Treatment of Cancer and Its Progress: Solving Cancer Problems - Research Paper Example

 Introduction Cancer has, over the past years, built itself a horrid reputation sending shudders down everyone’s back by the very allusion of its name. Since there is no other way of dealing with this menace, people have been left with no choice but to rely on science to solve it. With the recent advances made in science and the present great minds, it is now possible to solve cancer problems (Liu et al, 2012: 23). Cancer develops when the body cells of a part of an organ grow out of control. Though there are different forms of cancers, they all stem from the abnormal growth of cells. In essence, cancer is among the leading causes of deaths among people in the world. When a cell has cancer, it is likely to exhibit the six hallmarks that characterize cancer. These include growth signal autonomy, evasion of apoptosis, angiogenesis, evasion of growth inhibitory signals, and invasion and metastasis (Pardee & Stein, 2011: 80-84). In the growth signal autonomy, the cells grow even when no message is transmitted to them to continue growing. These cells still evade the growth inhibitory signals. This implies that the cancer cells ignore the messages transmitted to it to stop growing. In this case, the cells are insensitive to the growth signals and continue to grow. The cancer cells are responsible for sending messages to the nucleus of the cell to continue dividing (Ruddon, 2007: 54-67). This is because the genetic mutations that have taken place in the cells generates a protein that deceits the cell and makes it think that the receptor is getting a growing signal when it is not. This implies that the genetic alterations dictate the cells to grow and short circuits the growth factor lanes preventing them from turning off the growth of the cells (Pardee & Stein, 2011: 92-6) Cancer cells have the ability to evade death by avoiding all the signals that inform it to die. This is the apoptosis hallmark of the cancer cells. Normally, cells get a death signal when damaged. In the case of cancerous cells, they tend to behave as though they have bullet proof vests on them and so nothing stops them. These cells have transmutations that interrupt the death signals that instruct the nucleus of the cell to die (Pardee & Stein, 2011: 98). Normal cells divide till a certain point when they can divide no more. This is because the telomere in their chromosomes gets shorter with every divide till it gets too short to divide. On the other hand, a cancerous cell has the ability of keeping its telomeres from getting short; this makes the cell think that it is not getting old and needs to divide (Ruddon, 2007: 112) Another characteristic of cancerous cells is the aptitude to form new blood vessels through angiogenesis. The characteristic of invasion and metastasis implies that the cancerous cells move to regions that they are not allowed. Because of these attributes of cancerous cells, it has been hard to manage cancer since each of these characteristics requires different medications and therapies to contain them. The past one decade has witnessed primary advancements in management of cancerous cells. The past few years have observed the emergence of new treatments such as the use of targeted therapies in renal cell carcinoma and hepatocellular carcinoma. There has also been the addition of therapies which have improved the survival rates of pancreatic adenocarcinoma, colon cancer and head and neck cancers (Liu et al, 2012: 32-5). In another category, new therapies have developed where resistance was encountered to the existing therapies, for instance in chronic myeloid blood cancer and breast cancer. These advances have transformed the pattern of cancer management (Winer et al, 2010: 139). The control of cancers involves inhibition, scrutiny and early identification, treatment of the disease and the matters associated with endurance after the cure. This review focuses on the palliative and adjuvant settings of the advances of treatment of cancer. Lung Cancer One of the advancements made in the past ten years is the emergence of chemotherapy. In reference to Burney and Al-Moundhri (2008), chemotherapy is a therapy that enhances the survival of a handpicked cluster of patients with non-small cell lung cancer. Needless to say, chemotherapy is regarded as the standard of care for individuals with stage IIB and IV disease with an outstanding performance position. However, the benefits of adjuvant of chemotherapy are unknown. The National Cancer Institute of Canada Clinical Trial Group together with the United States National Cancer Institute Intergroup Trial established that overall survival among people with early stage non-small cell lung cancer (NSCLC), and who underwent adjuvant chemotherapy with cisplatin and vinorelbine after surgery, was 95 months, matched with 72 months for individuals who did not (Winton et al, 2005: 2595). In reference to studies by Douillard et al (2006: 719-727) and Strauss et al (2004: 7019), an individual who receives chemotherapy has a five year survival period and the risk of cancer reappearance is reduced by 40%. These revelations, together with the ones recounted by the Adjuvant Navelbine International Trialist Association, affirm that adjuvant chemotherapy plays a considerable role in the management of cancer among individuals with NSCLC. These researches offer solutions to a