseases. The interaction and information flow, a doctor can have from an in-house laboratory, is not possible if he is relying on a third party laboratory for testing and information. This is the void that we wanted to focus on. In terms of patient management, when a certain drug is administered to a patient, then as per international standards, it is advisable to monitor the patient response every three or six months. If you are unable to archive the data related to the patient results and give a consolidated picture to the clinician; it would be difficult for him to judge whether the patient has got remission.

At OncQuest, we started off with Flowcytometry and PCRs to fill this gap. Over the last couple of years, we have brought in technologies like surgical pathology, routine histopath and immunohisto-chemistry markers into our laboratory. At present we are looking at technology platforms like microarrays and tests for genetic predisposition towards a group of cancers, for early diagnosis. Moreover, clinicians would use early diagnosis as a tool for counselling the patients about cancer.

What are the research areas in cancer that you are aiming at?

We are aiming at research areas in two different ways. One of them uses the existing technology platform for tests in cancer. At present, we are looking at newer gene aberrations in particular genes to target paediatric oncology since there is a dearth of tools available in this field today. Secondly, we are looking at newer technology platforms like microarrays, which are commercially available in the west, and are FDA approved. We would like to be the first people to get it to India and then focus on making it more cost-effective.

Breast, colon, uterus, lung and oral are some types of cancers prevalent in India. Some of these tests are mixed and matched to make a profile which will give clarity for a particular clinical symptom.

We are looking at genetic predisposition towards breast and colon cancer, wherein we analyse multiple axons in a human gene to know whether the cancer is going to travel from mother to child or in the same lineage. In terms of leukaemias and lymphomas, our existing technologies are helping us a lot to look at newer tests that can be used.

OncQuest is also looking at novel tests using the same technology platform. Microarray, genomics and proteomics are not yet affordable to Indian patients. Therefore, we are using the same technology platform to build tests that could be used as markers for other leukaemias.

What are the new molecular diagnostic technological trends in cancer research?

A substantial amount of work is happening in the areas of microarrays, proteomics and genomics. Putting these together, we are looking at bioinformatics to enable better patient management. We provide molecular diagnostics using real-time PCRs, nested PCRs, also flowcytometry, FISH (Fluorescent In-Situ Hybridisation) and cytogenetics. The technology we offer is in accordance with the prescribing patterns of the clinicians.

Globally, if you look at the molecular diagnostic segment, genomics and genetics have been the key driving forces for a lot of activity concerning cancers and infectious diseases, hepatitis and diabetes. Molecular diagnostics provides answers to questions like test results, how to avoid a disease and whether by genetically engineering someone's composition one can avoid a particular kind of disease.

This is a sunrise area in India. Though there is information available in terms of the lab scenario, there are not many clinicians who are aware of the recent advancements in the field of cancer or infectious diseases. It is going to take time to spread awareness of the clinical utility of these tests.

What about the safety, effectiveness and acceptability of your molecular diagnostic tests?

We are probably the only oncology diagnostic lab in the country that received accreditation from NABL (National Accreditation Board of Laboratories), which is under the department of science and technology.

This covers the safety aspect. We have a base management company that takes care of all the biohazard material.

We have SOPs in all our centres that look into aspects like specimen collection in case of accidental breakage of tubes. All these are norms as per NABL standards.

The effectiveness and acceptability aspects are substantiated through publications and references on research and diagnostic markers for specific cancers. Tests conducted by us find mention in guides that are published in western media.

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