Cancers of the GI System — The Next Decade Holds New Rx Hopes

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EXECUTIVE SUMMARYColorectal cancer is the most common cancer of the gastrointestinal tract. It is one of the most common malignancies in the US, with about 133,500 cases of colon and rectal cancers diagnosed annually. An estimated 54,900 die of colon cancer each year in the US. Over 93% of the cases develop after the age of 50.In general, colorectal cancer is a highly treatable and often curable disease when localized to the bowel. It is the second most frequently diagnosed malignancy in the United States and the second most common cause of cancer death. Surgery is the primary treatment and approximately 50% of patients will be cured. Recurrence following surgery is a major problem and often is the ultimate cause of death.Cancer of the pancreas is hard to diagnose because the organ is hidden behind other organs, including the stomach, small intestine, bile ducts, gallbladder, liver, and spleen. Because of the very poor prognosis associated with this malignancy, there is an urgent need to find an agent able to increase survival time or effect a cure. The ras oncogene (whose product functions in signal transduction) is mutated in about 90% of pancreatic cancers.There are a wide variety of malignant neoplasms that arise from the stomach. Most often, however, these cancers are primary and arise from the mucosal glands. Historically, they have been addressed by surgery. The prognosis, after surgery, however, has been poor. In localized distal gastric cancer, more than 50% of the patients are curable. However, this currently accounts for only 10% to 20% of all cases diagnosed in the United States. The remaining patients present with metastatic disease in either regional or distant sites. The overall survival rate in these patients at five years is practically nil.Some stomach cancers are treated with antibiotics. The theory is that they are caused by H. pylori and the antibiotic eradicates H. pylori. One type of stomach cancer so treated is mucosal-associated lymphoid tumor (MALT or gastric MALT). Antibiotic therapy is credited with eliminating the need for surgery in many cases.Table 1 on page 23 shows approximately 200 programs for cancers of the GI system, primarily in the immunotherapy, low molecular weight, molecular, monoclonal antibodies, serotonin, and vaccine technologies. Importantly, these are well represented in the different stages of clinical trials. New technologies are expected to market over the near term as well as over the long term for this indication.The treatment of colorectal cancer can offer a platform for assessing the usefulness or efficacy of some of the treatment modalities. In some more severe cancers, such as pancreatic cancer, the standard for effectiveness will be judged differently from that for colorectal cancer. In addition to conventional chemotherapy, it is likely that some of the immunotherapeutic-based therapies, such as monoclonal antibodies, and more specific immunomodulators and immunoconjugates, and in the longer term, some vaccines, may be the first wave of a success story. Small-molecular-weight therapeutics and antiangiogenesis compounds play a large role in indications pertinent to this article.Source: 2000 to 2010 — Forecasting the Pharmaceutical Business in the Decade of Change — Genesis 1999

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