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Cancer is one disease that carries the burden of increased death rate and in the last 50 years, the disease has progressed through various stages from understanding the pathophysiological mechanism of the disease to identification of newer drugs. Cancer is one of the leading causes of death is treated by three major modes of treatment like chemotherapy, radiotherapy, and surgery. The chemotherapeutic drugs include non-cell cycle-specific drugs, cell cycle-specific drugs, and hormonal drugs. In addition to the conventional treatment, the current treatment approach is more towards specific therapies that target the molecular genetics involved in the tumor progression. The greatest challenges in cancer drug discovery that it includes various processes like genome sequencing, high throughput screening, identification of lead molecules, testing of drugs in complex multicentric trials. Despite all the steps and efforts involved in cancer drug discovery, the drugs the proportion of newly discovered highly efficacious drugs is still less. There is a great demand to follow up and identify the newer anticancer drugs that can combat the challenges imposed by cancer. The recently approved drugs in 2020 are mostly specific target drugs like monoclonal antibodies, antibody-drug conjugates, tyrosine kinase inhibitors and some of these drugs are accelerated approvals by FDA, used in the resistance cases who doesn’t respond to previous treatments, add on therapies.
The drug is an antibody-drug conjugate. It is a Trop-2-directed antibody and topoisomerase inhibitor drug conjugate approved for the treatment of patients with triple-negative breast cancer. The protein Trophoblast cell surface antigen (Trop-2) is highly expressed in epithelial cell cancers. A phase I/II single-arm multicentric study involving 108 patients identified that the overall response rate with the drug was 33.3% and the median duration of response was 7.7 months . It is given as an IV drug 10 mg/kg iv on days 1 and 8 every 21 days. The adverse effects are severe neutropenia and diarrhea .
A drug that targets the platelet-derived growth factor-alpha and it is indicated for the adults with unresectable metastatic stromal tumor at a dose of 300 mg orally once daily . The efficacy of the drug was evaluated in a multicentric single-arm trial involving 43 patients diagnosed with gastrointestinal stromal tumor in which the cells are harbored with platelet-derived growth factor receptor alpha mutation exon 18 mutation (GIST). It is a highly protein-bound drug and the adverse effects are cognitive impairment, diarrhea, hair color changes, and increased lacrimation .
It is a monoclonal antibody targeted against CD19 and it is approved for the treatment of relapsed or refractory B cell lymphoma in combination with the drug lenalidomide. The approval is an accelerated approval based on the results of the phase II trial in refractory diffuse large B cell lymphoma patients . It is given as an IV infusion at a dose of 12 mg/kg. The adverse effects are neutropenia, fatigue, anemia, diarrhea, thrombocytopenia, cough, pyrexia, and peripheral edema .
The cancer drug therapy is now directed towards the targeted therapies, immunotherapy, hormonal therapy which is good at attacking the cancerous cells compared to the normal cells. This is completely different from cytotoxic drugs which affect both cancerous and normal cells. Carugo  describe the three ages of cancer drug discovery which include bronze, silver, and gold age. The bronze age is the era of the discovery of the cytotoxic drugs by a team of academicians, the silver age is the period in which the discoveries in the cancer field were led by profit organizations and the golden age in which there are well-defined biomarkers that predict and performed by academic institutions. The efforts of the academicians, researchers, organization helps identify drugs with newer targets, good efficacy and still many drugs are under clinical trials. The other treatment options like surgery, radiotherapy along with targeted drugs can reduce the morbidity depending on the stage of the cancer.
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