Word: tumors
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...There are clearly good reasons for this; medicine as a whole is getting better and we expect higher levels of knowledge in our docs. I certainly wouldn't want anyone but a neurosurgeon dissecting a tumor out of my brain, or anyone but smart oncologist coming up with the drug cocktail that might save my life from a cancer. It's usually not that hard, though. The great bulk of patient visits are for really simple things - questions that a reasonably bright resident would get right. Most pneumonias, for example, are pretty easy to treat; the internist should have...
...Many newer drugs target other pathways for tumor growth. Herceptin, introduced in 1998, interferes with a protein called epidermal growth factor by blocking the her2 receptor, a binding site that is found on the surface of many cells but is overabundant in about 25% of breast cancers. Other smart drugs interfere with the same growth factor, using slightly different chemical strategies to do so, and some have proved useful in a range of cancers. Gleevec, for example, which was approved in 2001, prevents growth factors from attaching to cancer cells and activating an enzyme called tyrosine kinase, which regulates cell...
...Gleevec reversed the odds for patients suffering from two rare cancers - chronic myelogenous leukemia and gastrointestinal stromal tumors - for which there had been no effective treatments. In a matter of months, patients who were out of options had their lives back, and while their cancer was not cured, it was under control, at least for a while. Other new drugs, including Tarceva and Iressa, also halt tumor growth by messing with tyrosine kinase. The key to developing such drugs, says Glaspy, is "torturing cancer cells, and getting them to confess to us which pathways they are dependent...
...Researchers have wrung other kinds of information out of cancer cells, including the way they spur the formation of blood vessels, which nourish their growth. Avastin, approved in 2004, is the first drug to throw a wrench into the process by suppressing a tumor's ability to recruit vascular growth factors. As with many of the newer therapies, doctors have found that it works best as part of a cocktail of cancer drugs...
...Oncologists are also excited about a new generation of tests that enable doctors to do a better job of matching the treatment to the tumor. Oncotype Dx, introduced in 2004, looks at 21 genes in biopsied tissue to determine whether or not chemotherapy will be helpful for early breast cancer patients with recent diagnoses. At Duke University, molecular geneticist Joseph Nevins is testing a similar gene-based test for lung cancer. Researchers are aiming for tools that will tell them not only whether chemo is needed but also which specific drugs to use. Such a screen already exists for Herceptin...