Saturday, August 20, 2016

Fighting Drug Resistant Cancer Using Immuno Therapy

Cancer is a notorious medical anomaly that often gets resistant to chemotherapy. Hence, newer methods are constantly being explored for fighting against it. List of Commonly Used Chemotherapy and their potential side effects are listed in my previous blog. Usually, these drugs
are given in combination to fight cancer at molecular level.

Cancer can be classified on organ system level and molecular level. For eg. breast cancer is a carcinoma of breast tissue that is different from brain tumor, pancreatic cancer and other cancer types. Breast cancer also shows perturbations in expression of variety of receptors and proteins. Hence, it can be  classified further as

i)    Basal Type or Triple Negative
ii)   HER2 positive breast cancer
iii)  Luminal A
iv)  Luminal B breast cancer cases

Similarly, most cancer shows variation in the expression levels of genes and their respective proteins. Hence targeting specific molecular pathways on a personalised level has been the focus of the cancer treatments and research.  There are antibodies been developed to fight most cancers like breast cancer, melanoma and others. Antibodies work via different mechanisms for e.g. anti-HER 2 antibody mechanism is shown in following video


Mechanism of Pertuzumab and Trastuzumab in HER-2 positive breast Cancer

In the present blog we will discuss about the various immuno targeted therapies that are been developed to fight variety of cancer. Cancer immune therapy with mono-clonal antibodies is recently explored extensively for cancer as mono or in combination with conventional small molecular inhibitors.
It is been noted that under normal circumstances genetic mutations in cancer cells present as an antigen to human immune system, which causes development of antibodies that prevents the development of cancer. However, constant evolution of cancer cells causes failure in the immune defence mechanism leading to development of cancer and also causes failure in chemotherapy. Cancer immune therapy is been developed that prevents immune regulatory pathways that causes activation of T cell. Some times cancer cells suppresses T cells via. activation of immune checkpoints like CTLA-4 and PD-1. Monoclonal antibody causes blockage of these check points and renders cancer preventive immunity, which provides a desired anticancer pharmacological response. List of monoclonal antibodies used for the cancer therapy is covered in my previous blog post about "chemotherapy against most common type of cancer". Detailed mode of action of immunotherapy against melanoma using check point directed inhibition is shown in following video.

Immunotherapy Basics and Use of PD-1 and CTLA-4 blockade by Antibody

Inspite of the fantastic strategy to kill cancer cell by boosting human immunity; there are reports of immune therapy resistant cancers. These are mostly formed as the monoclonal antibodies fails to provide protection against activation of concomitant multiple pathways that helps in cancer proliferation.  In order to boost effect of monoclonal antibodies they are mostly given in combination with small molecule inhibitors. Insilico Inc. has come up with a unique method to boost the effect of currently used monoclonal antibodies for cancer therapy.

Insilico Inc. is a computational company based in John HopKins university. They are known for developing computer based strategies for fighting ageing and cancer. One of the ongoing work at Insilico Inc. is focused on measurement and analysis of perturbations happening in the cellular pathways in patients that gives positive or negative response to the checkpoint inhibitors. This novel strategy is aimed to provide potential inhibitors that may help in boosting the pharmacological response of monoclonal antibodies. 


These 12 leads are the part of DeepPharma AI developed by Insilico Inc that alsolarge number of molecules that are predicted to be effective against age related conditions like CVD, CNS. Public sector academic groups and private sector organisations can contact Insilico Inc to test their lead molecules and find newer molecules to fight cancer and ageing. Their recent paper on "Deep Learning Applications for Predicting Pharmacological Properties of Drugs and Drug Repurposing Using Transcriptomic Data" received editor choice award by American Chemical Society. They are known for their collaborative efforts to find newer and better solution for ageing and cancer.

Saturday, May 7, 2016

Clinical Trials For Breast Cancer In US

Figure 1: Illustration of HER2 appearance in cancer cell
In addition to previous reports on the various drugs that are commonly given for the treatment of breast cancer.  However, it is important to note that at the molecular level there are different types of breast cancer. One of the most aggressive form is known as HER2 positive type. As the name suggests HER2 over expressing types are considered to be extremely aggressive in nature. It is also considered as an important biomarker in nearly 30% of the breast cancer conditions. Further, 1 in 5 cancer patients shows up-regulation of HER2 protein. Hence, HER2 targeted therapy has gained momentum in last 1 to 2 decades.

HER2 is a 68kDa protein that helps in the cell growth and development by activation of cascade of cell proliferation pathways associated to RAS, MAP kinases, m-TOR and others as shown in figure 2.  HER2 is a mostly expressed as transmembrane protein that makes this as attractive drug target.

Figure 2 shows that there are two ways to inhibit HER2 receptor. For e.g extracellular domain as the attacking point for monoclonal antibodies and intracellular domain for small molecule inhibitors.
Figure 2: Mechanism of action of HER2 receptor and the respective
inhibitors to exhibit anti-cancer effect.
The figure shows that MEK, PKC and IKK inhibitors  may aid in the HER2 inhibitors. There has been large amount of efforts been made to develop newer drugs that would target HER2 protein. There are large number of clinical trials that are been conducted for HER2 targeted therapy as shown in table below along with their status.

Table 1: highlights the list drugs that are commonly used for HER2 positive breast cancer patients. It also shows the list of clinical trials under recruiting status by clinicaltrials.gov.in 


HER2 Targeted DrugsTypeNumber of Clinical Trial Studies Under Recruiting Status)
Trastuzumab (Herceptin)Monoclonal Antibody121 (given in table 2)
Pertuzumab (Perjeta)Monoclonal Antibody12 (data download here)
Lapatinib (Tykerb) Small Molecule12 (data download here)
Ado-trastuzumab emtansine (Kadcyla, also known as TDM-1)Monoclonal antibody conjugated to cytoxic molecule 7 (data download here)

All these drugs are either used in combination of each other or in combination of other drugs that can In order to help the community who are suffering from the HER2 positive breast cancer it will be essential for them to know the clinical trials under recruitment process at National Cancer Institute (NCI).

Table 2: List of clinical trial for HER2 positive breast cancer under treatment where the patients are been recruited for the treatment.


