What is Targeted Therapy, with Nicholas Vogelzang, MD

Last Updated: April 25, 2017

Dr. Nicholas Vogelzang explains what targeted therapies are, and how they are used in cancer treatment.

More Information

Understanding Targeted Treatments

Types of Treatment

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Full text transcript

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

What is Targeted Therapy?

Nicholas Vogelzang, MD: We think of cancer as the target. It's that simple. Cancer is the target. But we also know that within the cancer cell there are distinct pieces of the cell or machineries within the cell that require the therapy to be directed at that particular type or that particular piece of the machinery. So if you think of cancer as a machine, you could gum up the accelerator, you could gum up the carburetor, you could affect the pistons, you could affect the drivetrain - it's that simple. There's a lot of different places that the target in cancer could be conceived.

The very simplest way to think about this is the spark plug on a car. If you take the spark plug out of a car, the engine doesn't run very well. That is a target. The spark plug is a target. So in cancer cells, a target is a part of the cancer cell that we believe can be addressed. That's really all it is. It's just a subset of the cancer cell rather than thinking of the cancer cell as some mysterious big, black box. We know that it is effectively a cellular machine, and we can target that. We now realize that the cancer cell also has this environment around it. So we can also target the environment. You might imagine that the simple analogy would be to destroy the road; the cancer cell can't drive down it. And so we now have way to target the road, or we have ways to target the stop signs, or the street lights.

Types of Targeted Therapies

Dr. Vogelzang: When I was a young oncologist, the first drug ever developed was platinum. Platinum was a miracle drug as it killed cancer cells and killed the cancer such that the patients no longer died of their disease. This was testicular cancer. The target for platinum is DNA. It's very specific for a specific place on the DNA. So we have had targeted cancer therapy since the '70s. That's not new, but what's new is that we have more and more agents which target things, and some of the examples include targeting the blood vessels. These would be the feeders to the cell. And the new agents that affect the blood vessels include things like Avastin, or bevacizumab; Sutent, or sunitinib; pazopanib, otherwise known as Votrient. We have a whole host of these agents which affect the blood vessels or the feeders to the cells. We also can target new parts of the cancer cell. So for example, there is the waste elimination effect. It would be similar to the exhaust. If you put a potato in an exhaust pipe of your car, your car stops. It's that simple. We know how to put a potato in the cancer cell exhaust. It's called the proteasome, and the drug that targets the proteasome is called bortezomib and it's highly effective against myeloma.

Challenges of Using Targeted Therapies

Dr. Vogelzang: Well, as you might imagine, if the car is driving down the road and the road is used for other things besides cars, it might be used for trucks, or bicycles, or for scooters, or tricycles. Those are important for the normal functioning of the society. The society in this case being the organism, ourselves. So if we blast the road, the cancer cell might not be able to go down it, but likewise, the normal transportation system is disrupted. So for example, when we target the cancer cell with a drug like Taxol, that affects the nerves of the body. So a side effect of a targeted agent may be that it affects a normal part of your body. So when we target the blood vessels, we need the blood vessels normally to repair our wounds if we cut ourselves, that's going to need new blood vessels to heal. Well, when you give targeted therapy your wounds don't heal. So if you have then a need for surgery and you're on a targeted therapy, you have to be very careful because the cut that the surgeon makes may not heal fast enough or you may get an infection.

Where to Learn More About Targeted Therapies

Dr. Vogelzang: One easy way to learn about your cancer is to go to the ASCO Cancer.Net site, and at that point you get an idea of the diversity of human cancer. There are well over 150 different cancers, and at that site many of them are described, listed, and from that site you can link to other more subspecialized websites. It's really an ideal place to start your search and start your quest for knowledge about your cancer.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

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