The United States Food and Drug Administration has recently approved cabozantinib (Cabometyx) for patients with previously treated advanced neuroendocrine tumors. This is an oral tyrosine kinase inhibitor, which is offering a new standard for care of this patient group. This has been announced by the Dana-Farber Cancer Institute.

How Was The Drug Approved?

The approval came on the bases of the results from the phase 3 CABINET study. The study compared cabozantinib to a placebo in patients with advanced pancreatic neuroendocrine tumors.

As per the National Cancer Institute, neuroendocrine tumor grows from neuroendocrine cells. These cells receive and send messages through hormones to help the body function. These cells are found in organs throughout the body. The neuroendocrine tumor was called carcinoid tumor

These tumors grow very slowly and are mostly found in appendix, also known as appendiceal neuroendocrine tumors. When found in lungs, they are also called bronchial tumors. These areas are more common in children and young adults. Whereas for adults, it is mostly found in the digestive tract, called the GI neuroendocrine tumor. What makes it concerning is that it can also spread to other parts of the body but does so more in adults than in children.

They are rare in children and more common in adults, affecting up to 4 in 100,000 adults.

The drug which FDA has approved based on the phase 3 CABINER study's results have been published last September in the New England Journal of Medicine. Patients who were treated with cabozantinib survived significantly longer with no worsening of their disease compared with patients who received placebo. This also improved the efficacy as was observed in the interim analysis. The trial was in fact terminated early and unblinded in August 2023.

Are There Any Side Effects From The FDA Approved Drugs?

The reported side effects of cabozantinib were similar to those found in other studies of the drug. They include:

• Hypertension
• Fatigue
• Diarrhea

"Patients with neuroendocrine tumors often face a difficult journey," lead author of the CABINET study, Jennifer Chan, M.D., M.P.H., of the Dana-Farber Cancer Institute, said in a statement. "Despite advances in recent years, there has remained a critical need for new and effective therapies for patients whose cancer has grown or spread. Cabozantinib significantly improved outcomes in this patient population and this FDA approval provides new hope."

How Is Neuroendocrine tumor diagnosed?

While some people have symptoms, others may do not have any symptoms. These symptoms depends on where in your body the tumor has grown.

Patients who have appendiceal neuroendocrine tumors may have symptoms of appendicitis, such as pain in abdomen. They could also be later diagnosed with carcinoid tumor in case the doctor removes the appendix and finds a tumor. Patients with carcinoid tumor in other parts of the digestive tract may have symptoms such as:

• Pain in the abdomen
• Nausea or vomiting
• Diarrhea

Other ways to detect is by lab tests, imaging, and biopsy.

Cancer therapy is ever-evolving with new tests, treatments and pills- and in the middle of it is a revolutionary technology known as liquid biopsy. Just to think of a simple blood test that can diagnose cancer in its early stages, predict how a tumor will respond to treatment, and help doctors to change medications before cancer has a chance to develop anew. That's no longer science fiction anymore. Liquid biopsy is transforming the way we detect and treat cancer giving new hope to patients and changing the face of oncology.

Unlike earlier biopsies, in which tissue has to be taken from the tumor itself—usually through surgery or needle biopsies—a liquid biopsy is as easy as a blood test. This blood is then tested for circulating tumor DNA (ctDNA) or shed tumor cells in the blood. These bits contain the genetic material of the tumor and enable physicians to learn about the molecular nature of the cancer without gaining direct access to the tumor.

The latest versions of this test can even identify small, sinister changes in proteins—providing important clues about what a tumor might do and whether it is developing resistance to therapy.

A recent study published in The New England Journal of Medicine which was presented at the American Society of Clinical Oncology annual meeting illustrates just how potent liquid biopsy can be. The study involved individuals with estrogen-fueled metastatic breast cancer—a sub-type that is generally treated with medications that attack specific proteins on cancer cells.

With time, tumors evolve and these mutations can make treatments ineffective. In the research, scientists employed liquid biopsies to identify such protein mutations as far back as nine months prior to when they could be seen on conventional imaging scans. Early detection enabled doctors to change treatments preemptively—radically enhancing outcomes.

We have highly effective treatments, but they have to wear off," said Dr. Nicholas Turner, the study's co-author and a professor of molecular oncology at The Royal Marsden Hospital. "If we can pick up the changes early, we can move quickly—before the cancer does any more damage."

How Liquid Biopsies Could Enhance Outcomes?

The research had 315 patients, all of whom had acquired mutations following treatment. The liquid biopsy findings influenced a change in treatment in half of the cohort, with the other half retaining treatment as before.

Patients who had changed their treatment were twice as likely to maintain their tumors at bay in the coming year. Liquid biopsies could identify mutations up to nine months before conventional scans. In 10% of the volunteers, the test showed their treatment was no longer working, before symptoms or scans could detect it.

These results indicate a significant change in the way we monitor cancer and make medication changes—equipping clinicians and patients with sooner insights and more tailored treatment alternatives.

While this most recent study focused on breast cancer, liquid biopsy is being designed for a broad spectrum of cancers. A case in point is lung cancer, where liquid biopsies are already producing results 16 days sooner than traditional tissue biopsies, based on pilot data from the UK's National Health Service (NHS).

