Is Chemotherapy on the Way Out?

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New, less toxic cancer treatments are emerging, but don’t expect chemo to disappear anytime soon.
Immunotherapy is one type of new cancer treatment that could someday make chemotherapy a thing of the past. Getty Images
When Mary Olsen received a diagnosis of chronic lymphocytic leukemia, the most common types of leukemia in adults, she wanted to try a new, targeted cancer therapy that was showing great promise in clinical trials.
But when it came time to get treatment, Olsen, 68, a retired director for early child care education from Indiana, says chemotherapy was her only option.
“I was scheduled for one treatment a month for six months,” she said. “Unfortunately, I did not have a successful experience with chemo.”
After two cycles, Olsen developed sepsis, a life-threatening illness caused by your body’s response to an infection.
While recovering in the hospital, she says her oncologist came to her room and told her, “No more chemo.”
That was just what she wanted to hear.
Olsen had now qualified for a new drug called ibrutinib (Imbruvica). It targets cancer but, unlike chemo, doesn’t generally destroy healthy cells.
“I was anxious, and I did have and still do have some side effects,” she said. “Fortunately, in the scope of things, they are minor and manageable. They don’t interfere with my daily life, and I am grateful for the benefits of Imbruvica.”
Olsen isn’t alone.
She’s one of a growing number of cancer patients who are turning away from chemotherapy and toward a new generation of cancer medicines.
While chemotherapy regimens have been the standard of care for most cancers for more than a half-century, the paradigm is slowly but steadily shifting to newer, personalized, less toxic modalities.
In chronic lymphocytic leukemia, for example, the first-line therapy historically included cytotoxic agents that can cause significant immunosuppression, second malignancies, and other serious side effects.
But decades of painstaking research have given scientists a far better understanding of chronic lymphocytic leukemia and, more broadly, the mechanisms and mutations of all types of cancer.
This research has opened new doors that are leading to better, safer medicines. But it’s only been in the past few years that patients have begun to really see and feel the fruits of this labor in the lab.
The new treatment landscape includes such targeted therapies as Imbruvica and dabrafenib (Tafinlar), which treats people with melanoma who have a mutated BRAF gene.
In addition, trastuzumab (Herceptin), which treats people with breast cancer who have the HER2 gene mutation, is also widely used.
So are afatinib (Gilotrif) and cetuximab (Erbitux), which block a substance called EGFR that helps lung and colorectal cancers grow.
Other new classes of drugs that are positively challenging the chemo status quo include checkpoint inhibitors such as Keytruda as well as immunotherapies, bispecifics, gene therapies, chimeric antigen receptor (CAR) T-cell therapies, cancer vaccines, and natural killer cell treatments.
Some of thes treatments have been approved by the U.S. Food and Drug Administration (FDA), while others are in clinical trials or drug company pipelines.
Most oncologists, scientists, and cancer industry observers interviewed for this story agreed that while it won’t happen anytime soon, the writing is now on the wall.
“Chemotherapy’s days are numbered,” said Ivor Royston, the pioneering oncologist, scientist, and entrepreneur who’s helped co-found multiple American biotechnology companies.
But he adds this won’t happen overnight.
“There are cancers for which chemotherapy is effective in some patients and even curative,” Royston said, who’s currently the CEO of Viracta, a biotech company in San Diego that’s advancing new medicines to benefit patients that have viral-associated cancers, including several types of lymphoma.
Viracta’s treatment, which is in clinical trials and showing strong early results, is a precision therapy focused on cancers harboring the genome of the Epstein-Barr virus.
Unlike standard chemo, this treatment potentially presents few if any adverse side effects.
And this is what scientists, and patients, are moving toward.