Sunday, July 13, 2014

Progress in Cancer

Despite the rise of Ramucirumab released by the FDA in 4/2014,
"- Eli Lilly and Company (NYSE: LLY) announced today that the U.S. Food and Drug Administration (FDA) has approved CYRAMZA™ (ramucirumab) as a single-agent treatment for patients with advanced or metastatic gastric cancer or gastroesophageal junction (GEJ) adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy. With this approval, CYRAMZA becomes the first FDA-approved treatment for patients in this setting." press release by Lilly,
There are 2 major progress events noted in Oncology,
1. is the rise of PD1 /PDL1 inhibitor for solid tumors
2. the rise of Ibrutinib in Hematologic diseases

With the the Inhibitor of PD1/PDL1, science has found the best way to harness immunity against tumor, and doing so in most cases without significant side effects.  Indeed, these therapeutic interventions have proven to be for most patient achievable and well tolerated.  What the PD1 Inhibitors have been able to achieve is what we intended by Using IL-2 or Interferon (non specific global action of all old therapeutic interventions)  versus a new sophisticated well targeted therapy with Activated Lymphocytes.  Cancer cells try to escape surveillance by our immune system, and we are trying to say NO.  And ladies and gentlemen, this time it worked, and working in most recalcitrant cancers!  The Melanomas of the days will no longer escape our reach, and now respond in unprecedented number and for unprecedented length of time...this period is worth living!  Literally, These drugs can be tried in almost every solid tumors with some legitimate relative success, and quite frankly within days, we might end up with groups of solid tumor described of those PD-1 inhibitor sensitive, and those which are not!  And what is great, the addition of Modalities involving the immune system, seems additive in global effect.  So nothing stop you but the price, adding Ipilimumab to the Anti-PDL1 and the effect follows!   And of course clinicians follow ....

The success of Ibrutinib is just as incredible but hits one principle that we knew long time ago, and that is cells of the hematologic lineage, particurlarly white cells, stop differentiation and this simple fact protect them from natural maturation and simply dying of Apoptosis that awaits all mature cell.  Indeed in the treatment using this modality, there is a sharp Lymphocytosis that scientist has attributed to delocalization a normal step into maturation toward Apoptosis!  The drug has done what we intend to achieve  when we say Cure,  asking a cell to choose the natural way or pathway  to death.  Because we can't bomb every cell but asking to follow its fate is the only way to the cure!
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