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Anti Cancer Drugs

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The overwhelming majority of cancer drug therapy (90-95%) is currently covered by Medicare Part B because the drugs are injectable and are administered incident to covered physician services. In addition, some oral anti-cancer drugs are covered by Medicare Part B is there is an injectable version of the same drug that would be reimbursable if administered by a physician. 13

It is a treatment with one or more anti-cancer (also called cytotoxic) drugs. Anti-cancer drugs work in different ways, but they all damage cancer cells so they can’t divide and grow. 22

Cancer care in the future will be more heavily dependent on oral drugs; it is projected that oral drugs will comprise 25% or more of the oncology market within the decade. The new oral anti-cancer drugs include anti-proliferative agents such as signal transduction inhibitors (STIs), farnesyltransferase inhibitors (FTIs) and antiangiogenesis factors. 13

The focus of the cancer pharmacology laboratory is to explain inter-patient differences, in response and toxicity, to anti-cancer drugs. The treatment of cancer patients with drugs is difficult due to the fine balance between killing tumour cells and causing toxicity to normal cells. Therefore, the huge variability between patients in clearance of anti-cancer agents has a significant impact on the success of chemotherapy.� Anti-tumour action may be lost if the drug is cleared too rapidly, while slow drug excretion may lead to extreme toxicity.� A better understanding of the source of this variability should lead to improvements in the manner in which chemotherapy is administered and would represent a welcome advance for cancer patients. 20

In the second project, published in Cancer Research on December 1, 2005, Assaraf and doctoral student Ilan Ifergan discovered another resistance mechanism connected to the ABCG2 carrier. They found that cancer cells create �waste baskets� into which anti-cancer drugs are deposited. 38

However, utilising nanotechnology to design new drug delivery systems is helping to tackle this problem. Nanoxel’s polymeric nanoparticle drug delivery system is being touted as a ‘potential super generic’ due to its increased safety and pharmacokinetic profile. 17

Developing and testing new delivery systems for drugs can also be a problem because of the toxicity of anti-cancer drugs. The academics are overcoming this problem by using drugs that are used to treat the inflammation of the brain that accompanies brain tumours, but are much less harmful to the patient and easier for the researchers to work with. 32

The St Vincent’s team of scientists have visualised how anti-cancer drugs are attacked by this protein and are using the ACRF facility to design a drug to block the protein and prevent it interfering with anti-cancer treatment. Such a drug may lead to lower doses and shorter duration of chemotherapy treatment for cancer patients. 36

By using cutting edge technology, the collaborative study - working together with clinical trial groups and with support from Cancer Research UK - will analyse specific markers in cell DNA (methylation) to gather information for the detection and treatment of cancers of the lung, breast and ovaries. Signs of abnormal methylation often indicate cancerous cells and the study will compare these cells with normal cells to identify how methylation can provide novel information about the pathology of tumours. 41

Cancer cells do this, but so do healthy cells in some parts of the body, for example in the mouth, intestines, bone marrow (where blood cells are made) and scalp. So most of the side effects of anti-cancer drugs affect these areas. But a lot can be done to relieve them. See dealing with side effects. 23

Unfortunately, all the anti-cancer drugs used in chemotherapy for breast cancer do have side effects. Anti-cancer drugs are designed to kill cells that multiply quickly. Cancer cells do this, but so do healthy cells in some parts of the body, for example in the mouth, intestines, bone marrow (where blood cells are made) and scalp. So most of the side effects of anti-cancer drugs affect these areas. But a lot can be done to help relieve side effects. See dealing with side effects. 22

Patients who are particularly sensitive to the anti-cancer drugs sometimes experience mild nausea after the operation, but these symptoms are readily controlled with appropriate medications. A more serious, but very rare side effect, is thrombosis (clotting) in the veins or arteries of the limb. The risk of thrombosis is reduced by administering anti-coagulants (anti-clotting drugs) to the patient and into the limb during the operation, and by taking special precautions during the entire period of hospitalisation. There is nevertheless a risk of limb loss as a result of an ILI, but the chance of this occurring is very small indeed (less than 0.5%) � and it must be remembered that the only other effective treatment option is usually amputation. 10

ILI with anti-cancer drugs is an effective form of treatment for recurrent (secondary) melanoma confined to a limb, and for some other types of tumours. ILI was first performed at the Royal Prince Alfred Hospital in 1992, and over 300 procedures have been performed since then. 10

If the lesions are not widespread or troublesome, often the best approach is simply to treat the underlying HIV infection with potent antiretroviral drug combinations that suppress HIV replication. These drugs reduce the frequency of Kaposi sarcoma and may also prevent its progression or the development of new lesions. It is not yet clear why this approach works; one opinion is that the improvement in immune function results in reduced levels of tumour growth-promoting proteins. 44

At the present time, chemotherapy of gynecological tumors does not appear to have increased life expectancy except in sporadic cases. The problem of blind chemotherapy means not only a loss of the effect of the drugs, but also a lowering of the patient’s resistance to the cancer cells owing to the toxicity of these agents. 40

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