Targeted therapies and hormonal therapy?

Question by Rob: Targeted therapies and hormonal therapy?
I hear they are now trying to use targeted therapies and hormonal therapy in medicine and is 10 to 15 out?
How does this work? And they say in the future they are going to use targeted therapies and hormonal therapy in medicine .

Best answer:

Answer by saravanan
Cancer treatment, (i mean chemotherapy here, let alone surgery and radiotherapy) is difficult because you cannot simply TARGET your drug to act only on cancer cells.

cancer cells are not any different from our body cells, they just multiply at abnormal rate, and grow and spread UNCONTROLLED because they LOST certain Molecular BRAKES that normally regulate growth and cell division.

so, our anti cancer drugs (and also radiation) loosely aim at rapidly dividing cells, so they kill cancer cells as well as some normal cells that also divide rapidly like blood forming cells of bone marrow, and cells in our intestines.

Thus if you give chemotherapy at FULL DOSE, we can really CURE cancer, but the patient will die of bone marrow problem and diarrhoea. Hence they are called DOSE-LIMITING TOXICITIES. i.e. conventional chemotherapy is given in maximum tolerable doses, which are unfortunately not curative in all cases.

Thus we searched for properties that are unique for cancer cells, and not present in normal cells.

The breakthrough came in CML, a kind of blood cancer, that contains a unique “Philadelphia chromosome” that normal cells dont have. We produced IMATINIB (Gleevec) that TARGETS a unique protein that comes from this chromosome (and this protein causes this cancer) and BINGO !!!! it revolutionised cancer treatment forever and thus TARGETED THERAPY is born. [Terms like pre-imatinib and post-imatinib ERA can be found in oncology books!!!]

After extensive research into what genetic variations cause different cancers, we found that these variations also produce unique proteins (genes are ultimately translated to proteins that does the job of the gene), and we produced drugs against these proteins. Such drugs are essentially antibodies against the target proteins produced by genetic engineering. They have a common suffix -mab (monoclonal antibody) e.g. Rituximab, Alemtuzumab, etc.

These monoclonal antibodies, are the basis of targeted therapy, are remarkably (not totally) safe in their approach and very effective. Many are under trial some have come out.

Sexual organs like prostate of male, breast uterus of female depend on SEX HORMONES e.g. Testosterone and Progesterone/Estrogen for their growth. So cancers arising out of these organs (even though they lost their molecular brakes) still depend on some extent on the hormones for their growth. So we made drugs to block their hormone RECEPTORS, this only prevents their growth but not cure or even shrink such tumors. So we use this hormonal therapy only as adjunct, e.g. after surgery to prevent the growth of tumor cells that are seeded during surgery, in patients who are far too old to tolerate other potentially curative modalities.

Both these fields are growing at an explosive rate !!! and are finding applications for other diseases also, but the basis is simple

1. Targeted therapy is Antibodies against unique proteins expressed on surface of cancer (or other diseased) cell.

2. Hormonal therapy (as far as cancer is concerned) is Anti-sex-hormone !!!

Some geniuses have also attached our usual drugs to such antibodies that would add some killer instinct to the antibody (because, as you might know, antibodies by themselves are not destructive, seek the help of our immune cells to destroy their target) but would prevent collateral damage(of the usual drug) to bone marrow and intestine.

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