Morning Meeting: Not Just Chemo. What Else is Available?

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In this morning meeting, Dr. Sager discusses treatments outside of surgery, radiation, and chemotherapy.

This includes targeted therapies such as Antibody Drug Conjugates (ADCs) and immunotherapy such as checkpoint inhibitors


What kind of treatments are available for cancer?

Right? And generally you know, patients, and frankly, I think the system and standard of care is largely based on three types of treatments: surgery, radiation and chemotherapy. And from my perspective, you know, patients will basically associate chemotherapy with any of the medicines that are scientifically based.
And I think that's where we stand to help patients because from our perspective it's quite different that there are traditional chemotherapies which are non unselected. So they go systemically they exert some medicinal property, you know, stop the tumor growth but in a fairly unselective way so that normal healthy cells also get hit by the same medicine and that's what leads to a lot of the, I think, typical side effect that we hear about: nausea, vomiting, hair loss, other, you know, diarrhea. There is no end to the number of side effects that chemotherapy can cause.

Where I think we're trying to do better is with more of the modern scientific therapies, we call them innovative therapies, that are still treatments but they are different than the traditional chemo in that they are pointed more towards the cancer. And there's a variety of them right. So we talked about recently these antibody drug conjugates where they're literally taking an antibody which is against the proteins on the cancer and that's why it's important to make sure that the protein actually exists on the cancer and is it low medium or high? But especially for patients with high amounts of that protein, you'd expect that you can inject that antibody and find it will find its way to attached to the tumor, on the surface of the tumor.

On the other end of that is a chemotherapy agent but because it's bound to the antibody it's not sort of freely floating around in circulating and going to be pervasive all over. So the idea and these antibody-drug conjugates have really kind of come quite a long way just in the last year or two. I think there's something like eight or ten of these, maybe even 12 now approved and there's many more coming down the pike so it seems like they generally have been working when you know the protein expression is high and these companies are developing them in sort of a regulated way but they're kind of smart about it they know what they're doing and... so that's great and that's different than, to me, the chemo and then yet, there's other ideas right? And there's other ways of treating and for example the immunotherapy is sort of the final bucket.

So if I were to separate up a few we call it the traditional chemotherapy or the targeted therapy and then the immunotherapy is teaching the body to attack the cancer and really revving up the immune system and trying to aim it for the tumor so that it can begin to attack the tumor we know that in cancers in various cancers that happens, can happen, but usually doesn't happen on its own. And so the checkpoint inhibitors were sort of the first really sort of revolution in immunotherapy. Where we're able to excite the immune system and kind of uncloak a tumor that was trying to hide from the immune system and now there's lots of other attempts coming down the pike and the one that we were looking at yesterday was actually a bispecific antibody so again on one side it's attaching to the tumor cell based on proteins that's there. On the other side it's actually trying to attach to an immune cell, a T cell, that would come in and attack the tumor and try to by linking the two together saying Ah, let me point you in the right direction.

This is a something to attack and fight against and again you're making some headway there. A little less than, let's say, the antibody-drug conjugates. They are a bit newer but we'll be watching for these and hopefully putting many patients through and onto these sorts of protocols and trials in order to figure out how successful this can be and overall I think it's a it's a valid, a viable option scientifically. So from my perspective, those are all really important sort of aspect to understand so that patients don't just your say to their oncologist well oh you're going to give me chemotherapy. They say, "Hey are there targeted therapies that are available for me? Are there immunotherapy that are available for me?" And I think that alone will help patients to do better. So that's just a little tidbit that I thought would be worth talking about