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Cancer: the Good, the Bad, and the Ugly

We've made great progress since President Nixon declared war on cancer 30 years ago, but can the war be won?

New Warriors Join Battle

New "smart" drugs are also promising weapons in this war. "This year, there has been enormous progress in the angiogenesis inhibitors, and it is the first year that there has been a significant increase in survival of the three top cancers - colon, breast, and lung -- due to antiangiogenic therapies being introduced," Folkman tells WebMD. Antiangiogenic drugs, also called angiogenesis inhibitors, starve tumors to death by cutting off their blood supply.

For example, Avastin targets a protein called vascular endothelial growth factor (VEGF), which plays a role in making new blood vessels for tumors (a process called angiogenesis). This drug was approved in the U.S. for colon cancer in February 2004, and by January 2005 it had been approved in 27 other countries, he says.

Other antiangiogensis drugs being used include thalidomide and Tarceva. Tarceva blocks tumor cell growth by targeting a protein called HER1/EGFR that is important for cell growth in advanced nonsmall cell lung cancer. Tarceva "blocks three angiogenic proteins and really is an angiogenic inhibitor," Folkman says. Thalidomide became notorious in the 1960s when it was prescribed to pregnant women to ease morning sickness, but was found to cause severe birth defects by limiting the blood flow to developing limbs. As a result, many children were born limbless or with severely shortened limbs. Now scientists are capitalizing on these same blood-limiting properties to help block the blood supply to tumors.

Treatment No Longer Worse Than the Disease

"[These drugs] have changed our thinking," he says. "We don't use the word cure, but we now think of converting cancer to a chronic manageable disease like diabetes," he says. "When you see these patients, they are not very sick, their hair doesn't fall out, they don't have massive diarrhea and their spouses stay with them," he says. New treatments have decreased the toxicity and decreased the chance of drug resistance, he explains. "There are at least 40 other antiangiogenic drugs in the pipeline and some are doing very well," he says.

The bottom line is that "you can live with cancer today," he says.

Coming Soon?

"The newer things are biomarkers of angiogensis or blood tests that are so sensitive they can pick up a 1-millimeter tumor in a mouse just before it switches on," he says. "Say you have colon cancer. We could do a urine or blood test every four months and if levels of a certain protein stays flat, you are fine, but if it goes up we know the cancer may be returning," he says.

"Drugs like angiogenesis inhibitors that are approved are not as toxic as older cancer therapies, so you can take them for longer times, you don't develop resistance as fast and this is intersecting with biomarkers where we can diagnose cancers earlier and earlier," he says. "We are beginning to ask why do we care where the cancer is," he says. "If test is rising, why not treat with nontoxic antiangiogensis inhibitor until the numbers come down?"

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