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New cancer therapies give high hopes, but have complications



When you think about cancer therapy in recent years, the famous Dorothy's line from The Wizard of Oz comes to my mind: "We're no longer in Kansas."

Most oncology scientists – including myself – start teaching with the care of people with leukemia, because they need a lot of monitoring. Patients with leukemia often diagnose severe bleeding or infection and require urgent treatment.

For decades, acute leukemia treatment was largely the same: seven days of continuous IV medication followed by weeks in the hospital. to track complications ̵

1; kidney problems, infections and other life-threatening side effects

I spent the first three months of my communication in mid-2017, treating patients with leukemia. She was tense, but in the end, I felt confident in diagnosing leukemia and ordering primary drugs that would save their lives.

I returned to treatment for leukemia patients after a four-month break in early 2018. we diagnosed leukemia, and I was preparing our usual orders for chemotherapy.

A pharmacist of our team knocked on my shoulder and whispered: "Are you sure you want to order it?"

I was embarrassed: didn Did we treat leukemia exactly as we did four months ago?

It turns out that we are not doing this, and she was right: in just four months, the Office for Food and Drug Administration approved at least two new drugs for acute leukemia, the paradigm of the treatment completely changes. Several more drugs will be approved for this disease in 2018. Now, instead of treating all patients with leukemia in the same way, we had different versions of drugs, depending on the patient's genetic and molecular abnormalities

.

This is a general story for oncologists and cancer patients. The pace of change in cancer therapy has been striking for the past ninety years. Increasing the availability of new treatment options – often with higher chances of remission and fewer side effects – is good for patients. But for many of them and their doctors it can be difficult to keep up with all the changes.

This was not necessarily a problem 20 years ago: during the 60-year period, between 1940 and 2000, the FDA approved. 72 medicines for cancer treatment. But this figure has more than doubled over the next decade. Only in 2018, the FDA approved 19 narcotic drugs associated with cancer

It would be one if the drugs approved in the last 20 years had the same mechanisms and side effects. But we are moving from the era of generalized cancer drugs and in the era of personalized oncology. New drugs are targeted at specific genes or molecules, and many immunotherapies work by stimulating the immune system of the body to fight cancer

. hair. Fortunately, in the modern era, this is an exception rather than a rule.

Many cancers are treated with pills and most of the patients I see can work or relax even during treatment.

New treatments have raised ways of treating common cancers such as melanoma, lung cancer and kidney cancer. And survival – even in stage IV cancer – is rising

But it is a consequence of this renaissance in cancer therapy: Sometimes we know relatively little about the side effects of new therapies that we provide to patients. 19659017] Recently, I met a patient with stage IV melanoma treated with two of the immunotherapy approved for this condition. She has been in for months, and her cancer has fallen dramatically.

She was a story of success

However, a few days ago she became very tired and developed a new headache. MRI has shown that its pituitary gland – a small gland in the brain that secretes hormones – was extremely large because its own immune cells attacked it. . Unfortunately, it should be hormonal replacement before the end of life

I saw several patients who received new therapies that had similar side effects that seem to come out of it.

Another problem with new drugs: Immunotherapy such as CAR-T cells that have led to long-term remissions for some patients with lymphomas or leukemias have been approved by the FDA. But they require significant knowledge and experience to use, and therefore are available only for some types of cancer in several places in the United States. Some patients are disappointed that new drugs are not available for their location or illness

But perhaps the most difficult aspect of this new era in drugs for treating cancer is to convince patients that they do not need new therapies.

saw a man in a prostate cancer hospital that spread to numerous bones, caused significant pain in him, and even attracted him to the liver. He brought a page of drug data that has been approved over the last ninety years for the treatment of prostate cancer. They ranged from cancerous vaccines to target pills to immunotherapy. I calmly explained why new therapies, although promising, are not the best treatment for him. He reluctantly accepted chemotherapy. The last thing I heard, he did well after the end of the regime.

After four decades of investment in the war on cancer, life expectancy is rising, side effects are less, and cancer can sometimes be a chronic disease, not death. sentence. As treatment opportunities are expanding day by day, it's interesting as an oncologist-in-training to learn about these new therapies and also to keep in mind that existing cancer therapy can serve some patients.

Ravi Parich is a fellow at Hematology / Oncology at the University of Pennsylvania in Philadelphia. Follow it on Twitter @ravi_b_parikh


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