long-lasting discussion on the advantages of adjuvant chemotherapy. Breast Cancer i. Adjuvant Treatment Numerous significant advances have been made in breast cancer management after the publication of the meta-evaluation revealing the purpose of hormone therapy and adjuvant chemotherapy in early stages. By adding either taxanes or anthracyclines or a combination of both to cyclophosphamide in combination or without 5-fluorouracil, the overall survival and disease free survival will improve. A study by Clarke (2006: 60) revealed that the survival rates of women in early breast cancer increases by almost 7 percent after five years by adding either taxanes or anthracyclines or a combination of both to cyclophosphamide. Additionally, Burney and Al-Moundhri (2008) note that recent studies have shown that addition of trastuzumab to the chemotherapy improve the survival of individuals with breast cancer, which articulates the HER-2/neu oncogene. Almost 25 percent of patients suffering from breast cancer have oncogene, which triggers the manifestation of the protein on the cell wall, and is identified through fluorescent in-situ hybridization and immunohistochemistry. The protein is linked to surging risk of cancer recurrence and diminished responsiveness to some forms of chemotherapy. Trastuzumab prevents the oncogene protein from attaching itself to the cell wall and, thus, plummeting the danger of recurrence by almost 50% after three years. However, the use of trastuzumab has been associated with risks of heart failure by 4 %. Over the past five years, aromatase inhibitors such as anastrozole and letrozole have been established to enhance the overall survival and disease free survival in the adjuvant treatment. Earlier, these inhibitors were used in metastatic breast cancer (Clarke, 2006: 59-62). Lately, these inhibitors have been identified as adjuvant medical aids of early breast cancer through the utilization of distinct intervention approaches. ii. Treatment of Metastatic Disease Capecitabine, a pro-drug of 5-fluorouracil, is used to treat individuals with oncogene positive disease, who fail to be treated by anthracycline, trastuzumab and taxanes. Lately, two attempts revealed that a mixture of tyrosine kinase inhibitor and a chemotherapeutic agent of a new category are superior to capecitabine alone in the context of disease free survival. Chronic Myeloid Blood Cancer Over the past few years, patients suffering from Chronic Myeloid Blood Cancer have been treated with imatinib thus reducing the use of the poisonous allogeneic bone marrow transplant. According to Talpaz (2006:2533), Imatinib is an “inhibitor of the tyrosine kinase produced by a mutation in the BCR-ABL gene”. Nonetheless, some individuals acquire other mutations in this gene, triggering resistance of the cancerous cells to the drugs. In essence, this triggered the manufacture of dasatinib that targets the gene modifications. A study carried out by Talpaz and colleagues (2006: 2531-41) established that the effectiveness of dasatinib is 92.5 percent for patients who had not become resistant to imatinib. Dasatinib symbolizes a considerable improvement in the entire management of Chronic Myeloid Blood Cancer. Colon Cancer For a long period, controlled 5-FU has been employed as the only standard of care for stage II and III colon cancer in the adjuvant treatment. This had also been integrated with leucovorin with 5-FU in order to diminish recurrence rates by 40% in stage III colon cancer and almost 35 % in stage II of the disease. Lately, advancements have been made to reduce recurrence of colon cancer after surgery through adding oxaliplatin to typical chemotherapy (Anmdre et al, 2004: 2345). According to Kuebler et al (2007: 2198–2200), incorporating oxaliplatin to typical chemotherapy diminishes the danger of recurrence by 20% in the early stages of colon cancer patients. This has marked a change in the treatment of people suffering from colon cancer in need of chemotherapy after surgery. Gastric Cancer Gastric cancer is regarded as one of the most challenging tumours to manage and a leading cause of cancer deaths despite the availability of acceptable surgery. In the past one decade, there have been two considerable advancements which have established novel canons in the control of gastric cancer. A study carried out in the United States by McDonald (2004: 566-573) revealed that combined chemoradiation following comprehensive stomach resection enhances intermediate time to degeneration and overall survival. Additionally, another study carried out in the United Kingdom offered another considerable advancement. Modern-adjuvant chemotherapy, using three sequences of integration of epirubicin, 5-FU and cisplatin, trims numerous cancers, and makes them removable, and improving the overall survival of the patient (Cunningham et al, 2005: 4001). This implies patients who use chemotherapy combined with surgery have higher overall survival rates than those patients who only have surgery without undergoing chemotherapy. This has transformed the standard of treatment of stomach cancer. Glioblastoma Multiforme This is one of the most popular brain cancers among adults and has low survival rates. The orthodox management has been the removal of the tumour trailed by radiotherapy. Recent developments point to the use of temozolomide in cooperation with radiotherapy six months before and after removal of glioblastoma multiforme