S. No.TitleInterventionsIdentification Number
1Carboplatin+Nab-paclitaxel, Plus Trastuzumab (HER2+) or Bevacizumab (HER2-) in the Neoadjuvant SettingDrug: Carboplatin|Drug: paclitaxel albumin-stabilized nanoparticle formulation|Drug: bevacizumab|Drug: trastuzumab|Procedure: magnetic resonance imaging|Procedure: therapeutic conventional surgeryNCT00618657
2An Observational Study of Pregnancy And Pregnancy Outcomes in Women With Breast Cancer Treated With Herceptin, Perjeta In Combination With Herceptin, or Kadcyla During Pregnancy or Within 7 Months Prior To Conception (MotHER)Biological: Trastuzumab|Biological: HERMyl 1401O Trastuzumab|Drug: Paclitaxel|Drug: DocetaxelNCT00833963
3Side Effects Involving the Heart in Women With Breast Cancer Receiving Doxorubicin and TrastuzumabDrug: Afatinib|Drug: Trastuzumab|Drug: Paclitaxel|Drug: Epirubicin|Drug: CyclophosphamideNCT00875238
4Assessment of Cardiotoxicity by Cardiac Magnetic Resonance (CMR) in Breast Cancer Patients Receiving TrastuzumabProcedure: Cardiac MRI|Biological: Biomarker TestingNCT01022086
5Tolerability of the Combination of Lapatinib and Trastuzumab in Adults Age 60 or Older With HER2 Positive Locally Advanced or Metastatic Breast CancerDrug: Lapatinib|Drug: Trastuzumab|Other: laboratory biomarker analysis|Other: pharmacological studyNCT01273610
6Study of BKM120 or BYL719 and Capecitabine in Patients With Metastatic Breast CancerDrug: Tesevatinib in combination with TrastuzumabNCT01300962
7A Study Of Everolimus, Trastuzumab And Vinorelbine In HER2-Positive Breast Cancer Brain MetastasesDrug: Everolimus|Drug: Vinorelbine|Drug: TrastuzumabNCT01305941
8Intrathecal Trastuzumab for Leptomeningeal Metastases in HER2+ Breast CancerRadiation: TrastuzumabNCT01325207
9Intrathecal Trastuzumab Administration in Metastatic Breast Cancer Patients Developing Carcinomatous MeningitisDrug: paclitaxelNCT01373710
10A Study of Pertuzumab in Combination With Trastuzumab Plus an Aromatase Inhibitor in Patients With Hormone Receptor-Positive, Metastatic HER2-positive Breast CancerDrug: capecitabine [Xeloda]|Drug: trastuzumab [Herceptin]NCT01491737
11Efficacy Study of Herceptin to Treat HER2-negative CTC Breast CancerDrug: trastuzumabNCT01548677
12HER2 Imaging Study to Identify HER2 Positive Metastatic Breast Cancer Patient Unlikely to Benefit From T-DM1Drug: Trastuzumab|Drug: GemcitabineNCT01565200
13Combination Immunotherapy With Herceptin and the HER2 Vaccine NeuVaxDrug: pertuzumab|Drug: Trastuzumab|Drug: Capecitabine|Drug: Paclitaxel|Drug: Vinorelbine|Drug: Docetaxel|Drug: Exemestane|Drug: Letrozole|Drug: Anastrozole|Drug: Fulvestrant|Drug: TamoxifenNCT01570036
14Elderly Metastatic Breast Cancer: Pertuzumab-Herceptin vs Pertuzumab-Herceptin-Metronomic Chemotherapy, Followed by T-DM1Procedure: PRO Onc Assay and Treatment|Drug: Trastuzumab|Drug: PertuzumabNCT01597414
15Neratinib +/- Fulvestrant in Metastatic HER2 Non-amplified But HER2 Mutant Breast CancerDrug: Herceptin|Drug: GM-CSFNCT01670877
16Imaging for Response Assessment of Neoadjuvant Chemotherapy in Primary Breast Cancer (GALADON)Drug: Albumin-bound paclitaxel|Drug: Carboplatin|Drug: Herceptin®NCT01690325
17A Combination Study of Kadcyla (Trastuzumab Emtansine) and Capecitabine in Participants With Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Metastatic Breast Cancer (mBC) or HER2-Positive Locally Advanced/Metastatic Gastric Cancer (LA/mGC)Drug: Intra-arterial Cerebral Infusion of TrastuzumabNCT01702558
18A Study of Kadcyla (Trastuzumab Emtansine) in Patients With HER2 Positive Breast Cancer Who Have Received Prior Anti-HER2 And Chemotherapy-based TreatmentDrug: Trastuzumab|Drug: GRN 1005NCT01702571
19CharactHer. ICORG 12-09, V3Drug: trastuzumab|Drug: vinorelbineNCT01722890
20Ad/HER2/Neu Dendritic Cell Cancer Vaccine TestingDrug: Afatinib once daily (OD)|Drug: Vinorelbine WeeklyNCT01730118
21Lapatinib+Vinorelbine vs Vinorelbine HER2 Positive Metastatic Breast Cancer Progressed After Lapatinib/TrastuzumabDrug: Epirubicin|Drug: Docetaxel|Drug: Trastuzumab|Drug: CarboplatinNCT01730677
22Pertuzumab, Trastuzumab, and Paclitaxel Albumin-Stabilized Nanoparticle Formulation in Treating Patients With HER2-Positive Advanced Breast CancerBiological: pertuzumab|Biological: trastuzumab|Drug: paclitaxel albumin-stabilized nanoparticle formulation|Other: laboratory biomarker analysisNCT01730833
23Paclitaxel and Cyclophosphamide With or Without Trastuzumab Before Surgery in Treating Patients With Previously Untreated Stage I-III Breast CancerDrug: paclitaxel|Drug: cyclophosphamide|Biological: trastuzumab|Procedure: therapeutic conventional surgery|Radiation: radiation therapy|Drug: doxorubicin hydrochloride|Other: laboratory biomarker analysisNCT01750073
24HELENA Study: An Observational Study of Perjeta (Pertuzumab) in First-Line Treatment in Patients With Her2-Positive Advanced Breast Cancer After Adjuvant Herceptin TherapyDrug: Docetaxel|Drug: Carboplatin|Drug: Herceptin|Drug: VinorelbineNCT01777958
25Effect of Trastuzumab on Disease Free Survival in Early Stage HER2-Negative Breast Cancer Patients With ERBB2 Expressing Disseminated Tumor CellsDrug: non-pegylated liposomal doxorubicin|Drug: Carboplatin|Drug: Paclitaxel|Drug: Epirubicin|Drug: Cyclophosphamide|Drug: Pertuzumab|Drug: Trastuzumab|Drug: Ferric carboxymaltoseNCT01779050
26Phase 1b/2 Trial Using Lapatinib, Everolimus and Capecitabine for Treatment of HER-2 Positive Breast Cancer With CNS MetastasisDrug: nab-paclitaxelNCT01783756
27Pre Operative Trastuzumab in Operable Breast CancerDrug: docetaxel+lapatinib|Drug: docetaxel + trastuzumab|Drug: docetaxel + trastuzumab + lapatinibNCT01785420
