drug discovery rant and chemosensitivity

[john]

This is a interesting paragraph.

The story of one of the most successful drugs of all time, penicillin, seems bizarre, but the way we discover and develop drugs even now has similarities, being the result of chance, observation and a lot of slow, intensive chemistry. Until recently, drug design always seemed doomed to continue to be a labour-intensive, trial-and-error process. The possibility of using information technology, to plan intelligently and to automate processes related to the chemical synthesis of possible therapeutic compounds is very exciting for chemists and biochemists. The rewards for bringing a drug to market more rapidly are huge, so naturally this is what a lot of cheminformatics works is about.

It makes me angry that we hear all this lip service about "targeted therapies" and "individualized therapies", but we see the same old - "lets try this chemo - oh that didnt work - let's try the next chemo.

Where is the research to examine the genes/proteins/lung cancer types/etc that work for certain chemos? Yes there is some research out there but it sure gets frustrating

If more research was done with chemosensitivity testing then in theory the best chemo could be chosen the first time. I know it isnt that easy, but I don't see much research in the area.

If I take the "greedy corporation" view, then I would assume the drug manufacturers just want to sell more chemo drugs

[john]

I just found this

http://www.eurekalert.org/pub_releases/ ... 080503.php

I am sure there is a lot of progress, but it seems slow (even for us who arent directly battling cancer)

[-Cheryl-]

John,

My sentiments exactly! Gene therapy wasn't discussed at the Natl. Patient and Survivors forum and here we are for God's sake, right in Dallas where the bulk of research for GVAX is taking place. Targeted therapies??? They are all basically the same thing- knock offs of Iressa. Chemos haven't change much over twenty years. First line is still Cisplat! And finally, why the *#ll don't they do chemo sensitivity testing on everyone when they take sample of a tumor to determine a diagnosis? Instead, we waste people's time, money, and ultimately their lives!!!! Chemo is poison. Unfortunately, it is the best option for widespread cancer. But it doesn' stop lung cacer, it is not a cure. It will only buy time and perhaps shrink it. That is if it doesn't make you sick or, you die from an infection during the interim.

Cheryl

[dave s]

John,

As always your posts are insightful. Like you I am concerned that we seem to be painfully slow in bringing truly advantageous lung cancer treatment to practice. However it becomes easier to understand if we think about the mechanism by which treatments are "approved".

It gives us a great sense of safety and security to know that FDA approval is a long and expensive process. After all we must be protected from quackery at all costs, right?

Well there's a problem buried in there. The most recent estimates I've seen for the cost of taking a drug through the approval process is $900,000.00. Now where does that money come from? It is a "loan" of sorts from the major pharaceutical companies and is only granted if there's a reasonable expectation of it's being "repaid" with future revenues from a marketable product. This explains why only expensive new treatments are ever brought to market.

Think of it this way. Let's suppose you are very smart AND very lucky AND you stumble across a non-toxic substance which kills cancer instantly and leaves normal cells unharmed. Wonderful, that's our long dreamed of "silver bullet". OK, now how do you share this good fortune with the unfortunate victims of this disease? Well you can't, you can't even give it away. If you try you are breaking the law. You can't even talk about it until you have "proven" to the satisfaction of the FDA and the orthodox medical community (including the pharmaceutical companies) that it is effective and safe. How do you do that? Simple just pony up that $900 million for phase I, II and III clinical trials.

By the way, the pharmaceutical companies are not your friend in this endeavor. Your new cure jeopardizes $10,000 worth of revenue for each chemo treatment for each patient (oh yes, it makes linear accelerators obsolete too).

My point here is that this is not a simple problem to solve. We should not assume that if a treatment was effective and safe it would already be "approved". I wish we had a better system, but we don't.

I hope I haven't offended anyone here. I really think we all need to ponder these things and stop making so many potentially flawed assumptions.

Best Wishes to us all, Dave S