Module Abstract

Expanding the Targets in Adjuvant Therapy

Abstract

Adjuvant systemic therapy for the treatment of solid tumors improves survival and increases the likelihood of achieving remission in cancer patients; however, this benefit is associated with many adverse effects. Therefore, researchers continue to design alternative therapeutics striving for better risk/benefit profiles. Targeted or biologic therapies are possible alternatives, as they offer a high degree of efficacy with generally low toxicity. Targeted anticancer therapies are agents directed against particular pathways (such as those involving particular receptors or genes), processes (such as angiogenesis), or physiology (such as tumor pH) that are uniquely disrupted in cancer. By acting on molecular and cellular changes specific to cancer, targeted therapies may have increased efficacy compared with conventional treatments, as well as a lower risk of harming normal cells. In an effort to selectively target tumor cells while disregarding normal cells, the following characteristics inherent to cancer cells have been identified: 1) an ability to evade apoptosis; 2) a self-sufficiency in growth signals; 3) an insensitivity to antigrowth signals; 4) sustained angiogenesis; 5) a limitless replicative potential; and 6) an ability for tissue invasion and metastasis. While some of these characteristics have been exploited by the actions of conventional cytotoxic chemotherapy, several have been investigated as potential strategies for novel targeted therapies. In this educational module, Adam M. Brufsky, MD, PhD, reviews the current status of various approaches to using targeted anticancer therapies in the adjuvant setting, including an assessment of the latest data on strategies for targeting receptor tyrosine kinases, angiogenesis pathways, and the bone microenvironment.