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Treatments and Challenges
Published in Franklyn De Silva, Jane Alcorn, The Elusive Road Towards Effective Cancer Prevention and Treatment, 2023
Franklyn De Silva, Jane Alcorn
Broadly, approaches to cancer therapy can be separated into treatments targeting specific mechanisms or tumor phenotypes (i.e., under the umbrella of targeted therapies), and treatments targeting mechanisms which are considered general to the malignancy that is not tumor- or tissue-specific (i.e., hallmark therapies) [156]. Targeted therapies are often tissue-specific and, in many instances, are responsible for increasing the fitness of a cell within a particular cell type or environment resulting in treatment resistance [156]. On the other hand, the cancer hallmarks evolved to elevate and support the fitness of any cell or tissue regardless of the cell of origin or environment [156], and chemotherapy and radiotherapy are major treatment modalities targeting these general, non-tissue-specific mechanisms. This chapter provides an overview of the various targeted (e.g., protein kinase inhibitors and immune system targeted drugs) and hallmark therapies used for the treatment of cancer, including a focus on natural products, and addresses the challenges of treatment resistance and the need for valid biomarkers to diagnose cancer, basic understanding of pharmacokinetics (nutrikinetics) and pharmacodynamics (nutridynamics), identify appropriate treatments, and gauge treatment effectiveness.
Introduction to Cancer, Conventional Therapies, and Bionano-Based Advanced Anticancer Strategies
Published in D. Sakthi Kumar, Aswathy Ravindran Girija, Bionanotechnology in Cancer, 2023
Immunotherapy is a cancer treatment method that acts by boosting the immune system’s ability to fight cancer. This cancer therapy works by stimulating the body’s own disease-fighting mechanisms. A large number of studies have been conducted to treat different types of cancer by immunotherapy. For instance, researchers have used monoclonal antibodies that inhibit the function of specific proteins by binding to tumor cells, which, in turn, train the body’s immune system to identify and attack cancer cells. No major side effects have been reported with immunotherapy. Despite the success of immunotherapy, it only works in certain types of cancers and in less number of cancer patients respond to immunotherapy [116].
Cancer and exercise
Published in Adam P. Sharples, James P. Morton, Henning Wackerhage, Molecular Exercise Physiology, 2022
Tormod S. Nilsen, Pernille Hojman, Henning Wackerhage
The main objective of cancer therapy is to remove all malignant cancer cells whilst sparing normal cells. Despite recent improved anti-cancer treatments, radical resection, which is the complete surgical removal of the tumour, is still considered the main option for curing cancer. However, the oncologists’ toolbox also contains several other approaches, which, for the most part, are efficient in controlling advanced stage cancer. Thus, many patients can live with cancer for years.
Multidisciplinary approaches to cancer cachexia: current service models and future perspectives
Published in Expert Review of Anticancer Therapy, 2022
Vanessa C Vaughan, Peter Martin
It is generally accepted that the best way to treat cachexia is to cure the cancer, with cachexia the result of ineffective cancer control [57]. However, this is not always viable, and even after resection, weight loss may continue for as long as 12 months [66]. Patients experiencing cachexia leading up to and during chemotherapy receive a lower initial dose and experience more frequent and severe dose-limiting toxicity when compared to weight-stable patients, consequently receiving significantly less treatment [11,67,68]. Anti-cancer therapy may induce or magnify symptoms exacerbating cachexia, such as nausea, vomiting, and fatigue, which further reduces treatment tolerance and increases chance of early termination of treatment, further dysregulating cancer control, and associated cachexia, creating a vicious cycle. Referral of patients once cachexia is clinically pronounced is well documented by cachexia services [18,54,69,70], limiting the ability of health professionals to modify the syndrome beyond palliation of symptoms. Introducing cachexia management early in a patient’s cancer journey provides greater scope for interventions to prevent or address malnutrition, muscle loss and complex symptom profiles [3], acting as a prehabilitation approach facilitating improvements in the patient’s capacity for anticancer therapy completion [71].
Evolving treatments in high-risk neuroblastoma
Published in Expert Opinion on Orphan Drugs, 2020
Abhinav Kumar, John P J Rocke, B Nirmal Kumar
Immunotherapy is a growing field of cancer therapy; with interventions such as immune checkpoint blockades and cancer vaccines being developed. The incorporation of dinutuximab beta as a standard maintenance therapy highlights the importance of GD2 targeting for neuroblastomas. Further treatments exploiting the neuroblastoma cell expression of GD2 can be beneficial as immunotherapy seeks to improve treatment efficacy whilst reducing treatment-associated toxicities seen in conventional cytotoxic therapies. Personalized molecular therapies for neuroblastoma have been met by barriers such as resistance mechanisms and tumor heterogeneity that have reduced efficacy in pre-clinical trials. However, as our understanding of the genomic causes evolves, molecular therapies and newer generation drugs that target genetic abnormalities could play an important role in individualizing care for specific high-risk patients. This review highlights the important breakthroughs in both immunotherapy and gene targeting that could allow for a more effective maintenance therapy.
An expert overview of emerging therapies for acute myeloid leukemia: novel small molecules targeting apoptosis, p53, transcriptional regulation and metabolism
Published in Expert Opinion on Investigational Drugs, 2020
Kapil Saxena, Marina Konopleva
As knowledge of the biology of AML grows, so does an appreciation of its mutational landscape, tumor heterogeneity, escape mechanisms, and resilient LSCs. Developing targeted therapies has remained a challenge for many decades. The concept of targeted cancer therapy typically implies a type of treatment that is more selective for a patient’s cancer than for normal tissue. In contrast to classical conventional chemotherapeutics (such as alkylating and intercalating agents), which largely target DNA replication, targeted therapies are typically designed against specific oncogenic proteins. Conventional chemotherapeutics at one point were considered targeted agents, for they are also relatively more specific for actively replicating cells [148]. The disadvantage is that many of their on-target activities also affect nonmalignant replicating cells. The ideal targeted therapy would 1) selectively target and eliminate cancer cells, 2) have minimal on-target and off-target effects on nonmalignant tissue, and 3) lead to persistent cure even after treatment discontinuation. This goal of a ‘magic bullet’ for cancer has existed for over a century since introduced by Dr. Paul Ehrlich in the early 1900s [148]. Unfortunately, such an ideal treatment has been elusive for most AML patients, with the use of ATRA and ATO for acute promyelocytic leukemia being an exception. The recent approval of venetoclax introduced a novel targeted agent that has demonstrated partial efficacy against a broad range of AML subtypes [27,149,150].