This quicker turnaround enables patients to initiate life-extending, targeted treatments sooner—potentially avoiding the lag that allows cancer to develop further.

NHS National Clinical Director for Cancer, Professor Peter Johnson, captured the potential of liquid biopsies perfectly:

"They are taking us into a new age of personalized cancer treatment… and we can see the difference this test is already making."

In 2022, Australian scientists reported in The New England Journal of Medicine that liquid biopsy could predict whether individuals with early-stage colon cancer required chemotherapy following surgery. This enabled numerous patients to safely avoid chemotherapy, sparing them its energy-sapping side effects without sacrificing for treatment effectiveness.

Dr. Jeanne Tie, senior research fellow at the Walter and Eliza Hall Institute of Medical Research in Australia and lead author of the study, underlined that liquid biopsies could soon become routine tools in early cancer treatment and management, but availability still differs around the world.

How Does Liquid Biopsy Work?

The secret of this groundbreaking test is its capacity for analyzing ctDNA, or pieces of tumor DNA circulating in the bloodstream. These pieces provide a molecular snapshot of the tumor, exposing important genetic mutations that reveal:

• How aggressive the cancer is
• Whether it's responding to current treatment
• Which treatments are most likely to be effective

By detecting these changes earlier, liquid biopsies allow physicians to match patients with targeted treatments—drugs that are customized to a tumor's own individual genetic signature. Chief Scientific Officer for England Professor Dame Sue Hill welcomed this technology, "This technology is revolutionizing care and enabling clinicians to match patients sooner with potentially life-prolonging targeted therapies."

Liquid biopsy is not only a more accurate or quicker test—it's also cheaper and less invasive. One independent health economics review in the UK estimated that liquid biopsies would save the NHS as much as £11 million annually in lung cancer treatment alone.

Moreover, by minimizing the necessity for repeat scans, invasive biopsies, or cycles of unwanted chemotherapy, the test is also improving quality of life for many patients.

As the technology becomes even more advanced, researchers are looking to utilize it for:

• Pancreatic and gallbladder cancer
• Monitoring cancer growth and treatment response in real-time
• Screening healthy people for early cancer signs—before symptoms even begin

Cancer patients as well as patients with conditions such as cystic fibrosis and chronic pancreatitis are now confronted with an acute shortage of an essential medication—Creon. This pancreatic enzyme replacement therapy (PERT) is crucial to digesting food, one of the most fundamental of human activities which becomes all but impossible for those with pancreatic insufficiency.

The consequences are frightening- patients are forgoing meals, dividing up doses, and driving more than 30 miles just to receive the capsules. The effect is not just nutritional but life-threatening, because not being able to properly digest food can make a person vulnerable to infection, make them weaker, and restrict access to life-saving treatment like chemotherapy.

Creon is the brand name of pancreatic enzyme replacement therapy that is used to manage exocrine pancreatic insufficiency (EPI)—a disease in which the pancreas is unable to produce enzymes to help digest food. This inability can be due to a variety of reasons, such as pancreatic cancer, cystic fibrosis, chronic pancreatitis, and complications after surgery like gastric-bypass or pancreatic surgery.

For individuals with EPI, Creon® is not merely a supportive therapy—it is a lifeline. It allows them to extract nutrition from food and sustain body weight, energy, and immune capacity. Without it, patients experience persistent diarrhea, abdominal pain, malnutrition, and ultimately, reduced quality of life and survivability.

The Government in the UK has prolonged the Serious Shortage Protocol (SSP) for Creon until November 2025, enabling pharmacists to dispense a reduced quantity without a fresh prescription. Although the policy tries to make things more accessible, this is a short-term solution to an ongoing and hazardous shortage.

One survey carried out by the National Pharmacy Association (NPA), surveying more than 300 pharmacies, shows a dire picture. A whopping 96% of these pharmacies are struggling to get Creon, the essential pancreatic enzyme replacement therapy. Additionally, 89% have the same shortages with other drugs like Nutrizym and Pancrex. This shortage is making many patients go distances of over 30 miles just to get a pharmacy that will fill their prescriptions. Even more alarming, many patients are said to be skipping meals or cutting their doses in order to stretch their short supplies, jeopardizing their health and wellbeing in the process.

The shortage is primarily due to "European-wide supply issues" and production limitations on the drug that have caused interruptions in the manufacture and distribution of Creon, as reported by the Department of Health and Social Care. The interruptions are not specific to Creon but point to systemic weaknesses in pharmaceutical production.

In Creon's case, though, the end result is worse. Unlike certain drugs that can be skipped or substituted for others, Creon® is instantly vital with each patient meal. There is no "respite" from taking it, and even temporary discontinuation can cause health emergencies.

How is the Shortage of the Drug Affecting Cancer Patients?

The psychological and physical strain on the patients cannot be estimated. As Alfie Bailey-Bearfield, Pancreatic Cancer UK's Head of Influencing & Health Improvement, stressed, "It's completely unacceptable that they are still taking desperate steps which risk their health, wellbeing, and their suitability for treatment."

