what's new in cancer treatment; chemotherapy vs. targeted therapy
DESCRIPTION
Presentation by Jim Lechner, MD, for Providence Cancer Survivor Celebration on June 2, 2012 in Olympia, Wash.TRANSCRIPT
Chemotherapyvs.
Targeted Therapy
James J Lechner, MD
Medical DirectorProvidence Regional Cancer System
The Role of Systemic Therapy
• Treatment of the whole body• Intent?
– Induction therapy– Adjuvant therapy– Palliative
Chemotherapy vs Targeted Therapy
• Chemotherapy:– Drugs that effect cells that are doubling– Not very specific– Mostly intravenous, some oral agents– Cytotoxic
• Targeted therapy:– Drugs that inhibit a more specific target in cells– Many are oral agents– Mixture of cytostatic and cytotoxic
Sidney Farber (1903–1973)
The Normal Cell Cycle
Classes of Chemotherapy Drugs
• Alkylating agents• Antimetabolites• Anthracyclines• Anti-tumor antibiotics• Plant alkaloids
– Topoisomerase inhibitors– Vinca alkaloids– Taxanes
Class Example Method of Action Cycle Specfic
Alkylating agents Cytoxan Effects DNA chemically All
Antimetabolites 5-FUGemzar
Substitutes for normal cell building blocks
S
Anthracyclines Adriamycin DNA damage or inhibit topoisomerase
All
Anti-tumor Antibiotics
Bleomycin DNA damage All
Topoisomerase Inhibitors
Irinotecan Complex DNA and topoisomerase together
SG-2
Vinca Alkaloids Vincristine Binds to tubulin, interferes with mitosis
M
Taxanes TaxolTaxotere
Prevents microtubules from disassociating
M
Targeted Therapy
Attempts to take advantage of a genetic change in the malignant cells
The Origins of CML
Gleevec
BRAF Mutation in Melanoma
EML4-ALK Mutation in Lung Cancer
• Present in 3-5% of non-small cell lung cancer, usually adenocarcinoma
• Mutation leads to formation of a fusion gene that codes for an abnormal tyrosine kinase receptor
Response to crizotinib in patients with EML-ALK NSCLCA
Drugs in the Pipeline for ALK
Her-2/neu
• About 25% of breast cancer cases are associated with a amplification of the genes coding for a cell surface receptor called Her-2/neu
• These cells may a 1000 fold increase in the number of these receptors over normal breast cells
• Associated with rapid growth
Herceptin
There Are Multiple Agents Already Available
Non-Hodgkin Lymphoma
Old News Targeted Therapy
(But crucial in breast cancer)
Normal Estrogen Effects in Breast Cells
Anti-estrogen Therapy in Breast Cancer
Antibody-Drug Conjugates
A New Agent in Hodgkin's Disease
Stimulating an Immune Response
New Agent in Melanoma Therapy
Pushing Immune Cells to Recognize Cancer Cells
Provenge in Prostate Cancer
Recommended Reading
Thank You