For more on the potential of immunotherapies, read Ira Mellman's take.
How to Fight An Adaptable Enemy
To outsmart “resistance” to medicines and prevent relapse – and change cancer from a deadly disease to a manageable, chronic condition – we must develop treatments that directly overcome one of the main strengths of cancer cells: their ability to adapt in order to survive.
Cancer is cunning, and rational combinations of treatments that defeat critical cancer survival mechanisms are one of the most promising ways to help people with cancer live long and productive lives. It will take multiple medicines, diagnostic tests, companies, and the involvement of countless physicians, patients and regulators to reach this goal.
Targeting Cancer Cell Communications
Many new “targeted” medicines work by interrupting a single communication channel that tell cancer cells how to grow and spread.
This tends to work for some time, but cancer cells eventually find a way to reroute their communications. This can restart tumor growth and lead to relapse, even after a time of tumor shrinkage or stability. This is one reason why many cancers remain incurable.
Predicting How Cancer Will Adapt
We’ve spent many years researching the molecular “switchboard” that underpins cancer growth. The result is that more and more often we know - and in some cases can predict - how cancer cells will adapt and find ways around a medicine.
Fitting Attack to Adaptation
In some cases the best course of action may be to wait until resistance to the first medicine begins before layering on the next wave of attack.
We’ll have to think of better ways to test combinations in clinical trials and to support approval by regulators so we can be as nimble as the disease.
In other cases, it makes sense to come in with a one-two punch from the very beginning, and it may be that medicines that are modestly effective on their own can be very effective when part of a combination with other medicines that use different approaches.
Either way, what’s important is that these combination strategies are developed based on a deep understanding of the biology of cancer, and are tested to understand not only if they work, but if they are also safe when used together.
The Molecular Toolkit
Almost every one of our cancer medicines – those that are available today and those that are currently being investigated – are designed to interfere with one of the underlying molecular causes of cancer.
We want to give doctors a molecular toolkit of medicines that target different pathways, alongside diagnostic tests that accurately predict who is most likely to respond to them.
At Genentech, we’re enrolling or have completed about 30 trials investigating combinations of medicines (from our company and others) that may be even more effective at fighting cancer. Cancer is smart. Together, we are getting smarter.
Chris Bowden, M.D., is a board certified medical oncologist who has been working in the biotech and pharmaceutical industry for more than 15 years. Dr. Bowden entered the pharmaceutical industry in 1997 working in global development for large pharma companies in the U.S., Italy and Belgium, until 2006 when he joined Genentech as Senior Group Medical Director leading clinical development for Avastin in breast and gynecologic malignancies. Dr. Bowden is now Vice President, Global Signaling Franchise Head in the Product Development, Oncology, group. He received his medical degree from Hahnemann University, underwent post-graduate training in the Brown University program (Roger Williams Hospital and the Providence VA) and the National Cancer Institute, Medicine Branch.
MD - Hahnemann University, 1988
Residency - Brown University-Roger Williams Hospital and Providence VA, 1988-1991
Fellowship - National Cancer Institute, 1991-1994
University of Virginia, Department of Internal Medicine - 1994-1997
Janssen Pharmaceutica - 1997-1999
Pharmacia Corp - 1999-2003
Bristol-Myers Squibb 2003-2006
Genentech - 2006
Board certified-Internal Medicine, Medical Oncology