tag:blogger.com,1999:blog-36768584.post2317847942577726122..comments2024-03-03T18:49:34.382-05:00Comments on Omics! Omics!: Cancer Cellular EcologyKeith Robisonhttp://www.blogger.com/profile/04765318239070312590noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-36768584.post-88038771918311220822007-02-06T21:18:00.000-05:002007-02-06T21:18:00.000-05:00Thanks for the kind remark.
Indeed, what you desc...Thanks for the kind remark.<br /><br />Indeed, what you describe is a direction some oncologists are taking. Polypharmacy is the norm in oncology, though most drug combinations have been determined entirely empirically with no strong theoretical understanding of why certain combinations work and others don't. These combinations may be in parallel, in series, or some combination.<br /><br />Already we see Avastin, whose action is probably entirely anti-angiogenic, combined with more conventional cytotoxic agents -- I think the track record on Avastin is that it has not done well as a monotherapy. Trial designs have been described in the literature; for example in <a href="http://www.bloodjournal.org/cgi/content/full/107/2/431">this review (free!)</a> which combine an agent to target the tumor bulk and another agent to target cancer stem cells.<br /><br />And yes, the trials become more complex -- and longer. If the cancer stem cell hypotheses are correct, then changes in tumor volume are (or border on) irrelevance; what you need to look at is survival -- and that means a longer trial. Perhaps acceptable surrogates can be devised to expedite trials (such as changes in cancer stem cell markers), but those surrogates will need to be validated -- most likely in large, long trials.Keith Robisonhttps://www.blogger.com/profile/04765318239070312590noreply@blogger.comtag:blogger.com,1999:blog-36768584.post-29531618891372566902007-02-06T10:44:00.000-05:002007-02-06T10:44:00.000-05:00Great stuff as ever.
One of the issues that you r...Great stuff as ever.<br /><br />One of the issues that you raise is the metric, i.e. tumour size, that clinical trials use to approve drugs.<br /><br />It seems that clinical trials will have to become more complex to reflect what a complex disease cancer is. This seems an almost impossible task when one is trying to obtain statiscally significant data.<br /><br />For instance, if we reason that one drug can kill one type of cell, the drugs that kill the most abundant cells may appear most effective. <br /><br />I mean, do you think one day they will conduct a clinical trial where one is taking 5 drugs, one for the stem cells, one for the epithelial cells, one for the fibroblasts, ...Eats And Drinks More Than My Fair Sharehttps://www.blogger.com/profile/15379683910308072454noreply@blogger.com