Targeted Therapy in Oncology – Rethinking the Management of Cancer

Cancer is a multifactorial disease. It is a group of illnesses having traits, causes, and behaviours. For many years, everyone has utilised cancer treatment, which includes radiation to decrease tumours, chemotherapy to kill quickly growing cells, and surgery to remove the tumour. Even while these treatments are still effective today, science has advanced us to the era of targeted therapy, a special kind of cancer treatment that focusses on the particular changes that set cancer cells apart from healthy cells. There is no one-size-fits-all strategy. Rather, it looks at what’s going on inside the cancer cells and tries to stop those aberrant processes. In oncology, it is one of the cornerstones of what is now known as personalised or precision medicine.

Let’s examine targeted therapy in more detail, including how it works and what it means for patients.

What Is Targeted Therapy?

Simply put, targeted therapy is a cure that checks the growth and spread of cancer by disrupting particular molecules that play a role in the development and progression of the disease. Such molecules are frequently proteins or genes that occur in large quantities—or mutated versions—in cancer cells.

Consider targeted therapy as a sniper rifle, as opposed to chemotherapy, which is a shotgun. Whereas chemotherapy targets all rapidly growing cells (both regular and cancerous), targeted therapy targets cancer-specific mechanisms with less harm to normal cells.

How Does Targeted Therapy Work?

• Blocking Growth Signals
  Most cancers develop due to abnormal signals that instruct them to keep dividing. Targeted therapies can shut off these signals. For instance, certain breast cancers produce excess amounts of a protein called HER2. Medications such as trastuzumab (Herceptin) can inhibit HER2 and halt or slow the cancer.
• Cutting Off the Blood Supply
  Cancers require blood vessels to deliver oxygen and nutrients. Specific targeted therapies prevent new blood vessels from forming (angiogenesis). These drugs accomplish this by interfering with a protein known as VEGF.
• Inducing Cancer Cell Death
  Specific treatments induce cancer cells to die naturally. These drugs may trigger intrinsic suicide signals within the cell or inhibit survival signals.
• Targeting Toxins to Cancer
  Some medicines are like smart bombs, delivering chemotherapy or radiation to cancer cells by binding to specific proteins on the cell surface.

What Makes a Patient Eligible for Targeted Therapy?

Not all patients are eligible for targeted treatment. The cancer has to have a target that the medicine can use. To determine, physicians typically have a sample of the tumour genetically or molecularly tested. This can be accomplished through a biopsy or sometimes with a blood test (so-called liquid biopsy).

If tests indicate the presence of specific proteins, mutations, or pathways, targeted treatments can be pursued.

For example

• EGFR, ALK, or ROS1 mutant non-small cell lung cancer patients can be treated with targeted inhibitors.
• Colorectal cancer patients with KRAS wild-type tumours can be treated with EGFR blockers.
• Melanoma patients with BRAF mutation can be treated with BRAF inhibitors.

Types of Targeted Therapy Drugs

• Monoclonal Antibodies
  These are man-made forms of immune system proteins. They attach to particular targets on the surface of cancer cells or the tumour environment, and some transport toxic payloads to the cancer cells.
  
  Example – Rituximab is an example of a monoclonal antibody that is employed in certain forms of lymphoma.
• Small-Molecule Inhibitors
  These medications can get into cancer cells and disrupt the activity of molecules within. They are most often taken orally.
  
  Example – Imatinib is a small-molecule agent applied in chronic myeloid leukaemia (CML).

Advantages of Targeted Therapy

• Precision – They target only cancer-specific targets.
• Fewer Side Effects – Since they spare normal cells, side effects are normally less severe compared to chemotherapy.
• Effectiveness – In an appropriate patient, such drugs may be more effective than conventional treatment.
• Improved Quality of Life – Most targeted oral drugs do not need hospitalization.

Limitations & Challenges

• Resistance – Cancer cells become drug-resistant after a certain period.
• Cost – Targeted therapies are costlier, particularly in countries with limited budgets for healthcare.
• Access to Testing – Molecular testing is not universally available, which can postpone or restrict access to targeted therapy.
• Not a Cure-All – Targeted therapy is not appropriate for all patients or all cancers.

Examples of Targeted Therapy Success Stories

• Chronic Myeloid Leukemia (CML)
  Imatinib (Gleevec) was a turning point. Previously, CML was frequently lethal. Today, most patients survive for decades on daily treatment.
• HER2-Positive Breast Cancer
  Trastuzumab has greatly enhanced survival in HER2-positive breast cancer patients, once one of the more aggressive forms of breast cancer.
• Non-Small Cell Lung Cancer
  Medications such as osimertinib and alectinib have changed the game in treating patients with lung cancer harbouring particular mutations, providing specific relief and more extended survival.

Targeted therapy is a significant component of precision oncology, a rapidly expanding speciality that customizes treatment to individual patients. With the progress made in gene sequencing, more cancers are being analyzed at the molecular level, enabling physicians to decide better what medicines to administer and when.

In some cases, even if a targeted drug isn’t approved for a specific cancer type, physicians may use it “off-label” if the same mutation is present in a different kind of cancer.

The Future of Targeted Therapy

Research continues to expand the applications of targeted therapy. Clinical trials are investigating new targets and combination strategies, such as combining targeted drugs with immunotherapy, chemotherapy, or radiation.

In the next few years, you can expect:-

• More expensive genetic testing
• Pharmaceutical development for orphan mutations
• Increased access in low- and middle-income nations
• AI technologies in pairing patients with treatments

Conclusion

With Targeted therapy being employed for the treatment of cancer all over the world, cancer treatment services have been revolutionized as they innovated; cancer therapy provides an even more individualised and accurate solution, deviating from the “one-size-fits-all” strategy.

Despite its multitude of challenges, whatever success we have so far suggests that we are on the right path as far as many patients are concerned because targeted therapy is not only an additional option but a better one—one offering renewed hope in the fight against cancer.

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