Patients going without meals in order to cut corners on enzyme capsules put themselves at significant risk of malnutrition and severe weight loss. Not only does this compromise the immune response of the body, it lowers tolerance to chemotherapy, effectively excluding patients from life-sustaining or curative therapy. The medical risk is not abstract—it's real and measurable.

What is EPI?

Exocrine Pancreatic Insufficiency (EPI) is more prevalent than many people know. In the UK alone, approximately 61,000 patients need pancreatic enzyme therapy. Reasons are:

• Pancreatic cancer (especially advanced)
• Cystic fibrosis
• Chronic and acute pancreatitis
• Pancreatic surgery or gastric bypass
• Untreated celiac disease or inflammatory bowel disease

EPI results in undigested food entering the colon, leading to bloating, gas, cramps, and diarrhea. With time, the nutrient deficiencies cause weight loss, bone loss, and even increased cardiovascular risk. In children, it impairs growth and development.

Unlike regular prescriptions, Creon is not prescribed with a set amount. It has to be individualized for each patient, for each meal, and even for each snack. The dosing is 3,000 to 36,000 enzyme units per capsule. For comparison, a normal pancreas will release up to 720,000 units for a small meal.

Patients are instructed to self-regulate according to their intake, so that a consistent and plentiful source becomes not only the preferred but also the necessary mode of correct dosing. Under shortages, this individualized dosing is a luxury many cannot enjoy.

Healthcare providers and patient advocacy groups alike are demanding immediate government action. Bailey-Bearfield and Picard have issued public calls for a strategic restructuring to solve manufacturing constraints and enhance distribution systems.

"This crisis continues to put people's health at risk, and they cannot afford to wait any longer," Bailey-Bearfield implored.

It takes not only stockpiling but also long-term planning, such as investment in alternative manufacturing hubs, local production incentives, and better global supply chain coordination.

COVID-19 cases in India continue to rise, the numbers have now touched 3,758. Kerala, the southern-most state in India has reported the highest of the cases, leading with 1,400 cases, followed by Maharashtra with 506 cases.

On Saturday, the Union Health Ministry released a data, which registered 685 more active cases, another data was released on Sunday, which reported 360 new infections, which had been recorded within 24 hours.

Apart from that, two COVID-19 deaths were also reported during the same time, in Kerala and Karnataka. In Karnataka, a 63-year-old man who had comorbidities including pulmonary TB, squamous cell carcinoma of buccal mucosa, and was also tested positive for COVID-19, passed away. While in Kerala, a 24-year-old woman with COVID-19 and pre-existing conditions like sepsis, hypertension, and decompensated chronic liver disease (DCLD) also passed away, reported the Health Ministry.

As per the Ministry of Health and Family Welfare figures, in the last 24 hours, Kerala reported 64 new cases, Maharashtra reported 18, while Delhi reported 61 new cases.

India Impacted By COVID-19

In Delhi, a 60-year-old woman who had been tested positive with COVID-19 also passed away, as per the official. This has also marked the first death in the capital during the current wave. The woman is said to have undergone surgery for intestinal obstruction, and incidentally found out that she was also COVID-19 positive.

Gurugram too reported a spike in COVID-19 cases after two and a half years. Dr Alka Singh, who is the Civil Surgeon also urged people to not ignore flu-like symptoms. From the cases reported earlier, it has been found that people who had been suffering from flu were in fact, COVID-19 positive.

Four new Covid-19 cases were reported in Gurugram on Sunday, bringing the total during the current surge to 23, with 12 active cases. All patients have mild symptoms and are isolating at home. The health department collected 97 samples for testing the same day.

Maharashtra reported 65 new Covid-19 cases on Sunday, bringing the total since January 1 to 814. Pune accounted for 31, Mumbai 22, Thane nine, Kolhapur two, and Nagpur one. The state currently has 506 active cases, with 300 recoveries so far, according to the health department.

ALSO READ: India Records 3,395 Active COVID-19 Cases, 26 Deaths, Kerala And Maharashtra Among Worst-Hit States

In Odisha, active cases have risen to 12, all presenting mild symptoms and placed in isolation, said Nilakantha Mishra, the state’s Director of Public Health.

Andhra Pradesh’s information minister K Parthasarathi urged people to remain vigilant amid a national rise in infections, advising caution in crowded public spaces such as railway stations, bus stands, and airports.

West Bengal registered 82 new cases in the past 24 hours, taking the number of active cases in the current wave to 287. Six people were discharged after testing negative. Updated figures from the state health department are awaited.

Punjab has six active Covid-19 cases, with five reported from Ludhiana. One death has occurred. Among the infected are two children of the deceased, who are asymptomatic and in quarantine. The remaining cases include a returnee from Kerala and two individuals who had contact with travellers from high-infection states.

In view of the rising Covid-19 cases, the Karnataka government on Saturday issued an advisory urging the public to wear masks in crowded spaces, maintain physical distancing, and follow hygiene protocols.

Union minister of state for health and AYUSH, Prataprao Jadhav, assured last week that the central government is fully prepared to manage any emerging Covid-19 situation.