Tuesday, December 31, 2013

Oncologist of today must be "MR Clean"

The Beauty of target therapy is that you know exactly, at least you feel like you know, what you have done, and could possibly predict the response.  You can predict what will happen and deviations are expected but within the realm of our understanding.  You could make adjustment and make a somewhat rational decision.  You know you gave Avastin, and you know the escape mechanism can be by way of MTOR (biomarkers needed! don't be surprised and hurt my feelings!).  You know you can use MTOR inhibitor (sequentially) just as the cell as reacted and started resisting.  There is a logical thinking!

On the other hand when Adriamycin or Etoposide, you have your eyes on the DNA, when indeed the action is somehwere in the in the epigenetic events. And BOMMM! you are surprised by a resistance at Mitochondrial level (BCL-2).  In short, you just don't know what to expect.  You are left with the only Inconsequential strategy, the kill all spraying with a combination chemotherapy approach from the dungeons of Oncology.   Beside, the side effects of non specific attacks on cancer cells have manged to give the bad rep to Oncology.  We have to move fast away from these drugs and come back to them in desperate situations.  Oncologists of today must become "Mister clean", with specific target and hit only at will after a careful search of targets for our specific patients.  No collateral damages!  And for that, we need to tease every gene, and know who it is talking to and how to mend the message incognito!


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