Download Targeted Therapy Patient Centred - Options Based

Targeted Therapy
Patient Centred - Options Based - Decisions
The developments in the treatment of cancer over the last 100 years have been slow and
steady. Usually it would take 10 to 15 years for any new effective therapies/drugs, having
significant advantage over and above the existing one, to be discovered. And the world of
oncology community had enough time to study all aspects, using a type of study called
randomised study (where patients are allotted to different groups in random fashion to avoid
bias and then followed over the years to find the best of the available treatments) of the new
therapy and recommend the most acceptable form of therapy to the patients. But, of late the
scenario is changing fast and the onus of the decision making process is on the patients, in
view of a series of drugs, which target the cancer cells specifically, that are hitting the market
almost every month.
This fast-paced change is consequent to the discovery of item on the surface of the cells
known as receptor, which is like a door or window of a house. These receptors are the entry
or blocking points for the drugs, which in turn would lead to changes inside the cells leading to
the death of cancer cells. The cancer cells are identical to the normal cells in physical aspects.
Therefore, the cancer killing police force of the body e.g. NK cells (Natural Killer cells) had no
way of differentiating between normal cells and the cancer cells, and hence were ineffective in
killing the bad cells. Contrarily, the expression receptors are different for cancer cells and the
normal cells. It is like differentiating two playing teams with the colour of the shirt. Cancer cells
wear different hues compared to the normal cells and drugs are developed to attack the a
particular colour, which the normal cells do not possess. The development of this technology is
called as targeted therapy. These drugs are unlike the well-known commonly used
chemotherapy drugs, which act on both cancer cells and normal cells. Hence, the targeted
therapy is devoid of major side effects.
Simultaneously, there have been discoveries about the differences in the way a cell functions
within. The way of the “road” or “pathway” of daily movement of the various raw materials for
building and daily functioning of cells varies between cancer cells and normal cells. Presently,
there are several drugs (molecules), which can block the unusual activity that are seen in
certain “pathways” in cancer cells. This discovery lead to a lot of excitement and it was
believed that the end of the road, in eliminating cancer was reached.
[Unfortunately, the very protective mechanism of having several “roads” or “pathways” for the
survival of species became a disadvantage in treating cancer, because once one “road” is
blocked by a drug, several “collateral roads” opened up and the tumour would continue to grow
after stopping growing for the a variable period of time.]
On the contrary, the radiation therapy had the ability to block multiple “pathways”. Additionally,
when delivered along with these targeted drugs, radiotherapy is found to be much more
effective. The reason for this effect is easy to understand, since the radiation acts best on
active cancer cells, and blocking one road would make the cancer cell active in opening up
other “side roads”.
Concurrently, there has been a revolutionary development in the way the radiotherapy
treatment is given. The developments in the computer technology, extraordinary imaging
techniques and sophistication in the treatment machine has lead to the development if
precision delivery of radiation to the tumour known as Intensity Modulated Radiotherapy
(IMRT) and Image Guided Radiotherapy (IGRT) (See Technology section in this site). Hence,
presently even the radiation therapy is akin to “targeted therapy”.
Also, the strategy is moving in the direction of using multiple targeted drugs to effectively block
as many “pathways” as possible along with radiation therapy.
Therefore, modern day therapy of cancer is a combination of targeted drug therapy with
targeted radiation therapy and organ preservation surgery (least surgery to preserve the
function of the organ), in an effort to move in the direction of giving normal quality of life. Of
course only major side effect, as of now, is the cost of the treatment!
The exploration to find the various pathways and to block them has lead to the explosive
number of possibilities. Pharmaceutical companies and researchers all over the world are
working simultaneously on different “pathways” and slew of drugs are entering the market. This
has lead to the situation of multiple options to be offered to the patients to choose from, since
there is lack of time for detailed examination of effectiveness of one type of treatment over the
other.
Therefore, we are in a situation where the patients have the additional burden of choosing from
these options, and the cost of the therapy involved.
Finally, based on the above developments, one of the objectives of this site is to place the
possibilities and options that are scientific in front of the patients to make their decision easier.
Of course, your decision along with that of your treating specialist is the final one.