New drug for HER2/neu breast cancers may be available soon!
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At the recent annual meeting of the American Society of Clinical Oncology in Atlanta postitive results of a study testing a new drug for treating breast cancer were announced.
The new drug is called Tykerb. The study involved 321 women with advanced breast cancer who were divided into two groups. One group only took the drug Xeloda (a standard chemotherapy drug for use in breast and some other cancers). The other group took both Xeloda and Tykerb.
The study was actually stopped early because the results looked so good. The growth of the tumors were delayed about twice as long in the group that was also taking Tykerb.
The target of Tykerb is the protein HER2/neu, which is a member of the epidermal growth factor receptor (EGFR) family. Around 20-25% of breast cancers involve the overexpression of the HER2/neu protein.
Tykerb functions similarly to Herceptin, but also targets another protein and works from inside the cell. Other advantages of Tykerb include few side effects, its taken in a pill form rather than intravenously and is a smaller molecule which may be able to cross the blood-brain barrier and attack metastatic brain tumors also.
Tykerb is made by the British company GlaxoSmithKline PLC. There are additional studies taking place now with Tykerb and it may be approved for use in the US either this year or next.
(Technorati Tags: breast cancer, HER2, neu, Herceptin, Tykerb,health)
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on August 15th, 2006 at 10:32 am
Is Tykerb better than Herceptin?
Maybe, for these reasons.
Cells are the most basic structure of the body. Cells make up tissues, and tissues make up organs, such as the lungs or liver. Each cell is surrounded by a membrane, a thin layer that separates the outside of the cell from the inside.
For a cell to perform necessary functions for the body and respond to its surroundings, it needs to communicate with other cells in the body. Communication occurs through chemical messages in a process called signal transduction. The purpose of these signals is to tell the cell what to do, such as when to grow, divide into two new cells, and die.
Targeted cancer therapies use drugs that block the growth and spread of cancer by interfering with specific molecules involved in carcinogenesis (the process by which normal cells become cancer cells) and tumor growth. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be more effective than current treatments and less harmful to normal cells.
However, the monoclonal antibodies like Herceptin and Erbitux are “large” molecules. These very large molecules don’t have a convenient way of getting access to the large majority of cells. Plus, there is multicellular resistance, the drugs affecting only the cells on the outside may not kill these cells if they are in contact with cells on the inside, which are protected from the drug. The cells may pass small molecules back and forth.
Exciting results have come from studies of multitargeted tyrosine kinase inhibitors, “small” molecules that act on multiple receptors in the cancerous cells, like Tyberb and Sutent. Targeted “small-molecule” therapies ruled at the recent annual ASCO meeting of oncologists. The trend is away from the monoclonals to the small molecules, a trend in which a new predictive test may be able to hasten.
The EGRFx (TM) assay is able to test molecularly-targeted anti-cancer drug therapies like Iressa, Tarceva, Tykerb, Sutent and possibly Nexavar, because of being small molecules. The EGFRx (TM) assay relies upon a technique known as Whole Cell Profiling, in which living tumor cells are removed from an individual cancer patient and exposed in the laboratory to the new drugs.
Basically, Whole Cell Profiling measures the response of the tumor cells to drug exposure. Following this exposure, it measures both cell metabolism and cell morphology. The effect of drugs on the whole cell, resulting in a cellular response to the drug, measures the interaction of the entire genome.
A variety of metabolic and apoptotic measurements are then used to determine if a specific drug was successful at killing the patient’s cancer cells. The whole cell profiling method differs from other tests in that it assesses the activity of a drug upon combined effect of all cellular processes, using several metabolic (cell metabolism) and morphologic (structure) endpoints, at the cell “population” level (rather than at the “single cell” level).