28Paclitaxel + Trastuzumab + Pertuzumab as Pre-Op for Inflammatory BrCaDrug: Lapatinib and Capecitabine and VinorelbineNCT01796197
29Imaging With 111 Indium (111In)-Pertuzumab (PmAb) to Predict Response to Trastuzumab (TmAb) in Human Epidermal Growth Factor-2 (HER2) Positive Metastatic Breast Cancer (MBC) or Locally Advanced Breast Cancer (LABC)Drug: Palbociclib|Drug: Trastuzumab|Drug: LetrozoleNCT01805908
30Ado-Trastuzumab Emtansine in Treating Patients With HER2-Positive Metastatic or Locally Advanced Breast Cancer That Cannot Be Removed by SurgeryDrug: docetaxel|Drug: pertuzumab|Drug: trastuzumab emtansineNCT01816035
31A Prospective, Randomized Multicenter, Open-label Comparison of Preoperative Combination of Trastuzumab and Pertuzumab With or Without Concurrent Taxane Chemotherapy Given for Twelve Weeks in Patients With Operable HER2+/HR- Breast Cancer Within the ADAPT ProtocolDrug: Lapatinib|Biological: TrastuzumabNCT01817452
32Phase 2 Study of the Monoclonal Antibody MGAH22 (Margetuximab) in Patients With Relapsed or Refractory Advanced Breast CancerDrug: Lapatinib|Biological: TrastuzumabNCT01828021
33Identification of Early Markers of Response and Resistance to TrastuzumabDrug: Metoprolol|Drug: Placebo|Drug: Candesartan|Drug: PlaceboNCT01834950
34Study of Propranolol in Newly Diagnosed Breast Cancer Patients Undergoing Neoadjuvant ChemotherapyDrug: trastuzumab (Herceptin®)|Drug: anastrazole (Arimidex®)NCT01847001
35NSABP Biospecimen Discovery ProjectDrug: BEZ235 + paclitaxel|Drug: BKM120 + paclitaxel|Drug: BEZ235 + paclitaxel + trastuzumab|Drug: BKM120 + paclitaxel + trastuzumabNCT01850628
36T-DM1 vs Paclitaxel/Trastuzumab for Breast (ATEMPT Trial)Biological: trastuzumabNCT01853748
37Phase 2 Trial of Pertuzumab and Trastuzumab With Weekly Paclitaxel and Chemotherapy for HER2 Positive Breast CancerDrug: LJM716|Drug: TrastuzumabNCT01855828
38Capecitabine, Cyclophosphamide, Lapatinib Ditosylate, and Trastuzumab in Treating Patients With HER2-Positive Metastatic Breast CancerDrug: capecitabine|Drug: cyclophosphamide|Drug: lapatinib ditosylate|Biological: trastuzumab|Other: laboratory biomarker analysisNCT01873833
39Defining the HER2 Positive (+) Breast Cancer Kinome Response to Trastuzumab, Pertuzumab, Combination Trastuzumab +Pertuzumab, or Combination Trastuzumab + LapatinibDrug: Trastuzumab|Drug: pertuzumab|Drug: lapatinibNCT01875666
40Efficacy and Safety of Bevacizumab in the Neodjuvant Treatment of Inflammatory Breast CancerDrug: Standard chemotherapy|Drug: bevacizumab [Avastin]|Drug: trastuzumab [Herceptin]NCT01880385
41Phase II Trial to Validate Markers for a Response Evaluation of a Combined Therapy in Patients With HER2+ Breast CancerBiological: MargetuximabNCT01891357
42Chemotherapy Before Surgery and Tissue Sample Collection in Patients With Stage IIA-IIIC Breast CancerDrug: Cyclophosphamide|Other: Cytology Specimen Collection Procedure|Drug: Doxorubicin Hydrochloride|Other: Laboratory Biomarker Analysis|Drug: Paclitaxel|Biological: TrastuzumabNCT01897441
43Cardiac Safety Study in Patients With HER2 + Breast CancerDrug: Herceptin|Drug: Taxol|Drug: Fluorouracil|Drug: Cytoxan|Drug: EpirubicinNCT01904903
44Phase II Study of Eribulin Mesylate, Trastuzumab, and Pertuzumab in Women With Metastatic, Unresectable Locally Advanced, or Locally Recurrent HER2-Positive Breast CancerDrug: Pertuzumab, Trastuzumab and EribulinNCT01912963
45Pertuzumab and Trastuzumab as Neoadjuvant Treatment in Patients With HER2-Positive Breast CancerDrug: fulvestrant 500 mg|Drug: Docetaxel (T) 75 mg/m2 (Taxotere)|Drug: Trastuzumab (H, 8mg/kg|Drug: Pertuzumab (P, 840 mgNCT01937117
46Trastuzumab Combined With Chemotherapy or Endocrine Therapy to Treat Metastatic Luminal B2 Breast CancerDrug: doxorubicine, cyclophosphamide, docetaxel|Drug: doxorubicine, cyclophosphamide, trastuzumab, docetaxel|Drug: trastuzumab, docetaxel, carboplatinNCT01950182
47IMaging PAtients for Cancer Drug selecTion - Metastatic Breast CancerDrug: Standard Therapy|Drug: AMG 386|Drug: AMG 479 (Ganitumab) plus Metformin|Drug: MK-2206 with or without Trastuzumab|Drug: AMG 386 and Trastuzumab|Drug: T-DM1 and Pertuzumab|Drug: Pertuzumab and Trastuzumab|Drug: Ganetespib|Drug: ABT-888|Drug: Neratinib|Drug: PLX3397|Drug: PembrolizumabNCT01957332
48Trastuzumab and Pertuzumab or Bevacizumab With Combination Chemotherapy in Treating Patients With Stage II-III Breast CancerBiological: trastuzumab|Biological: Pertuzumab|Drug: docetaxel|Drug: carboplatin|Drug: doxorubicin|Drug: cyclophosphamide|Drug: paclitaxel|Other: laboratory biomarker analysis|Other: pharmacogenomic studies|Drug: BevacizumabNCT01959490
49Validity of HER2-amplified Circulating Tumor Cells to Select Metastatic Bresat Cancer Considered HER2-negative for Trastuzumab-emtansine (T-DM1) Treatment.Drug: bevacizumab|Drug: no bevacizumabNCT01975142
50Phase 1b Study of PD-0332991 in Combination With T-DM1(Trastuzumab-DM1)Drug: Trastuzumab|Drug: Pertuzumab|Drug: Palbociclib|Drug: FulvestrantNCT01976169
51NK Cell Infusions With Trastuzumab for Patients With HER2+ Breast and Gastric CancerDrug: Lapatinib|Biological: TrastuzumabNCT02030561
52A Study of Subcutaneous Herceptin (Trastuzumab) Administered at Home By Single-Use Injection Device in Patients With Early HER2-Positive Breast Cancer (HOMERUS)Drug: Lapatinib plus trastuzumabNCT02040935
53Study of Optimizing Neoadjuvant Regimens in Subtypes of Breast CancerDrug: Nab-PaclitaxelNCT02041338
54Ganetespib, Paclitaxel, Trastuzumab and Pertuzumab for Metastatic Human Epidermal Growth Factor Receptor 2 Positive Breast CancerDrug: ganetespib|Drug: paclitaxel|Biological: trastuzumab|Biological: pertuzumabNCT02060253
5589ZrTrastuzumab Breast Imaging With Positron Emission TomographyDrug: Epothilone D|Drug: HerceptinNCT02065609
