Yet Another New Way to Exterminate a Cancer Cell
| Thursday 02 Jul 2009 |
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There are two fundamental ways that a healthy normal cell can traverse the pathway to becoming a cancer cell:
- Activation of an oncogene.
- Inactivation of a tumor suppressor gene.
It is easy to comprehend how inhibiting an overly active oncogene would throttle back cancer growth. In fact, it’s being done already with drugs like gleevec and rituxan.
Harder to conceive is how to restore the function of a missing tumor suppressor gene. Despite hearty and hale efforts, this hasn’t been accomplished in any practical way.
So rather than beating your head against the wall of an intractable problem, why not approach it from a different angle? To wit, don’t try to resurrect a missing gene function, but instead take advantage of the fact that it is missing. This concept is embodied in a newish idea called synthetic lethality.
Two genes are synthetically lethal if the absence of one alone isn’t problematic, but the absence of both leads a cell to expire. Not only is this a devilishly clever idea, it’s been put to the test in a recent publication.
Writing in The New England Journal of Medicine, Fong et al. report on a clinical trial with a small molecule called olaparib (published online, 24 June 2009). The patients in the study inherited a loss of function in one of the two copies of either BRCA1 or BRCA2. Both are tumor suppressor genes that assist in preventing errors during DNA replication, and the tumors formed because the second copy became mutated.
Olaparib inhibits another enzyme independently involved in DNA proofreading. Patients getting the drug are spared the most common toxic consequences of cancer chemotherapy because normal cells have an intact BRCA system.
This may seem complicated, but the trial is a terrific success story in advancing cancer treatment. Don’t be too optimistic, though: no drug exists that is completely lacking in toxic repercussions, and no drug exists that securely avoids the challenge of drug resistance. But we’ll take any progress we can get!
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