In a first, toddler in Mumbai receives rare cancer therapy

Diya Gala

A three-and-a-half-year old Mumbai girl has become the first patient in the country to be treated with dinutuximab immunotherapy after she was diagnosed with a rare type of nerve cell cancer. Diya Gala, born to a couple from Andheri, received this immunotherapy on a compassionate basis.

Dr Prashant Hiwarkar, a bone marrow transplant physician at Wadia Hospital, said, "She came to us with non-resolving abdominal pain. An ultrasound detected a mass in her abdomen and a number of tests revealed she had metastatic neuroblastoma. It is a cancer that starts in a very early form of nerve cells and occurs in young children." He said this type of cancer begins in immature nerve tissue present in the adrenal glands, neck, chest, or spinal cord. "The disease is mainly seen in children less than five years old, and the symptoms are bone pain and a lump in the abdomen area, neck or chest." Said Dr. Hiwarkar.

In India, these children get treated through a number of therapies involving chemotherapy, surgery, autologous stem cell transplant followed by radiotherapy. Despite all of it, only 40 out of 100 children survive long term.

First patient to get it

Dr Hiwarkar further said, "Diya is the first patient in the country to receive this drug on a compassionate basis. It has been approved by The US Food and Drug Administration and is used for patients whose condition doesn't improve through the standard cancer treatment. The drug can be administered into a vein for around 10 days. A total of five courses are given in gaps of 35 days." The actual cost of the therapy, Rs 1.35 crore, has been completely waived for Diya, as she is the first patient receiving it.

Dinutuximab is an antibody therapy, a form of immunotherapy. The antibody acts against a sugar-fat molecule present on nearly all neuroblastoma cells (GD2). When the antibody binds to GD2 on the neuroblastoma cells, the cells die in a different way than after chemotherapy or radiotherapy.

"Autologous stem cell transplant improves the outcome marginally in this case but the addition of monoclonal antibody-like Dinutuximab beta improves the disease-free survival to 60 per cent," said Dr Hiwarkar.

"Neuroblastoma is a completely unknown entity for us. Our world came crashing down after Diya was diagnosed with cancer. We were shocked and appalled to see her crying in pain. My wife and I spent sleepless nights thinking about how to manage the treatment as I work in general stores and we live hand-to-mouth," said Rajesh Gala, Diya's father.

Challenging year

The couple raised funds for her initial treatment via various platforms. "We are thankful to Wadia Hospital for successfully starting the treatment with a novel drug. Over the past year, Diya had to make multiple trips to the hospital and spend around eight months there. The year was challenging for us due to the COVID lockdown. Now, she is slowly getting back on track. She has completed the first course of Dinutuximab and will get admitted for the second one after 35 days. Her treatment will be completed after five courses," added Gala.