56Ruxolitinib in Combination With Trastuzumab in Metastatic HER2 Positive Breast CancerDrug: Ruxolitinib|Drug: TrastuzumabNCT02066532
57Neoadjuvant TDM1 With Lapatinib and Abraxane Compared With Trastuzumab Plus Pertuzumab With PaclitaxelDrug: paclitaxel plus trastuzumabNCT02073487
58TDM1 With Abraxane and Lapatinib for Metastatic HER2 Positive Breast CancerDrug: docetaxel + trastuzumab sc + pertuzumab|Drug: trastuzumab emtansinNCT02073916
59Strain Imaging in Breast Cancer Patients Receiving TrastuzumabDrug: BMK120|Drug: Capecitabine|Drug: BYL719|Drug: Trastuzumab|Drug: LapatinibNCT02080390
60A Study to Assess the Efficacy and Safety of Enzalutamide With Trastuzumab in Subjects With Human Epidermal Growth Factor Receptor 2 Positive (HER2+), Androgen Receptor Positive (AR+) Metastatic or Locally Advanced Breast CancerDrug: enzalutamide|Drug: trastuzumabNCT02091960
61Cardiotoxicity in Metastatic Her 2 Positive Patients Treated With Trastuzumab ,Pertuzumab and TaxanesDrug: Paclitaxel and carboplatin|Drug: Paclitaxel|Drug: Epirubicin and PaclitaxelNCT02101879
62A Phase III Trial Comparing Two Dose-dense, Dose-intensified Approaches (ETC and PM(Cb)) for Neoadjuvant Treatment of Patients With High-risk Early Breast Cancer (GeparOcto)Drug: Trastuzumab emtansineNCT02125344
63Anti-PD-1 Monoclonal Antibody in Advanced, Trastuzumab-resistant, HER2-positive Breast CancerDrug: HBI-8000|Drug: Trastuzumab|Drug: PaclitaxelNCT02129556
64Phase I/IIa Trial of Gemcitabine Plus Trastuzumab and Pertuzumab in Previously Treated Metastatic HER2+ Breast CancerDrug: BIBW 2992|Drug: trastuzumab|Drug: vinorelbine|Drug: vinorelbineNCT02139358
65Everolimus, Letrozole and Trastuzumab in HR- and HER2/Neu-positive PatientsOther: 111In-Pertuzumab + SPECT-CTNCT02152943
66Open-Label Study Evaluating the Safety and Tolerability of LJM716, BYL719 and Trastuzumab in Patients With Metastatic HER2+ Breast CancerDrug: Lapatinib|Drug: TrastuzumabNCT02167854
67Carvedilol for the Prevention of Anthracycline/Anti-HER2 Therapy Associated Cardiotoxicity Among Women With HER2-Positive Breast Cancer Using Myocardial Strain Imaging for Early Risk StratificationBiological: MGAH22NCT02177175
68An Open-Label Randomized Study to Investigate the Tolerability of Subcutaneous (SC) Trastuzumab Administration in Patients With HER2-Positive Early Breast Cancer (eBC) Using Either a Single-Use Injection Device or Manual AdministrationDrug: HKI-272 (neratinib)|Drug: HKI-272 (neratinib)NCT02194166
69Evaluation of Biomarkers Associated With Response to Subsequent Therapies in Subjects With HER2-Positive Metastatic Breast CancerDevice: PICC|Device: PORTNCT02213042
70MM-302 Plus Trastuzumab vs. Chemotherapy of Physician's Choice Plus Trastuzumab in HER2-Positive Locally Advanced/Metastatic Breast Cancer PatientsDrug: MM-302|Drug: Gemcitabine|Drug: Capecitabine|Drug: Vinorelbine|Drug: TrastuzumabNCT02213744
71Neoadjuvant Trastuzumab and Letrozole for Postmenopausal WomenDrug: pertuzumab|Drug: pertuzumab|Drug: trastuzumab [Herceptin]|Drug: trastuzumab [Herceptin]|Drug: vinorelbineNCT02214004
72Copper Cu 64-DOTA-Trastuzumab PET in Predicting Response to Treatment With Ado-Trastuzumab Emtansine in Patients With Metastatic HER2 Positive Breast CancerRadiation: fludeoxyglucose F 18|Procedure: positron emission tomography|Procedure: computed tomography|Biological: trastuzumab|Radiation: copper Cu 64-DOTA-trastuzumab|Procedure: positron emission tomography|Biological: ado-trastuzumab emtansine|Other: laboratory biomarker analysisNCT02226276
73Phase 2 Study of Standard Chemotherapy With Trastuzumab, Plus or Minus Pertuzumab, for Pre-treated Metastatic Breast CancerDrug: Trastuzumab|Drug: Pertuzumab|Drug: Vinorelbine, Paclitaxel, Nab-Paclitaxel , Docetaxel, CapecitabineNCT02229149
74A Dose-Escalation Study Evaluating the Combination of Trastuzumab Emtansine (T-DM1) With Neratinib in Women With Metastatic HER2-Positive Breast CancerDrug: pegylated liposomal doxorubicinNCT02236000
75Cardiotoxicity Prevention in Breast Cancer Patients Treated With Anthracyclines and/or TrastuzumabDrug: Neratinib|Drug: Fulvestrant|Drug: TrastuzumabNCT02236806
76Safety and QoL of Trastuzumab With Lapatinib or Chemiotherapy in MBC and HER2+ Patients Refractory to Anti HER2 TherapiesDrug: INCB007839 300mg BID|Drug: Trastuzumab|Drug: VinorelbineNCT02238509
77Gemcitabine, Trastuzumab, and Pertuzumab in the Treatment of Metastatic HER2-Positive Breast Cancer After Prior Trastuzumab/Pertuzumab, or Pertuzumab Based TherapyDrug: Everolimus|Drug: PlaceboNCT02252887
78Cabozantinib +/- Trastuzumab In Breast Cancer Patients w/ Brain MetastasesDrug: Cabozantinib|Drug: TrastuzumabNCT02260531
79Can HER2 Targeted 89Zr-trastuzumab PET/CT Identify Unsuspected HER2 Positive Breast Cancer Metastases, Which Are Amenable to HER2 Targeted Therapy?Radiation: 89Zr-trastuzumab|Device: PET/CT scanNCT02286843
80Phase II Trial of Combination Immunotherapy With NeuVax and Trastuzumab in High-risk HER2+ Breast Cancer PatientsBiological: NeuVax vaccine|Drug: Trastuzumab|Drug: GM-CSFNCT02297698
81An Observational Study of Herceptin SC Safety in Breast CancerBiological: HER2 CTL vaccine (plus trastuzumab)NCT02305628
82An Observational Study of Kadcyla Safety in Breast CancerDrug: Docetaxel|Drug: pertuzumab [Perjeta]|Drug: trastuzumab [Herceptin]NCT02305641
83Pembrolizumab and Monoclonal Antibody Therapy in Advanced CancerOther: Standard Dose Dense Doxorubucin and Cyclophosphomide|Other: Standard Doxorubucin and Cyclophosphomide|Other: Standard Docetaxel, Carboplatin, and Herceptin|Other: Standard Docetaxel, Doxorubucin and Cyclophosphomide|Other: Standard Docetaxel and CyclophosphomideNCT02318901

