The development of targeted therapies has seen incremental improvements in the response of some cancers. It has also seen opportunities for treatment of other cancers considered refractory to traditional therapies, and challenged perceptions regarding traditional cancer control efforts.37
The focus in the future may not be the identification of new drugs, but progressing our understanding of the molecular pathways that regulate cell growth, apoptosis, angiogenesis, and metastasis, and the communication or cross talk between these mutated pathways and receptors.10, 11, 17 Several critical steps need to be realised in the application of targeted therapies in cancer control:11, 38, 39
- developing clinically useful prognostic markers to identify individuals needing treatment
- developing predictive markers that identify and select individuals who will benefit most from these therapies
- avoiding treatment in those unlikely to respond or at risk of unacceptable toxicity
- combining agents that target different key pathways
- combining agents with conventional therapies
- developing strategies to overcome acquired resistance.
Clinical trials are vital and play a key role in addressing these issues, identifying new agents and the individuals who will benefit. Clinical trials give individuals access to new agents before they become routinely available. Individuals participating in clinical trials help answer critical questions such as who will benefit, what are the effects, and which individuals are unlikely to respond.9
Another challenge is the financial cost of targeted therapies. These agents can be considerably more expensive than traditional therapies, with the duration of therapy for some agents lasting years. Clinical trials investigating targeted therapies usually include these agents free, at no cost to the individual. As more of these agents become available the following issues will need to be addressed:9
- how much an individual or the general community is prepared to pay for progress in cancer therapy
- how agents will be reimbursed by the government and private insurance companies
- ensuring access to these agents is equitable.
The SCN has a key role in educating individuals on the importance of clinical trials, promoting participation, and supporting individuals during trials, when they withdraw, or when they find the toxicities unacceptable.
Access Targeted therapies, aspects of pharmaceutical and oncological management5 and summarise the current and future challenges for targeted therapies.
Discuss potential implications for the SCN with increasing numbers of people being treated with targeted therapies.