Systemic cancer therapy: achievements and challenges that lie ahead

Abstract

In the last half of the century, advances in the systemic therapy of cancer, including chemotherapy, hormonal therapy, targeted therapy, and immunotherapy have been responsible for improvements in cancer related mortality in developed countries even as the population continues to age. Although such advancements have yet to benefit all cancer types, systemic therapies have led to an improvement in overall survival in both the adjuvant and metastatic setting for many cancers. With the pressure to make therapies available as soon as possible, the side-effects of systemic therapies, in particular long-term side-effects are not very well characterized and understood. Increasingly, a number of cancer types are requiring long-term and even lifelong systemic therapy. This is true for both younger and older patients with cancer and has important implications for each subset. Younger patients have an overall greater expected life-span, and as a result may suffer a greater variety of treatment related complications in the long-term, whereas older patients may develop earlier side-effects as a result of their frailty. Because the incidence of cancer in the world will increase over the next several decades and there will be more people living with cancer, it is important to have an understanding of the potential side-effects of new systemic therapies. As an introductory article, in this review series, we begin by describing some of the major advances made in systemic cancer therapy along with some of their known side-effects and we also make an attempt to describe the future of systemic cancer therapy.

Targeted therapy and its availability in Serbia

“…Adverse reactions from this mAb include common injection reactions, rash, diarrhea, venous thromboembolic events and electrolyte abnormalities. There is no benefit of addition of another mAb to standard chemotherapy combination [1].…”

“…It has already been established that bevacizumab use with irinotecan plus 5-fluorouracil and leucovorin combination increases overall survival in metastatic colon cancer approximately by 4 months [30]. Addition of bevacizumab to adjuvant chemotherapy has not shown any benefit, as well as addition of other mAbs [1]. However, increase in adverse reactions associated with bevacizumab was seen, which included gastrointestinal perforation, arterial thromboembolic events, bleeding events, wound healing complications, hypertension [31].…”

“…Since the introduction of imatinib for treatment of CML, studies have shown that almost 80% of all treated patients had progression free and overall survival. It is even estimated that majority of patients with CML have normal life expectancy [1]. From the beginning of 2013 new imatinib containing drugs have got marketing authorization in EU (Imatinib Teva ® , Imatinib Actavis ® ).…”

“…Still, remains need for carefully balanced administration and getting new data of long-term side effects, since the relatively short period of time they have been approved for the treatment [1].…”

“…Its acute toxicity profile differs from cytotoxic therapy and shows stunning improvement in patient survival and disease remission. However, taking into consideration that many modified cellular signaling pathways are of substantive importance for growth or homeostasis of normal cells, there is still not enough clinical experience for prolonged period of utilization and of long term toxicity profile of these drugs [1]. Drugs for targeted therapy are mostly biological or biotech products, but there are also small synthetic molecules, like family of tyrosine kinase inhibitors, that expressed their efficacy in several indications.…”