The Death Of Chemotherapy As We Know It?

If you were diagnosed with testicular cancer in the 1970s, there would be a more than 30% chance it would kill you. Today it’s only 4%, as 96% of those diagnosed undergo complete remission, the word for “cured” in oncology-speak. The primary reason for this vast improvement in survival chances is chemotherapy. There is no questioning the treatment’s effectiveness. When used in conjunction with radiotherapy and physical surgery it can improve the chances of survival for most cancer types. The tide is changing however; doctors are starting to predict the end for chemotherapy as we know it, and here’s why.

Chemotherapy, however effective, can be extremely and permanently harmful to a patient, even after treatment ends. It works by introducing toxic chemicals into a patient’s body, designed to attack cells that reproduce rapidly, like cancer cells. Fortunately, in an adult body the reproduction rate of most cells is relatively stable, but most is not all, and things like hair cells, nail cells and the lining of the digestive system also attract the attention of the toxic drugs. For a long time this all-in approach has been the best way to attack cancer cells, but a string of recent clinical trials are approaching completion that deliver treatment in a much improved and overall safer manner. While the treatments in question differ somewhat they all share a common denominator -- accurate targeting.

Targeting cancer cells means no more collateral damage and a much higher quality of life for those undergoing treatment; if proven effective it could revolutionize cancer treatment.

Xalkori, Pfizer’s fastest growing drug by sales
Let’s begin with one treatment that is already approved and selling on the market.

One form of targeted cancer treatment that is already making waves, and is set to expand rapidly, is based in genetics and is commonly referred to as targeted therapy. Targeted therapy was born out of the human genome project, a global effort to map the entire human genome. As part of the project, scientists discovered 150 genes, which they now refer to as oncogenes. When mutated, all 150 of these genes demonstrate cancer-causing traits, for example, inhibiting the process that would normally put a stop to cell division. Targeted therapy involves patients taking drugs that specifically inhibit these oncogene mutations.

One well-known example is Pfizer’s (SNTA ). Ganetespib inhibits a protein called Hsp90, which is reported to play a key role in the survival and reproduction of cancer cells. The study has already demonstrated some positive results, with 4 of 15 patients experiencing significant shrinkage of breast cancer tumors that are otherwise nearly impossible to treat.

What Does This Mean For Cancer Patients?
Treatment using the IL-12 cytokine described earlier, and other targeted therapy drugs, is in a technical sense chemotherapy because all attack cells that reproduce quickly. The major difference between the traditional chemotherapy approach, and the approach likely to take hold in the near future, is the side effects associated with the treatment. The quality of life that cancer patients experience is seriously reduced by the current standard of care treatment (chemotherapy, radiation and surgery), and while there will still be side effects associated with modern targeted treatments they will most likely be much less detrimental.

Will The New Therapies Become Standard Of Care Soon?
The current FDA approval system makes it very difficult for new drugs and treatments to become commercially available and targeted therapy, by its very nature, requires many different forms of drugs to treat the many different forms of cancer. Each of these drugs takes years to develop, and then an average of 12 years before they receive FDA approval. For this reason, it is unlikely that the standard of care treatment for cancer as a whole will change in the next year or two unless one of these in the pipeline is the next Gleevec for multiple cancers, something that is far-fetched; more likely it will be a step-by-step process for each caner. As each new drug is developed, it could become the standard of care treatment for the particular cancer it is used to treat. Having said this, many of the drugs in development will treat a number of cancers, and one that already has approval for treatment of one cancer is likely to be approved more quickly for treatment of another. This should cause a snowball effect in the uptake of the modern cancer therapies as they become more widely adopted.

Conclusion
All said, while an all-out cure for cancer might still be a long way off, the R+D undertaken over the last 30 years is finally paying off in the form of therapies that will make cancer treatable, and in turn bearable, for those living with it. Traditional chemotherapy and the side effects so commonly associated with it, will, in the not too distant future, hopefully become a thing of the past.

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Written By: Louis Dematteis