84T-DM1+Pertuzumab in Pre-OP Early-Stage HER2+ BRCADrug: Herceptin|Drug: afatinib|Drug: trastuzumab|Drug: Herceptin|Drug: afatinib|Drug: afatinibNCT02326974
85Study of ASLAN001 in Combination With Capecitabine in MBC That Has Failed on Prior TrastuzumabDrug: Herceptin™ (Her)|Drug: Herceptin™ (Her) + chemoNCT02338245
86Neoadjuvant Phase II Trial in Patients With T1c Operable, HER2-positive Breast Cancer According to TOP2A StatusDrug: Kadcyla (trastuzumab emtansine)NCT02339532
87Detect V / CHEVENDO (Chemo vs. Endo)Drug: TAC chemotherapy|Drug: TC chemotherapy|Drug: Dose Dense AC or FEC100 followed by paclitaxel or docetaxel chemotherapy|Drug: TCH chemotherapy|Drug: T + trastuzumab followed by CEF + trastuzumab|Drug: Dose dense AC followed by T + trastuzumab|Drug: Dose dense AC followed by T + trastuzumab + pertuzumab|Drug: PTH followed by dose dense AC of FECNCT02344472
88Neoadjuvant Hormonal Therapy Combined With Chemoimmunotherapy (Taxotere, Trastuzumab and Pertuzumab) in Patients With HER2-positive and ER-Positive Breast CancerRadiation: radiation therapy|Drug: Capecitabine|Drug: Trastuzumab|Drug: PaclitaxelNCT02345772
89A Multi-Center Study of Lapatinib in Patients With Trastuzumab-refractory Metastatic Breast CancerDrug: capecitabine [Xeloda]|Drug: Taxotere|Drug: Herceptin (HER2-neu positive patients only)|Drug: capecitabine [Xeloda]|Drug: TaxotereNCT02362958
90Phase Ib Dose-escalation Trial of Taselisib (GDC-0032) in Combination With Anti-HER2 Therapies in Participants With Advanced HER2+ Breast CancerDrug: GDC-0941|Drug: Trastuzumab|Drug: trastuzumab-MCC-DM1NCT02390427
91Dose-confirmation Study of ASLAN001 Combined With Weekly Paclitaxel and Carboplatin in Advanced Solid Tumours, Followed by a Study in Patients With Stage I-III HER2 Positive Breast CancerDrug: Myocet|Drug: Taxotere|Drug: HerceptinNCT02396108
92A Study Looking the Incidence and Severity of Diarrhea in Patients With Early-Stage HER2+ Breast Cancer Treated With Neratinib and LoperamideOther: Blood, Echocardiography, and Questionnaire Timepoints for Anthracycline abd Trastuzumab|Other: Blood, Echocardiography and Questionnaire for Trastuzumab|Other: Blood, Echocardiography and Questionnaire for Anthracycline RegimenNCT02400476
93Phase IIIb Study to Evaluate the Safety and Tolerability of Herceptin SC With Perjeta and Docetaxel in Patients With HER2-positive Advanced Breast CancerDrug: Temsirolimus|Drug: NeratinibNCT02402712
94Preoperative Study With Trastuzumab, Pertuzumab and Letrozole in Patients With Breast Cancer Sensitive to Hormonal TherapyDrug: bevacizumab|Drug: vinorelbine|Drug: trastuzumabNCT02411344
95Trastuzumab Emtansine in Treating Older Patients With Human Epidermal Growth Factor Receptor 2-Positive Stage I-III Breast CancerBiological: Trastuzumab Emtansine|Other: Questionnaire Administration|Other: Laboratory Biomarker Analysis|Other: Quality-of-Life AssessmentNCT02414646
96Safety and Efficacy of Trastuzumab as Part of Breast Cancer Treatment RegimenDrug: vinorelbine|Drug: carboplatin|Drug: trastuzumabNCT02419742
97Physical Activity Intervention on Myocardial Function in Patients With HER2 + Breast CancerDrug: lapatinib and capecitabineNCT02433067
98Breast Cancer Treatment Using Weekly Carboplatin + Paclitaxel With Pertuzumab + Trastuzumab (HER2+) or Bevacizumab (HER2-) in the Neoadjuvant SettingDrug: trastuzumab|Drug: chemotherapyNCT02436993
99Cardiac Toxicity in Medical Treatment of Breast CancerOther: Cardiac MRINCT02440620
100Safety Study of Pertuzumab (In Combination With Trastuzumab and Docetaxel) in Indian Patients With Breast CancerDrug: Gemcitabine|Drug: Carboplatin|Drug: TrastuzumabNCT02445586
101Study of Palbociclib and Trastuzumab With or Without Letrozole in HER2-positive Metastatic Breast CancerDrug: G-CSF|Drug: trastuzumab|Drug: vinorelbine|Drug: G-CSF|Drug: salineNCT02448420
102A Study of Liposomal Doxorubicin + Docetaxel + Trastuzumab + Metformin in Operable and Locally Advanced HER2 Positive Breast CancerDrug: Liposomal doxorubicin|Drug: Docetaxel|Drug: Trastuzumab|Drug: MetforminNCT02488564
103Margetuximab Plus Chemotherapy vs Trastuzumab Plus Chemotherapy in the Treatment of HER2+ Metastatic Breast CancerDrug: Trastuzumab, Pertuzumab, Ado-trastuzumab emtansineNCT02492711
104A Study on Neoadjuvant Therapy for Her-2 Positive Breast Cancer and the Prognosis by Detecting CTCsBiological: recombinant interleukin-12|Biological: ABI-007/carboplatin/trastuzumabNCT02510781
105A Randomized, Open-label Phase III Trial to Evaluate the Efficacy and Safety of Pertuzumab Retreatment in Previously Pertuzumab, Trastuzuamb and Chemotherapy Treated Her2-Positive Metastatic Locally Advanced and Metastatic Breast Cancer(Study of Perjeta Re-treatment for Clinical Outcomes)Drug: Doxorubicin|Drug: cyclophosphamide|Drug: paclitaxel|Drug: docetaxel|Drug: Trastuzumab|Drug: PertuzumabNCT02514681
106Pertuzumab With High-Dose Trastuzumab in Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Metastatic Breast Cancer (MBC) With Central Nervous System (CNS) Progression Post-RadiotherapyDrug: Trastuzumab emtansineNCT02536339
107Long-term Outcome of HER2-amplified Metastatic Breast Cancer: A Retrospective AnalysisOther: BiopsyNCT02560311
108T-DM1 and Non-pegylated Liposomal Doxorubicin in HER2-positive Metastatic Breast CancerDrug: E7389NCT02562378
109Neoadjuvant Response-guided Treatment of HER2 Positive Breast CancerBiological: trastuzumab|Drug: capecitabine|Drug: paclitaxelNCT02568839
110Super-selective Intra-arterial Cerebral Infusion of Trastuzumab for the Treatment of Cerebral Metastases of HER2/Neu Positive Breast CancerDrug: Zoledronic acidNCT02571530
111A Randomized, Double-Blind, Placebo-Controlled Study in Patients With Early-Stage or Locally Advanced HER2-positive Breast Cancer to Evaluate Treatment With Trastuzumab + Pertuzumab + Docetaxel Compared With Trastuzumab + Placebo + DocetaxelDrug: Epirubicin|Drug: Docetaxel|Drug: Capecitabine|Drug: TrastuzumabNCT02586025
112Neoadjuvant Nab-PTX and Trastuzumab for ER Negative and HER2 Positive Breast CancerDrug: nab-paclitaxel|Drug: TrastuzumabNCT02598310
113Safety and Pharmacokinetics of Atezolizumab in Combination With Trastuzumab Emtansine or With Trastuzumab and Pertuzumab in Participants With HER2-Positive Breast CancerDrug: Doxorubicin|Biological: Trastuzumab|Drug: Cyclophosphamide|Drug: Paclitaxel|Drug: Epirubicin|Drug: Docetaxel|Drug: Carboplatin|Drug: FluorouracilNCT02605915
114Study of ONT-380 vs Placebo in Combo w/ Capecitabine & Trastuzumab in Patients w/ Metastatic HER2+ Breast CancerDrug: trastuzumab, docetaxel and carboplatin in dose dense regimenNCT02614794
115Assessment for Long-Term Cardiovascular Impairment Associated With Trastuzumab Cardiotoxicity in HER2-Positive Breast Cancer SurvivorsDrug: Lapatinib|Drug: Doxorubicin|Drug: Cyclophosphamide|Drug: Docetaxel|Drug: pegfilgrastim|Drug: filgrastim|Drug: dexamethasone|Drug: trastuzumabNCT02615054
116PErsonalized TREatment of High-risk MAmmary Cancer - the PETREMAC TrialDrug: TrastuzumabNCT02624973
117Adjuvant Trastuzumab, Pertuzumab Plus Docetaxel in the Treatment of Early HER2-positive Breast CancerDrug: Pertuzumab|Drug: TrastuzumabNCT02625441
118Pertuzumab in First Line Treatment of HER2-positive Metastatic Breast Cancer PatientsDrug: lapatinib|Drug: carboplatin|Drug: trastuzumab|Drug: paclitaxelNCT02642458
119microRNA of Human Epidermal Growth Factor Receptor 2 (HER2)Positive Patient Treated With HerceptinOther: Blood testNCT02656589
120An Open-Label, Phase Ib/II Clinical Trial Of Cdk 4/6 Inhibitor, Ribociclib (Lee011), In Combination With Trastuzumab Or T-Dm1 For Advanced/Metastatic Her2-Positive Breast Cancer.Drug: Durvalumab|Drug: TrastuzumabNCT02657343
121Trial of Neoadjuvant Trastuzumab Emtansine in Patients With HER2-Equivocal Breast CancerDrug: Trastuzumab emtansineNCT02725541


