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The biggest irony in cancer treatment for decades has been that oncologists (cancer specialists) have often had to rely on the 'trial and error' method. Despite having the same type of cancer, each person's genetic makeup, tumor microenvironment, and body's response to drugs are completely different. In such a situation, the same chemotherapy or immunotherapy that saves the life of one patient may prove to be ineffective in another patient and fill his body with severe toxicity and unbearable side effects.

But stemming from the confluence of artificial intelligence (AI), genomics, high-performance computing and multi-omics data 'Virtual Twin' Technology has raised hopes of changing this basic dilemma of oncology forever. Under virtual twin technology, doctors now create a living, dynamic and multi-dimensional digital clone (computerized replica) of a cancer patient. Before giving any heavy dose, toxic chemotherapy or radiation to the patient, doctors test hundreds of different drugs on that virtual model on the computer screen and see in advance whether the tumor will shrink or there will be any serious reaction to the drug.

How is a patient's 'virtual twin' created? Digital coordination from genome to MRI

A virtual twin is not a simple 3D animated model, but a mathematical and biological simulation of real biological processes from the molecular level up to entire organ systems:

• Aggregation of Multi-Model Data: First of all, the complete health data of the patient is collected. This includes whole genome sequencing of the patient, genetic mutation profile of the tumor obtained from biopsy, high-resolution 3D images of CT scan, PET scan and MRI.

• Creation of tumor microenvironment: AI algorithms create an exact digital environment of blood vessels, immune cells (T-cells) and oxygen levels around the tumor.

• Real-Time Biomarker Tracking: Circulating tumor DNA (ctDNA) in the patient's blood, hormonal changes, and biological signals from smart wearables are continuously fed into the model, allowing the digital twin to synchronize with the patient's actual body and update in real-time.

'In silico' drug testing: The most effective drug will be known within a few seconds

Once the virtual twin is created, it becomes possible for cancer experts to conduct 'in silico' (computer based) clinical trials:

• Hundreds of combinations tested: Doctors can run 50 to 100 different chemotherapy, targeted therapy or immunotherapy drug combinations simultaneously in computer simulations.

• Prediction of Drug Resistance: Cancer cells often become resistant to drugs after some time. The virtual twin can sense in advance through which mutation the tumor will try to eliminate the effect of the drug in which month, so that doctors can change their strategy in advance.

• Precise dosing of radiation: While radiation therapy destroys the tumor, there is a risk of damaging nearby healthy tissues and organs (such as the heart or lungs). With the help of a virtual twin, radiation oncologists are able to determine the angle and dose of the proton beam or X-ray with millimeter accuracy.

• Surgical Planning: Before surgery for complex and rare tumors (such as brain tumors or head and neck cancer), surgeons can practice virtual surgery on the patient's virtual twin, minimizing bleeding and risks in the operating theatre.

Avoid painful side effects and financial ruin of chemotherapy

Traditional cancer treatment is extremely taxing physically, mentally and financially for patients and their families. Often, after taking expensive medicines for months, it is found that they have no effect on the tumor, while the patient has lost his hair, appetite, immunity and lakhs of rupees.

Virtual twin technology has the potential to virtually eliminate this failure rate:

• Drastic reduction in toxicity: The computer model predicts in advance how much side effect a particular medicine will have on the patient's liver or kidneys. This eliminates the risk of overdose and organ damage.

• Time Saving: In cancer treatment, time is life. Instead of wasting months testing the wrong drugs, from day one the patient is given the drug that is 100% accurate in killing his or her specific tumor.

• Reduction in treatment expenses: By eliminating the use of ineffective immunotherapies and unnecessarily expensive drugs, the total cost of treatment is significantly reduced.

Global Initiatives and Impact in Indian Health Sector: $7.2 Billion Emerging Market

Virtual twin technology is no longer just a research work in laboratories, but its clinical use is rapidly increasing in the world's top cancer institutions. Leading organizations like the European Union's 'Horizon Europe – Virtual Human Twin' (VHT) mission, Humanitas Research Hospital in Milan, Italy, Dassault Systèmes of France, Mayo Clinic of the US and Siemens Healthineers are developing patient-specific twins for rare and complex cancers. According to market analysts, the global market for digital twins in oncology is expected to grow from $594 million by 2026 to $594 million by 2035. $7.2 billion (about ₹60,000 crore) It is estimated to exceed.

In India too, scientists from Tata Memorial Center (TMC), All India Institute of Medical Sciences (AIIMS) and Indian Institute of Science (IISc) are working on developing AI simulation tools based on genetic data of Indian cancer patients under the National Digital Health Ecosystem. Given the high incidence of oral cancer, cervical cancer and breast cancer in India, this technology will pave the way for highly affordable and accessible precision oncology for Indian patients.

Challenges and the way forward: Data privacy and computational efficiency

Although virtual twin technology has emerged as a miraculous hope against cancer, certain technical and ethical challenges stand in the way of its widespread and universal use:

• Standardization of multi-omics data: Different hospitals and labs have different data formats, which makes synchronizing them into a central AI system a complex process.

• Data Privacy and Security: It is essential to protect patients' sensitive genetic and medical data from cyber attacks and misuse.

• Cost of Supercomputing: Real-time simulation of biological systems requires enormous computational power and supercomputers, which are currently expensive to deliver to primary level hospitals.

The beginning of a new golden era of precision oncology

Medical experts are unanimous that virtual twin technology will become the standard of care in cancer treatment in the coming years. There was a time when cancer was considered only a shot in the dark, but Artificial Intelligence and Virtual Twin have taken oncology out of superstition and guesswork and brought it to the level of complete mathematical and biological accuracy. Thanks to their own digital avatar, now cancer patients will be able to get the perfect life support without any pain and side effects, which is the basic right of every patient.