Does your medical policy pay for trial or developmental drugs?

April 2, 2007

The smart-pill solution

By David G. Nathan

FOR most of the past half-century, medical treatment of invasive tumours like those of the breast and colon has relied mainly on drugs, radiation or both, in effect carpet- bombing the DNA of cancer cells. This highly toxic treatment is effective in many cases, but it does not address the root causes of cancer.

Fortunately, the revolution in genetics of the past 30 years has taught us how cancer results from defects in DNA repair that arise when certain genes are damaged by solar radiation, tobacco smoke and the chemical products of intestinal bacteria and cell metabolism. Cancer cell genes depend on only a very small number of mutated genes to ensure their own survival. These are typically the genes responsible for repairing other genes and for controlling growth and death. Our challenge is to outsmart the cancer by determining which genes are keeping the cancer going, and to design drugs that can inhibit them.

The first such 'smart' agent to see action in patients is trastuzumab, or Herceptin, which is not a drug in the strict sense but rather a large protein, an antibody that binds to a growth-controlling protein found in about 20 per cent of patients with a highly aggressive form of breast cancer. When it is administered with standard chemotherapy and radiation, Herceptin ties up the protein, and thus markedly improves the survival of such patients.

Gleevec (imatinib), the first smart anti-cancer pill, inhibits a protein produced by a single gene that is key to the growth of a form of leukaemia. Even more remarkable is Gleevec's effect on an intractable bowel cancer known as gastrointestinal stromal tumour, a ravaging tumour derived from nerve cells in the bowel wall. In its early stages, this cancer is driven by a single gene and its protein, and it can be inhibited overnight by a single dose of Gleevec. A large number of patients who have received this drug have remained in remission for years.

There are at least 100 such smart antibodies and drugs in practice, trials or development. Among them are Iressa (gefitinid) and Tarceva (erlotinib), which are effective in treating about 10 per cent of lung cancers, those that are initiated by a specific mutation in a growth-controlling gene. But we need many more, because cancer cells are wily foes that readily develop further mutations to help them evade such drugs. Also, because cancer cells are genetically unstable and vary slightly from one to the next, it is difficult for a single drug attacking a single protein to do the whole job. We need multiple smart drugs, and creating them will take time.

Patients, organisations that finance research and the public want faster progress. So do cancer researchers and clinicians. We are trying, and we are succeeding. The pace is slow because the problem is difficult, but we will get there.

The writer, the president emeritus of the Dana Farber Cancer Institute, is the author of The Cancer Treatment Revolution.

Read the fine print! Many Singapore medical insurance policies be it cash or Medishield does not pay for trial or developmental drugs!! This would mean the usage of such drugs which are expensive (may be in the area of hundreds to thousands dollars a pill) will have to be forked out of your own pocket!

The drug may save, but you may loose your life savings!

Transfer the risk for just $538 for a yearly medical for a person age 60 and below a year in good health, can qualify for a class Ward A "as charged" plans . Co-Insurance and deductibles apply.

Contact us for your reliable needs based advice on the best and cost effective medical policies.