New Developments in Oncological Treatment: Targeted Treatments and Immunotherapy

Abstract

In the last 20 years, when we started to understand cancer biology better, targeted therapies and immunotherapies have been developed insystemic treatments and they have started to take their place as monotherapy or combined therapies in routine practice. Treatments thataffect specific molecules are called targeted therapies. Monoclonal antibodies (mAbs), tyrosine kinase inhibitors (TKIs) and those affecting theproliferation cascade constitute the majority of targeted therapies currently used. mAbs are targeted molecules produced from a single B-cellclone by antigen exposure. Most immunotherapeutics currently in use are in the form of mAbs. The targets of mAbs that we frequently use incancer treatment today are human epidermal growth factor receptor-2 (HER-2), epidermal growth factor receptor (EGFR), vascular endothelialgrowth factor, nuclear factor kappa-B ligand receptor activator, programmed death-1 and programmed death ligand-1. Treatments fortyrosine kinases, which play an important role in growth signal modulation, are used in many types of cancer. TKIs are small molecules andare used orally. The most commonly used TKIs are anti-angiogenic multikinase inhibitors. However by the EGFR and anaplastic lymphomakinase inhibitors, a great progress has been made especially in the treatment of non-small cell lung cancer. Again BRAF/MEK, smoothened/hedgehog pathway, poly (ADP-ribose) polymerase, phosphoinositide 3-kinase, HER-2 inhibitors are other TKIs in use. The mammalian targetof rapamycin pathway is also used as a target in many cancers. Immunotherapies are therapies that regulate the immune microenvironment,strengthening the immune system and allowing immune cells to fight against tumor cells. The effect of immunotherapy on cancer cells hasbeen demonstrated by the high dose interferon, which was the first immunotherapy used. It consists of cancer vaccine, oncolytic viruses, exvivo activated T-cell and natural killer cell transfer and immune checkpoint inhibitors. All these treatments contribute significantly to thesurvival and quality of life of patients with more antitumor efficacy. A large number of new molecules are being researched going forward,and promising advances in cancer treatment will continue.