This weekend, I had the opportunity to sit down with a friend, a cancer surgeon who works at a major teaching hospital in the US. He, his wife and two kids were up visiting us for the weekend.
Over coffee, I was asking him about the state of cancer therapeutics. Although he himself does not administer drugs or design treatments, he is part of a larger team which includes molecular oncologists that perform this task. What I heard was quite surprising.
From the vantage point of academia, we have been told that the development of new anti-cancer chemotherapy has been a disaster (here’s one example). Every good idea that we’ve come up with, such as rapamycin, has basically failed in big clinical trials. But according to my friend the view from the bedside is not so bad. For kidney, bladder, and prostate cancer (that was his area of expertise) many of these new drugs ARE being used. None of them is the answer, “each is about 30 to 40 percent effective, there is no silver bullet.” However in combination they can actually do a lot of good for treating cancers that are unresponsive to the standard chemo treatments. The list of drugs being used includes rapamycin, anti-tyrosine kinase inhibitors such as Sorafenib, and the anti angiogenesis drug avastin, a compound that came out of Judah Folkman’s research. Recently we’ve learned that new anti-TOR pathway drugs are being developed that not only target the mTORC1 complex, which sits at the center of the TOR pathway, but also the mTORC2 complex, which is related to the first complex except that is unresponsive to rapamycin.
So perhaps all this money being spent at the NIH was worth it …