achieving remissions, or at least slowing down the growth of the cancer. One major problem with this approach is that the toxicities associated with each individual drug in the mixture may not just be additive, they may also be synergistic and cumulative. Killing the patient along with the tumor is not an effective cancer treatment strategy, so dosing must be carefully monitored, and these drug combos can usually be administered for only a limited time.
Throw the Kitchen Sink at the Enemy = Repurposing Old Drugs for New Diseases
Sometimes your armed forces run out of options. There are no more rockets in the armory, the Air Force has dropped all of their bombs, and the Marines are out of mortars. This is when you just have to wing it and look for anything that can be used as a weapon against the enemy soldiers. Bring the muskets, the bayonets, the swords, and the crossbows to your battle. Old weapons can sometimes be quite effective if given the chance, especially when you are in desperate straits and have nothing to lose.
This repurposing approach has been employed successfully by screening drugs that were previously used in other diseases, but which had not been previously shown to work against cancer cells. The best-known example is thalidomide (Thalomid). It was originally prescribed back in the 1950’s as a sedative and as an anti-nausea agent for pregnant women, but was abandoned in the early 1960s when it was discovered to cause serious birth defects. Years later, however, it was shown to be useful in treating leprosy, and more recently thalidomide (and it’s derivatives) were found to be quite effective in treating multiple myeloma, a cancer of plasma cells.
M.A.S.H. = Palliative Agents
Sometimes the best offense is a good defense. Your troops need effective healthcare to treat their wounds and diseases acquired during battle so that they can get back to the theater of combat quickly. Having a superbly outfitted mobile army surgical hospital located near the front lines may save many lives and help wounded soldier’s return to the fight once they have recovered.
Some drugs that are given to cancer patients are not designed to attack the cancer at all. They are palliative agents and are designed to help replenish some cell type that is being damaged by the disease itself or the treatments. Examples include agents (e.g. filgrastim (Neupogen)) that stimulate the proliferation of white blood cells that are killed off collaterally by chemotherapy. This improves outcomes and the patient’s quality of life by helping them fight off potentially lethal infections while they recover from treatment.
Summary: We’re Made Advances, But We’re Not Winning the War Yet
Continued investments in basic as well as applied research will translate into new medicines and treatments that are beyond today’s science, so our commitment to funding this work must be maintained. It’s not clear that many new approaches are really needed to win the war on cancer. A stronger and more focused armamentarium using some of the cutting edge approaches I’ve defined above should significantly decrease our national losses in this battle. I’ve focused here on defining the medical aspects of our battle with cancer, but this won’t happen in a vacuum. New drugs and treatment modalities (especially combination cancer therapies) are going to be ultra-expensive, and we need to find a way to effectively pay for and deliver them. Patients will need to be coaxed into signing up for appropriate clinical trials. They will also need the help of their loved ones and employers to find the time to get treated, as well as assistance while they recover from what are often difficult-to-tolerate therapies. As with any war, the battles are never easy, but the costs of not winning are unimaginable. We must fight on.
