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Chemo Packs New Punch Outside Cancer Fight’s Spotlight

Chemo Packs New Punch Outside High-Tech Cancer Fight’s Spotlight

(Bloomberg) -- Newfangled drugs that target flaws in tumor cells grabbed headlines at a cancer conference in Barcelona over the weekend. But Mark Velleca was just as eager to discuss a type of therapy that was cutting edge in the 1950s.

“Chemotherapy has been declared dead many times,” said Velleca, chief executive officer of G1 Therapeutics Inc. But “it will continue to be used, even as these new regimens come on.”

Velleca’s views reflect a stubborn reality in the world of cancer. Targeted and immune-oncology drugs have grabbed the spotlight, but chemotherapy -- despite its shortcomings and harsh side effects -- remains a pillar of care for millions of patients. For a growing number, chemo is a part of an ever-more sophisticated mix of treatments. For others, it’s still the only hope.

“Chemotherapy is still the backbone for some patients,” said Jennifer Litton, a breast cancer specialist at the M.D. Anderson Cancer Center, at the University of Texas in Houston. “I don’t know that we’ll ever go all the way away from that until we get a specific biomarker that leads to a targeted therapy for everything.”

Splashy Displays

Doctors are hunting for such targets, along with better ways of boosting the immune system’s fight. The enthusiasm was hard to miss at the European Society for Medical Oncology’s meeting, where Amgen Inc. had a splashy interactive display, accompanied by booming narration, about the quest to defeat “undruggable” targets. Nearby, Bayer AG had a wall-sized promotion for its “first-in-class” treatment of tumors caused by rare abnormal genes. And Novartis AG set up a light show for its therapy Kisqali. “Superior overall survival,” it said in big letters.

For all the progress in those new approaches, though, companies including Merck & Co. and Roche Holding AG are looking to pair up their new blockbuster immune therapies with chemotherapy. One promise in that, according to G1’s Velleca, is that when chemo kills tumor cells, they sometimes release things that the immune system can learn to attack.

Protective Effect

G1 is putting many eggs in the chemo basket. The small drug developer’s most advanced experimental product, trilaciclib, aims to preserve stem cells that often suffer from chemo. That may reduce side effects like anemia and fatigue, and allow patients to get stronger, more effective treatment.

By the end of this year, 1.8 million new cancer cases will have been diagnosed in the U.S., according to the American Cancer Society. More than half of them will receive chemotherapy, according to the Dana-Farber Cancer Institute in Boston.

For decades after World War II, it was the hot ticket. Chemo is based on a strategy of attacking rapidly growing cells -- a hallmark of cancer -- which also means that it often harms normal, healthy tissue. Side effects often limit how much treatment patients can receive.

A rapidly growing understanding of cancer and what sets it apart from normal tissue led to a boom in so-called targeted therapies in the late 1990s and 2000s. Then came this decade’s wave of immune therapies that unleash the body’s defenses on tumors.

One of these is Roche’s Tecentriq, approved for lung cancer in combination with chemotherapy, along with other uses. The Swiss company on Monday reported data from a study that showed some bladder cancer patients, when given Tecentriq with chemotherapy, saw better results. That could broaden the population of bladder cancer patients receiving Roche’s new treatment.

Best Option

“We’d love to be able to eliminate chemotherapy, but we’re not always able to do that,” said Alan Sandler, head of Roche’s product development for solid tumors.

French drugmaker Sanofi, meanwhile, published results Monday that could potentially boost doctors’ reliance on chemo. A clinical trial showed that prostate cancer patients given the aging chemotherapy drug Jevtana did better than those who instead received a second targeted hormonal treatment.

Ronald de Wit, an oncologist and professor at Erasmus MC Cancer Institute in Rotterdam, led the trial. Back home, he sees many patients who’ve been eagerly following the recent advances in cancer and expect to get cutting-edge treatments. They’re often surprised to hear they’ll instead get chemo, leaving him to explain it’s still the best option for some tumors, such as testicular and bladder cancers.

“That is something that I discuss with my patients every day,” he said. “But it remains the cornerstone.”

To contact the reporter on this story: Tim Loh in Munich at tloh16@bloomberg.net

To contact the editors responsible for this story: Eric Pfanner at epfanner1@bloomberg.net, Marthe Fourcade, John Lauerman

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