TOP 5 ADVANCES IN MODERN ONCOLOGY

As part of this year's 50th anniversary celebrations at the American Society of Clinical Oncology (ASCO), the society prepared a list the most significant clinical cancer advances in aMajor Milestones Timeline. It then invited physicians, patients, and the public to vote for what they considered to be the top 5 advances in the last 50 years. The votes are now in, and ASCO has revealed what it describes as the "Top 5 Advances in Modern Oncology."

"All of these advances mark major turning points for cancer care and have improved and saved the lives of countless Americans," ASCO president Peter Yu, MD, commented in a statement.

The 5 advances considered to be the most significant were as follows:

1. Chemotherapy cures advanced Hodgkin lymphoma ― In 1965 came the first chemotherapy breakthrough for advanced cancer in adults, when a 4-drug combination chemotherapy regimen (cyclophosphamide, vincristine, mechlorethamine, and prednisone, known as MOPP) induced long-term remissions in more than half of patients with aggressive Hodgkin lymphoma. This regimen quickly became standard treatment, but in the 1970s, a different 4-drug combination (doxorubicin, bleomycin, vinblastine, and dacarbazine, known as ABVD) proved even more effective, curing about 70% of patients with advanced Hodgkin lymphoma. The ABVD combination remains a mainstay of treatment today, ASCO comments. It adds that the 1965 discovery of MOPP "sparked the first hope that advanced cancers could be cured with drug treatment, and paved the way for 90% cure rates for patients with this disease today."

2. HPV vaccine approved to prevent cervical cancer ― In 2006, the Food and Drug Administration (FDA) approved the first human papillomavirus (HPV) vaccine, Gardasil, which protects against the two strains of HPV (16 and 18) known to cause 70% of cervical cancers, as well as two other HPV strains (6 and 11) associated with genital warts. Another HPV vaccine, Ceravix, which protects against the the 2 strains linked to cervical cancer (16 and 18), was approved in 2009. Gardasil was first approved for the prevention of HPV-related cervical cancer, but this later expanded to include prevention of additional HPV-related diseases, including vaginal, vulvar, and anal cancers in women, and anal cancer and genital warts in men. ASCO adds that studies have also linked HPV infection to head and neck cancers, suggesting that the vaccine may help prevent these cancers as well. "Widespread vaccination, if fully implemented, stands to drive dramatic reductions in cervical and other HPV-related cancers in the US and worldwide," it adds.

3. Targeted drug transforms treatment of chronic myelogenous leukemia ― In 2001, the rapid FDA review and approval of imatinib (Gleevec) dramatically changed the treatment of patients with chronic myelogenous leukemia (CML). This easy-to-take daily pill ― which targets a molecular defect (the Philadephia chromosome) present in nearly all patients with CML ― turned a disease with almost no long-term survivors into one with 5-year survival rates of 90%, ASCO comments. It also ushered in a new era of successful research on molecularly targeted treatments for many more cancers.

4. Chemotherapy cures men with testicular cancer ― In 1977 came the pivotal trial showing that the 3-drug chemotherapy regimen known as PVB (cisplatin, vinblastine, and bleomycin) produced complete remissions and some cures for more than 70% of men with advanced testicular cancer. Earlier chemotherapy treatments worked in just 5% of men, ASCO notes. This combination regimen, coupled with later surgery, radiation, and chemotherapy advances, has made testicular cancer "one of the most curable cancers and one of oncology's biggest success stories."

5. Powerful antinausea drugs dramatically improve many patients' quality of life ― In 1991, the FDA approval of the antinausea drug ondansetron (Zofran), as well as other supportive-care drugs in the following years, have together dramatically changed the experience of cancer treatment, bringing unprecedented improvements to patients' quality of life, ASCO comments. Ondansetron, a 5HT3 receptor antagonist, works by deactivating the nervous system's natural trigger for vomiting, and other similar drugs were also soon approved, including granisetron (Kytril), dolasetron (Anzemet) and palonosetron (Aloxi). These and other antinausea drugs, like aprepitant (Emend), which is a substance P/neurokinin 1 antagonist, allow most cancer patients to receive chemotherapy in an outpatient setting, with minimal disruption to their daily routines, ASCO commented. "These drugs not only bring relief from intense, treatment-induced nausea, but make it possible for patients to avoid once-routine hospital stays, complete their full course of treatment, and live longer and better lives," it added.