Strategies for reducing the toxicity of cancer therapy
Recognising needs, taking action
- Date : 10 Jul 2012
- Topic : Personalised medicine
The understanding of the biology of cancer and the application of this knowledge to cancer treatment has greatly outpaced what is currently known about the biology underlying the symptoms and toxic effects that therapies produce. The adverse effects of therapy cause substantial discomfort and distress to patients and their families, limit treatment tolerability and can persist indefinitely in post-treatment survivorship. Despite these concerns, little research effort is targeted at documenting the nature of these effects. Similarly, limited efforts are being made in the drug-development arena to identify or develop treatments that might prevent or reduce toxicities.
A panel of clinicians and researchers as well as representatives from advocacy groups, federal agencies and the pharmaceutical industry was convened to identify gaps in cancer treatment toxicity research and to provide direction for future action. With an emphasis on coordinating multidisciplinary efforts, the panel has published a strategy to increase funding for the field and develop a coherent research agenda on 3 July 2012, as an advanced online paper in the Nature Reviews Clinical Oncology. The first author of the article is Charles Cleeland, PhD, McCullough Professor of Cancer Research at The University of Texas MD Anderson Cancer Center, Houston, USA.
In March 2011, The University of Texas MD Anderson Cancer Center partnered with Friends of Cancer Research, based in Washington, to host a colloquium in Houston entitled Developing Strategies for Reducing Cancer Treatment-Related Toxicities and Symptoms. The meeting was sponsored by the C. Stratton Hill Colloquium on Pain and Its Relief. The individuals approached to participate in the colloquium were identified by the sponsors and were believed to be high-level stakeholders who could best research, advocate for and effect policy change toward understanding, managing and possibly eradicating the negative consequences of cancer treatment. These stakeholders from universities, hospitals, government agencies and pharmaceutical companies attended the meeting: The University of Texas MD Anderson Cancer Center, Baylor College of Medicine, Texas Oncology, Memorial Sloan–Kettering Cancer Center, National Cancer Institute (NCI), FDA, American Cancer Society, American Society of Clinical Oncology, American Society for Therapeutic Radiation Oncology, National Comprehensive Cancer Network, Oncology Nursing Society Foundation, National Coalition for Cancer Survivorship, National Center for Policy Analysis, National Patient Advocate Foundation, American Association for Cancer Research Survivorship Task Force, Lance Armstrong Foundation, Duke University Medical Center, Amgen, Pfizer, Genentech and Novartis.
Developing a coherent research agenda and toxicity 'phenotypes'
In their article, in the form of perspectives, the authors wrote that it is widely recognised by the oncology community that toxicity from cancer therapy can be debilitating, interfere with treatment dose and adherence, affect survival and persist indefinitely in cancer survivors. Much of the scientific expertise, from genomic or molecular to epidemiological and drug development, is already mature enough for rapid progress to be made in the reduction or prevention of treatment-related toxicities. The predominant need now is to recognise and quantify the consequences that these toxic effects have on patient function and survival as well as understand the individual and societal burdens that they cause. The next step is to develop a scientific strategy to coordinate the many disciplines that must work together to reduce adverse effects to therapy experienced. Variability in symptom and toxicity expression must be addressed; why do some patients have relatively minor toxic or symptomatic responses to cancer therapy, whereas the toxic effects of therapy can debilitate others with the same cancer who are undergoing the same treatment? The same methods being successfully used to understand the biological variability underlying risk for developing cancer, drug response and drug resistance could and should be applied to risk for toxicity. And, as the researchers discover agents that modify drug resistance and the mechanisms that produce it, the same discovery pathways should be applicable to toxicity reduction. An immediate need is the development of toxicity 'phenotypes', which will require refinement of toxicity measurement, both in the clinic and through behavioural and self-reported measures. Once these phenotypes gain consensus support, the research strategy will become more tractable to the cancer research community, and research approaches will become clearer. Working groups could be formed to focus on specific toxicities or clusters of toxicities that commonly co-occur—a strategy that has been productive with other health problems, such as rheumatic disease. Early successes should sustain persistent efforts in this area.
The stakeholders participated in panel discussions to identify the challenges that have prevented progress in reducing treatment-related toxicities and symptom burdens and to develop strategic steps to meet these challenges. Recommendations were identified in five key areas: increasing the recognition of the impact of treatment-related toxicities on patients, improving cancer care in the clinic, promoting symptom and toxicity research, establishing research needs and a research agenda, and developing a policy and advocacy strategy. In their article, the participants discuss each of these key areas and the ways to address the challenges faced in this important arena of oncology care.
The full article you can read via ESMO Scientific Journal Access programme. Broad communication is essential to promote the message that the cost of developing this research (from training toxicity-focused researchers to expenditures for the wide range of needed research) is feasible.
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