Friday, March 11, 2016

Cancer diagnosis and chemotherapy Part-2 (AIDS Related Cancers)

Part-1 of series focused on diagnosis method for 12 most common cancer types. In the present series we have discussed about the other forms of cancers.  For the easement of reading about the cancer diagnosis procedure we have divided the series in segments. In this part of this series we will be discussing about AIDS (Acquired Immune Deficiency Syndrome) related cancer. There are three cancers that commonly occurs due to AIDS such as a) Kaposi Sarcoma, b)AIDS related lymphoma and c) Cervical cancer. Figure 1 shows incidence rates of all three types of AIDS related cancers. It indicates that NHL
Figure 1:  Incidence Rate of AIDS related cancers

a) Kaposi Sarcoma

Kaposi sarcoma is cancer where cells lining lymphs or blood vessels. It is marked by formation of black or purple colored lesions on skin or soft tissues. They usually appear on face and legs. These lesions are painful and swells. It is also possible to have such lesions/ tumors on soft tissues like mouth, lungs, digestive track or lymph nodes. There are different forms of Kaposi Sarcoma  that are divided by American Association Of Cancer based on the region they are formed viz. Epidemic AIDS related Kaposi Sarcoma, Mediterranean Kaposi Sarcoma, Endemic Kaposi Sarcoma, and Transplant related Kaposi Sarcoma. However, the Kaposi Sarcoma cells remain similar.