Other tests, such as those which identify DNA or RNA sequences or expression of individual proteins often examine only one component of a much larger, interactive process. Whole Cell Profiling measures genes before and after drug exposure. Gene Expression Profiles measures the gene expression only in the “resting” state, prior to drug exposure.
on March 13th, 2007 at 7:24 pm
FDA Approves Tykerb for Advanced Breast Cancer Patients
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01586.html
What is of particular note is that monoclonal antibodies (like Herceptin) are large molecules that attach to specific proteins on the outside of cancer cells and do not have a convenient way of getting access to a large majority of the targeted cells on the inside, which are protected from the drug. Plus, there is multicellular resistance, the drugs affecting only the cells on the outside may not kill these cells if they are in contact with cells on the inside. The cells may pass small molecules back and forth. This would be a very good reason Tykerb may be much better than Herceptin.
on March 31st, 2007 at 9:12 pm
Cancer Drugs’ Spectacular Costs Shifting Market Dynamics
Tykerb (lapatinib) is one of the first oral agents with the potential to compete directly with the IV drugs which is both a high-volume and high-revenue part of office-based practices. Early use of Tykerb will likely be limited to patients whose breast cancer is refractory to Herceptin (trastuzumab). In the longer term, it could supplant or perhaps find a place in combination with Herceptin.
Of course, will patients be able to afford the cost of these drugs? Herceptin’s wholesale price on an annualized basis is approximately $45,000 per year. Tarceva, $40,000 per year. Nexavar, $60,000 per year. Avastin, $47,000 per year. Will the price of Tykerb approximate these novel agents or exceed their costs? The problem is not unique to these drugs, but also to all of the new molecularly-targeted agents.
Lee Newcomer, former chief medical officer and currently an executive with United Health Group, stated at the 12th annual conference of the National Comprehensive Cancer Network, that “Avastin improves outcomes in about 20% of patients, but we have no idea which cancer patients will benefit from a course of treatment. Because Avastin is included with numerous drug cocktails, it costs $354,000 per year of life extended with Avastin because of today’s ‘cookie-cutter’ approach to chemotherapy. You don’t know in advance who is going to respond.”
Everyone is scared to death (and rightly so) at what is going to happen to the healthcare economic system with the introduction of increasingly expensive new drugs that benefit only a small percentage of patients who receive them, hence the headlong rush to develop tests to identify molecular predisposing mechanisms whose presence still does not guarantee that a drug will be effective for an individual patient. Nor can they, for any patient or even large group of patients, discriminate the potential for clinical activity among different agents of the same class.
Profit is a powerful motivating force. Among medical benefit payors, the profit motive is entirely consistent with the goal of developing a molecular test, which is to identify efficacious therapies irrespective of drug mark-up rates.
The FDA finds themselves under increasing pressure to allow new drugs into the marketplace, while at the same time protecting the safety of potential recipients of those drugs and also the financial interests of those who will have to pay for them. The pressure is so great that companion molecular diagnostics approved often have been mostly or totally ineffective at identifying clinical responders (durable and otherwise) to the various therapies.
It should be in the FDA’s interest in saving the healthcare system perhaps billions of dollars a year (and thereby the healthcare system itself) by ensuring that expensive treatments are used appropriately. It should serve their interest not only in discovering new cancer treatments, but also using currently-available cell culture technologies to improve the effectiveness of existing drugs and save lives today by administering the right drug to the right patient at the right time.
The methods of cancer medicine during the last thirty some years are coming to haunt the “one-size-fits-all” establishment. Technologies, developed over the last twenty years by private researchers, hold the key to solving some of the problems confronting a healthcare system that is seeking ways to best allocate available resources while accomplishing the critical task of matching individual patients with the treatments most likely to benefit them.
on August 22nd, 2007 at 10:04 am
Although oral tyrosine kinase inhibitors, like Tykerb, offer patients a well-tolerated, conveniently administered alternative to intravenous (IV) therapy, Decisions Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, found that oncologists are not yet ready to use Tykerb as a replacement for Herceptin. Ninety-one percent of surveyed oncologists stated that intravenous (IV) cancer therapies are more profitable than oral therapies. And fifty-eight percent of oncologists say they would favor IV Herceptin over oral Tykerb because administration of IV drugs remains an important source of income for their practices.
Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists
http://www.healthyskepticism.org/news/2007/Jun.php
on April 16th, 2009 at 11:02 pm
it’s a bit unfortunate, but my physician friends constantly remind me of how the hospital hierarchy, politics all sort of revolve around money. departments with more money are able to dictate more of hospital policy. people who bring in research money, donations, practice revenue etc achieve higher positions. in light of that, not surprising that most treatment choices are heavily influenced by financial profit.