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The anticipated return of a better Iressa!!!


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Pill may be as good as chemo for lung cancer

Gina Akers, Daily Vidette Senior Staff

Issue date: 12/8/08 Section: News

PrintEmail Article Tools Page 1 of 2 next > An international study has revealed that a pill may allow some patients with advanced lung cancer to bypass the negative side effects of chemotherapy.

In the study, patients on Iressa, a new and expensive treatment, survived about as long as those being treated with another course of chemotherapy.

Though the FDA in the United States approved the drug in 2003, it was relabeled in 2005. The FDA said it could only be used in specific clinical trials and in patients who have previously taken the drug.

"The study shows that there is a survival benefit. They're hopeful that the drug can return as a treatment for lung cancer in the United States, but it is not commercially available," Eileen Lowery, RN at Respiratory Health Association Metropolitan in Chicago, said.

"It wasn't used mostly because they didn't see it as effective…there was no additional survival benefit from it. But the new study is saying there is, so they're hopeful it will be available again in the United States."

Not many treatments for lung cancer exist, and most patients die within a few years of diagnosis. About 1.4 million people die from lung cancer each year.

Iressa, made by Astra Zeneca PLC, does less harm to patients by attacking specific growth receptors on cancer cells. The downside is that it costs thousands of dollars a month, much more than regular chemotherapy.

While patients on chemotherapy can suffer from hair loss, fatigue and blood-related side effects, the most common side effects in patients who take Iressa are rash, acne and diarrhea.

Jackson Pillow, a senior mass communications major, talked about his father, who is being treated with chemotherapy for an aggressive form of colon cancer, which has begun to spread to his spine and liver.

"It's made him really sick, but eventually I think it's going to lead to something else," Pillow said. "It's definitely been really challenging at times.

"It's hard to see the end, but he's been really strong."

Although Iressa is only for lung cancer patients, Pillow said he would like it if his dad could be treated by a drug that could cut out many of chemotherapy's side effects.

"It would definitely be a lot of help and a great advancement," Pillow said. "The shorter [cancer patients] have to suffer, the better."

In the study, researchers in 24 countries looked at 1,433 advanced lung cancer patients who had already been through chemotherapy. About half took Iressa, or gefitinib, once a day, while the other half were on docetaxel, an intravenous chemotherapy drug administered every three weeks.

According to previous reports, patients who took Iressa survived approximately 7.6 months, versus chemotherapy patients, who survived about eight months. After a year, 32 percent of Iressa patients were still alive, compared to the 34 percent on chemotherapy.

Iressa tends to work better in Asians, women, patients who have never smoked and those with a specific genetic profile.

"Though the benefits of prolonging life are modest, patients on [iressa] get a higher quality of life," Chris Twelves, a professor of clinical cancer oncology at Leeds University, said. "That should swing the pendulum in its favor."

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The cancer drug Iressa actually does work miracles, in some patients. Cell function analysis has been able to find the cellular signal for response to the drug and can identify clinical responders - prospectively.

The Iressa situation is a great argument for pre-screening an individual's tumor. Iressa has been shown to benefit those that are benefitting from it. If the drug is working for some people, then obviously there are others out there who would also benefit. Who are those that benefit from its use? All the more reason to test the tumor first.

Assay-directed therapy is an individualized approach to killing cancer. The bio-marker method is used to determine what precise medications would kill the particular cancer. Doctors have assumed that stopping cell division would stop cancer, because most cancer cells divide and grow rapidly. But the approach didn't always kill the malignant cells. Cancer isn't a case of cells growing out of control, but of cells refusing to die on schedule.

By inhibiting anti-apoptosis with Iressa (small molecule inhibitor of tyrosine kinase, a key intermediary in the EGF cascade pathway), the cells undergo apoptosis and die. This can be detected at the whole cell level and reported out prospectively. It is a unique tool for identifying newer, better drugs, testing drug combinations, and serving as a "gold standard" to develop new DNA, RNA, and protein-based tests of drug activity.

The EGF system is a target for a number of newer anti-cancer drugs. However, EGF-targeted drugs like Iressa are poorly-predicted by measuring the ostensible target (EGFR), but can be well-predicted by measuring the effect of the drugs on the "function" of live cells. It is an area of cancer research which has been abandoned by the entire cancer research establishment. A bioengineering problem overcomed by a band of private-lab cell biologists.

More and more physicians and patients are turning to individualized therapies to treat cancers. Under this approach, scientists study how an individual's cancerous cells respond to several drugs. Doctors have learned that even when the disease is the same type, different patients' tumors respond differently to chemotherapeutic drugs. Without individualized testing, it's difficult to determine which drugs are best for patients who don't respond to standard therapies.

There are over numerous different therapeutic drug regimens out there. Any one or combination of them can help cancer patients. The system is overloaded with drugs and under loaded with wisdom and expertise for using them. What's needed is to make extensive use of bio-marker tests in treatment decisions.

Literature Citation: Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 17117

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