b) AIDS related Lymphoma

Lymphoma cancer is a type of problem cased due to uncontrolled growth of cells in lymph nodes. There are two types of lymphomas a) Hodgkin and b) Non-hodgkin lymphoma (NHL). People with Hodgkin lymphoma have abnormally large lymphocytes in lymph nodes. People with Hodgkin lymphoma can be cured easily. Whereas, Diagnosis method and treatment for NHL was discussed previously here. 

c) Cervical cancer

It is a cancer of cervix in females. The cells in cervix do not choiange suddenly change to cancerous. They convert to precancerous such as i) cervical intraepithelial neoplasia (CIN), ii) squamous intraepithelal lesion (SIL) and iii) dysplasia. These precancerous conditions changes to squamous cell carcinoma (where exocervix joins endocervix) and adenocarcinoma (mucus producing cells of endocervix). Cervical adenocarcinoma is most common type of cancers.

Table 1: Diagnosis & Therapy of AIDS Related Cancer


Cancer TypeTissue BiopsyBlood TestsBiomarker and Gene mutation TestsUrine TestImaging TestsOther Tests
Kaposi SarcomaPunch biopsy for skin lesionNANANAX-RaysNA
Excisional biopsy if entire lesion is removedBronchosopy
Bronchosopy or endoscopy is done for biopsy of lungs and intestinesUpper endoscopy
Colonoscopy
Capsulescopy
Double balloon enteroscopy
Hodgkin LymphomaExcisional or incisional biopsy of lymph node (microscopic identification of Reed-Sternber cells)NACD15 and CD30 positive on surface of Reed-Sternberg cellsNANANA
Fine needle aspiration (FNA) or core needle biopsy
Bone marrow aspiration and biopsy
Non-Hodgkin Lymphoma (NHL)Discussed Previously
Cervical CancerPap TestNANANACystoscopy, proctoscopy, and examination under anesthesiaNA
Colposcopic biopsyMRI
Endocervical curettageCT Scan
Cone biopsyChest X-ray
Intravenous Urography

Table 2: Chemotherapy for AIDS related cancers



CancerChemotherapySide Effects
Kaposi SarcomaDoxorubicinWeaknening of heart muscles causing decrease in blood pumping capacity
Daunorubicin
PaclitaxelPeripheral neuropathy, allergic reactions, low blood counts, low blood pressure
Gemcitabineflu like symptoms, fatigue, blood or protein in urine
VinorelbineMuscle weakness

VinblastineFever,extreme fatigue, black or tarry stools, chest pain, presistant headache, urinary retention
VincristineAbdominal cramps, peripheral neuropathy, severe abdominal pain, constipation
EtoposideMenopause, loss of fertility, peripheral neuropathy
Hodgkin LymphomaDoxorubicinDISCUSSED PREVIOUSLY
VinblastineDISCUSSED PREVIOUSLY
DacarbazineSlight risk of leukemia, fever, low blood counts leading to increased the risk of anemia
EtoposideMenopause, loss of fertility, peripheral neuropathy
CyclophosphamideLoss of fertility, discoloration of nails
Procarbazinelow platelet and white blood cell counts
PrednisoneIncreased apetite, insomnia, heartburn, muscle weakness
MechlorethamineRinging sensation in ears, taste change, increased uric acid levels
VincristineDISCUSSED PREVIOUSLY
Non Hodgkin Lymphoma (NHL)
Cervical CancerCisplatinPeripheral neuropathy (nerve damage)
5-fluorouracilCardiovascular problems
CarboplatinPeripheral neuropathy, central toxicity, hearing loss, infection
PaclitaxelDISCUSSED PREVIOUSLY

GemcitabineDISCUSSED PREVIOUSLY
DocetaxelPain and buring sensation in hand and feet, sensitivity to cold and heat
IfosfamideNeurotoxicity and there is a risk of developing leukemia
MitomycinPulmonary fibrosis, pneumonitis, hemolytic uremic syndrome
IrinotecanHeart burn, dehydration, head ache, flatulence

Thursday, February 18, 2016

Insilico Medicine launches Aging.AI -- deep-learned predictor of age trained on blood tests

Insilico Medicine launches Aging.AI -- deep-learned predictor of age trained on blood tests: Insilico Medicine launched aging.AI, a system allowing users to guess their age and gender by entering the results of their blood test.

Thursday, January 21, 2016

Chemotherapy for Most Common Cancers- Part 1

In part-1 of this series we are focusing on drugs that are used for most common cancer types that are discussed in our most viewed piece "Clinical Diagnosis of Cancer or Cancers"

Figure 1: Commonly diagnosed cancers. It shows estimated cases and
deaths due to these cancers


In our previous discussions, we showed how Oncofinder service introduced by Insilco Inc and Pathway Pharmaceutical helps in identification of chemotherapy drugs for patients on personalised basis. This se
rvice is accessible to patients and doctors. In addition we observed that in many cancer discussion forums there is a great confusion and anxiety about the use of correct chemotherapy.

Moreover, there were flooded with following questions:

a) What type chemotherapy to be used for breast cancer, pancreatic cancer etc.?
b) If "A" molecule worked for a specific person will it work in my case?
c) What are the specific side effect or toxicity of drug?
Figure 2: Word Cloud for Chemotherapy Drugs
d) Is there any alternative to "drug A" if it does not work in a cancer condition?
e) What are the new drugs introduced for cancer therapy?

To answer all these questions we have compiled a list of drugs that are being used for most common type of cancers in table 1. Further, we have also linked it to reliable sources so that readers can cross refer to the authenticated links for more details about side effects and pharmacology of the drugs used. Readers can also click on cancer types to locate the details of the therapies recommended for cancer type.


Most commonly seen side effects of chemotherapy are

a) Weight loss
b) Gastrointestinal abnormalities like diarrhoea and constipation
c) Hair loss
d) Severe muscles fatigue
e) Nausea and vomiting
f) loss of appetite
g) Rashes

In addition to this there are some serious and less common toxicities for specific drugs. We have listed them in the table 1. Readers can also cross check them by clicking on the drug type.