in order to extend the overall survival. There is a high relationship between the use of temozolomide together with radiotherapy and increased overall survival as shown in a study by Stupp (2005: 989). This study showed that patients who received both temozolomide and radiotherapy had an average survival of 15 months while those who received radiotherapy alone had average survival of 12 months. This was evident after two years where the patients who had used temozolomide and radiotherapy were still alive while those who had not used temozolomide had passed. In another study (Hegi, 2005: 999-1003), the people who gain from the temozolomide develop a certain genetic marker in their cancerous cells. Patients with this marker and who underwent radiotherapy attained an increase in seven months of their survival. This is a breakthrough on increasing the overall survival of patients. Head and Neck Cancer For a long period, the management of the scaled cancerous cells of the head and neck section have been either remedial removal, removal incorporated with radiotherapy or radiotherapy alone (Bonner et al, 2006: 569). Even addition of chemotherapy did not add any significant benefits to patients. Recent advancements include the integration of cetuximab to radiotherapy to improve the overall survival of patients with head and neck cancers (Vermorken et al, 2005: 5505). Cetuximab is a monoclonal antibody that aims at the epidermal growth factor receptor (EGFR) in cancer cells. The progression free survival is high in patients who use cetuximab; 30 months compared to 15 months. The overall survival is also high at 49 months as compared to 30 months of those who do not use cetuximab (Bonner et al, 2005: 5533). Additionally, the use of cetuximab with chemotherapy is another advancement that has been used to increase the overall survival of patients. Cetuximab also reduces the chances of recurrence of head and neck cancers. Multiple Myeloma This form of cancer was for fifteen years ago regarded as an incurable disease. However, recent advances have centred on the employment of a novel category of medications, proteasome inhibitors and immunomodulatory (lenalidomide and thalidomide), which have been primary therapeutic advances in the management of Multiple Myeloma. Initially, thalidomide was identified to increase the response rate and survival when integrated with prednisolone and melphalan. This made it an inherent part in the treatment of Multiple Myeloma. However, the side effects of the drug are unknown. More researches should be carried out to identify any harmful side effects and their long-term impact on an individual’s health. Recently, the efficiency of lenalidomine was shown in phase III clinical trials (Dimopoulos, 2007: 2125-2127). In a study by Weber et al (2007:2133–2140), individuals with degenerated Multiple Myeloma were arranged in random order to lenalidomine together with dexamethasone. The results established that the individuals who used lenalidomine acquired greater response rates and extent of reaction. In essence, lenalidomide is an equivalent of thalidomide, and functions by constraining angiogenesis and immune intonation, therefore, increasing apoptosis. It was identified that Lenalidomine is more efficiently tolerated than thalidomine. Additionally, the treatment of Multiple Myeloma has witnessed a new advancement. Bortezomib, a proteasome inhibitor, was developed to assist treat Multiple Myeloma. Bortezomib targets the 26S proteasome. The advantages of this inhibitor have been demonstrated in a research by Richardson et al (2005: 2487-92). This study identified that patients who used bortezomib had a one-year increase in their overall survival and increased response rate. Additionally, clinical trials have illustrated the function of stem cell transplantation and the advantages of post-transplant maintenance therapy. These progressions have not only led to increased and improved cancer management options but also changed the history of cancers that were incurable. Conclusion Treatment of cancer has experienced progress in quantum bounds. A closer look at this review would hint that while in some fields there has been a paradigm shift in treatment, such as the employment of targeted therapy in management of breast cancer and the use of monoclonal antibody, in other areas, novel treatments have developed in tough chronic cancers such as the Multiple Myeloma and Glioblastoma Multiforme, giving hope to patients on prolonged life. The increase in overall survival of patients suffering from head and neck cancer, colon cancer and non-small cell lung cancer through the utilization of targeted therapies symbolizes improvement in the treatment of cancerous cells among patients. However, some of these medications employed may have numerous adverse long term side effects on the patients. Therefore, future research should focus more on the long term effects of using thalidomine, bortezomib, lenalidomide, cetuximab and temozolomide. References Anmdre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, & Hickish T. 2004. Oxaliplatin, fluorouracil and leucovorin as adjuvant treatment of colon cancer. New England Journal of Medicine. (350):2343–2351 Bonner JA, Harari PM, Giralt J. 2006. Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med. 354:567–578. Bonner JA, Harari PM, Giralt J, Baselga D, Shin R, Cohen J. 2005. 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