Added value of molecular targeted agents in oncology

• Published in: Annals of oncology Vol. 22; no. 8; pp. 1703 - 1716
• Main Authors: Soria, J.-C., Blay, J.Y., Spano, J.P., Pivot, X., Coscas, Y., Khayat, D.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-08-2011; Oxford University Press
• Subjects: Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic agents; Antineoplastic Agents - therapeutic use; Benzamides; Biological and medical sciences; biomarkers; Biomarkers, Pharmacological; Breast Neoplasms - drug therapy; economic perspectives; Female; Humans; Imatinib Mesylate; Indoles - therapeutic use; Lymphoma, Non-Hodgkin - drug therapy; Medical sciences; Molecular Targeted Therapy; Pharmacology. Drug treatments; Piperazines - therapeutic use; Proto-Oncogene Proteins c-kit - antagonists & inhibitors; Proto-Oncogene Proteins c-kit - genetics; Pyrimidines - therapeutic use; Pyrroles - therapeutic use; Receptor, ErbB-2 - immunology; Rituximab; Sunitinib; targeted therapy; Trastuzumab; targeted therapy; economic perspectives; biomarkers; Perspective; Cancerology; Treatment; Targeted therapy; Biological marker; Economic aspect; Malignant tumor; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdq675

The treatment of certain cancers has been revolutionised in recent years by the introduction of novel drugs designed to target specific molecular factors implicated in tumour growth. Notable examples include trastuzumab, a humanised monoclonal antibody (mAb) against human epidermal growth factor receptor (HER)-2 in women with HER2-positive breast cancer; rituximab, an anti-CD20 mAb in patients with non-Hodgkin's lymphoma; imatinib, a tyrosine kinase inhibitor in KIT-positive gastrointestinal stromal tumours and sunitinib, another tyrosine kinase inhibitor, in metastatic renal cell carcinoma. For regulatory reasons, new molecular targeted agents are first evaluated in advanced and metastatic disease, wherein they prolong survival. However, their most profound impact has been observed in the adjuvant setting, where they may contribute to curative therapy rather than mere palliation. Expansion in the use of molecular targeted therapies will have important cost implications for health care systems. Although expensive, on a monthly basis, molecular targeted therapies may not be more costly than treatments for other major chronic diseases, especially considering the contribution of cancer to the global disease burden, the associated socioeconomic costs and the long-term benefits of therapy. Nevertheless, the use of these agents must be optimised, in part using molecular biomarkers associated with drug response.