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Dr. Gabriel N. Hortobagyi is chair of and professor in M. D. Anderson’s Department of Breast Medical Oncology and immediate past president of the American Society of Clinical Oncology. |
At this year’s annual meeting of the American Society of Clinical Oncology (ASCO), it was more apparent than ever that the paradigm of cancer treatment has irrevocably changed. In a short 15 years, targeted therapy has transformed from a dream into a substantive reality; drugs like imatinib, trastuzumab, bevacizumab, cetuximab, and others have become integral components of modern anticancer treatment.
Today, we no longer search for substances that have differential toxicity for cancer cells; instead, we identify the molecular abnormalities responsible for the malignancy and design chemical compounds or monoclonal antibodies that inhibit their activity. The current generation of trials combines these agents with chemotherapy, endocrine therapy, or other targeted therapies in the hope of inhibiting multiple signaling pathways or interfering with the dominant pathway at more than one level.
Of particular significance at this year’s ASCO meeting was a report indicating that single-agent sorafenib prolonged survival of patients with advanced hepatocellular carcinoma compared to placebo and best supportive care. This is the first systemic therapy to alter the outcome of this deadly tumor.
Another study extended the indications of bevacizumab to advanced kidney cancer, showing that adding the anti-vascular endothelial growth factor (VEGF) antibody to treatment with interferon alpha A2 nearly doubled progression-free survival, from 5.4 to 10.2 months. Thus, after decades of assessing mostly ineffective treatments for renal cell carcinoma, we now have four highly effective targeted therapies for use in the disease: sorafenib, bevacizumab, tensirolimus, and sunitinib. Now studies will seek to determine optimal combinations of these and other agents in managing this tumor.
Another highly refractory tumor, advanced thyroid cancer, also yielded ground to a molecularly targeted therapy. Axitinib, a VEGF inhibitor, was reported to produce major responses in 22% of patients with advanced thyroid cancer and disease stability in another 50%. This is the first systemic agent to show antitumor efficacy in this tumor type.
I feel confident that as these strategies evolve, most types of cancer will become increasingly treatable, more frequently curable, and sometimes even preventable. We must, however, increase participation in clinical trials if we are to accelerate the pace of progress. I urge physicians to educate their patients about opportunities to receive novel therapies and encourage them to seek out clinical trials when appropriate.
For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.
Other articles in OncoLog, September 2007 issue:
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