Oncology R&D is tough and there are many more failures than successes, despite the FDA approving more than they’ve rejected over the last two years. That’s quite unusual in my experience.
As Dr Mario Sznol (Yale) told us at SITC recently, sometimes these things are sometimes more whimsical. He was referring to different types of modalities that can be used in conjunction with cancer immunotherapies, but the sentiment is also highly relevant to the FLT3 AML space.
The critical questions we need to think here about are:
- What’s different about the various approaches?
- What can we learn from the FLT3 experiences to date that give us clues about the changing landscape in AML?
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At the last count, the renal cell carcinoma (RCC) space is quite competitive with five VEGF inhibitors (sunitinib, sorafenib, axitinib, pazopanib and bevacizumab), two mTOR blockers (temsirolimus and everolimus) and not forgetting IL–2, all approved by the FDA for the treatment of advanced disease.
Much of the recent focus has been on sequencing, exploring combinations (generally too toxic with little added benefit), and evaluating the potential for novel immunotherapies in development such as checkpoint inhibitors. Biomarkers are few and far between, making it hard to rationally decide which therapy each patient should get and in which sequence.
The key question is, why is this tumour type so challenging from a clinical and scientific perspective?
Recently, new data has begun to emerge that may help inform or enable us to switch to new approaches. While the urologists are eagerly watching the live surgery on the EAU cam, we highlight research data presented at the European Association of Urology (EAU) in Madrid and take a look at how the underlying biology of RCC can elevate our knowledge about where the potential future strategies and blueprint might lie, if we want to facilitate exciting new developments in this field.
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Adenocarcinoma associated with gastric (stomach) cancer is more common in Asian than North America people and tends to occur in men over 40. Risk factors include smoking, H. pylori, and diet. Asian countries also tend to have larger amounts of smoked foods, salted fish and meat, and pickled vegetables in their diet. Nitrates and nitrites are substances commonly found in cured meats and can be converted by bacteria, such as H. pylori, into compounds that have been shown to cause stomach cancer in animals.
According to the NIH cancer statistics, it was estimated that there would be approximately 22,000 new cases in the US in 2014 and 11,000 deaths.
Treatment of advanced gastric cancer typically involves chemotherapy, or in cases where the patient is HER2+, with the monoclonal antibody, trastuzumab (Herceptin).
Numerous trials with EGFR inhibitors and also multi-kinase blockers have unfortunately proven fruitless and largely negative, with the exception of ramucirumab (Cyramza), a VEGF antibody, which was approved earlier this year for the treatment of both gastric and gastroesophageal junction adenocarcinoma by the FDA.
At the recent ESMO conference in Madrid, initial results from several early studies were presented on gastric cancer, with vastly different results. In this post, we take a deeper look at the new data, including the novel checkpoint inhibitors, and where R&D might be heading in this dynamic space.
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