Table 1: Chemotherapy Drug and Its Side Effects


CancerChemotherapy Molecules/ DrugsSevere Side Effects
Bladder Fluorouracil (5-FU)Cardiovascular problems
MitomycinPulmonary fibrosis, pneumonitis, hemolytic uremic syndrome
CisplatinPeripheral neuropathy (nerve damage)
CarboplatinPeripheral neuropathy, central toxicity, hearing loss, infection
DocetaxelPain and buring sensation in hand and feet, sensitivity to cold and heat
DoxorubicinWeaknening of heart muscles causing decrease in blood pumping capacity
Vinblastin
Ifosfamide (Ifex ®)Neurotoxicity and there is a risk of developing leukemia
Permetrexed (ALIMTA ®)Low blood platelet count, flu like symptoms, depression, increase in blood creatinine level
Breast CancerDocetaxel ( Taxotere®)DISCUSSED PREVIOUSLY
PaclitaxelPeripheral neuropathy, allergic reactions, low blood counts, low blood pressure
Cisplatin and CarboplatinDISCUSSED PREVIOUSLY
VinorelbineMuscle weakness
Capecitabine (Xeloda®)Elevated liver enzymes, hand and foot syndrome (Palmar plantar erythrodysesthesia-PPE)
DoxorubicinDISCUSSED PREVIOUSLY
Gemcitabineflu like symptoms, fatigue, blood or protein in urine
MitoxantroneArrythmia, low blood pressure, blue/green discoloration of whites of eyes/ or urine for 1-2 days after treatment
IxabepilonePeripheral neuropathy, weakness, joint pain
Eribulin (Halaven ®)Constipation, muscle pain
Trastuzumab (Herceptin ®)Infection, cold symptoms, body pain
Pertuzumab (Perjeta™)Decreased apetite, fever, muscle weakness, weight gain, upper respiratory track infection
Colon Rectal Cancer5-FUDISCUSSED PREVIOUSLY
Capecitabine (Xeloda®)DISCUSSED PREVIOUSLY
Irinotecan (Camptosar®)Heart burn, dehydration, head ache, flatulence
OxaliplatinPeripheral neuropathy, diarrhea
TrifluridinNeuropathy
Endometrial CancerPaclitaxelDISCUSSED PREVIOUSLY
CarboplatinDISCUSSED PREVIOUSLY
Doxorubicin (Adriamycin ®) DISCUSSED PREVIOUSLY
Doxorubicin liposome (Doxil ®)DISCUSSED PREVIOUSLY
CisplatinDISCUSSED PREVIOUSLY
Ifosfamide (Ifex ®)DISCUSSED PREVIOUSLY
DISCUSSED PREVIOUSLY
Kidney CancerVinblastineFever,extreme fatigue, black or tarry stools, chest pain, presistant headache, urinary retention
FloxuridineStomach ulcers, elevated liver enzyme, PPE, yellowing of skin and eyes
5-FUDISCUSSED PREVIOUSLY
CapecitabineDISCUSSED PREVIOUSLY
GemcitabineDISCUSSED PREVIOUSLY
Interferone alpha (Intron® A, Roferon®-A )Flu like symptoms, fatigue and low blood counts, injection site reaction, liver damage
Nivolumab (Opdivo)Lymphocytopenia, low sodium, potassium, magnesium levels, shortness of breath, pneumonia,
Interleukin 2 (IL-2)Extreme fatigue, low BP, kidney damage, heart attacks, intestinal bleeding, rapid heart beat
Soforanib (Nexavar ®)PPE, high BP, bleeding, increased heart rate, shortness of breath
Sunitinib (Sutent ®)Heart burn, hypertesnsion, increased liver enzyme
Temsirolimus (Torisel ®)Hyperglycemia, increased cholesterol levels, increased liver enzymes, black tarry stools, constipation
Everolimus (Afinitor ®)Anemia, increased cholesterol and triglycerides, black tarry stools
Bevacizumab (Avastin ®)Upper respiratory track infection, proteinuria, gastrointestinal perforations, fistula, hemorrhage, congestive heart failure
Pazopanib (Votrient ®)Hypertension, elevated liver enzymes, bilirubin, extreme fatigue
Axitinib (Iniyta ®)High bloood pressure, kidney disfunction
Leukemia (Chronic Lymphocytic Leukemia)Fludarabine (Fludara ®)Increased risk of infection
Pentostatin (Nipent ®)Easy bruising or bleeding
Cladribine (2-CdA, Leustatin ®)Fatigue
Chlorambucil (Leukeran ®)Tumor lysis syndrome
Cyclophosphamide (Cytoxan ®)Loss of fertility, discoloration of nails
Rituximab (Rituxan ®)Pharyngitis
Bendamustine (Treanda ®)Infertiliy, yellow of skin or eyes
Prednisone Increased apetite, insomnia, heartburn, muscle weakness
MethylprednisoloneAlmost similar to prednisone
DexamethasoneAlmost similar to prednisone
Doxorubicin (Adriamycin ®)DISCUSSED PREVIOUSLY
MethotrexateAlopecia, skin photosensitivity, kidney toxicity
OxaloplatinPeripheral neuropathy
Vincristine (Oncovin ®)Abdominal cramps, peripheral neuropathy, severe abdominal pain, constipation
Etoposide (VP-16)Menopause, loss of fertility, peripheral neuropathy
Cytarabine (ara-C)Skin Rash, blurred visions, dry eyes heart palpitations, chest pain, difficulty to pass urine
Leukemia (Acute Lymphocytic Leukemia)Vincristine (Oncovin ®) or Liposomal vincristine (Marqibo ®)DISCUSSED PREVIOUSLY
Daunorubicin (Daunomycin or Cerubidine ®) or Doxorubicin (Adriamycin ®)DISCUSSED PREVIOUSLY
Cytarabine (Cytocine arabinoside, ara-C or Cytosar ®)DISCUSSED PREVIOUSLY
L-asparaginase (Elspar ®) or PEG-L-asparaginase (pegaspargase or Oncaspar ®)DISCUSSED PREVIOUSLY
Etoposide (VP-16)DISCUSSED PREVIOUSLY
Teniposide (Vumon ®)Infection, shortness of breath, swelling of facial features, rapid heart beat
6-mercaptopurine (6-MP or Purinethol ®)Losss of fertility, hyperpigmentation
MethotrexateDISCUSSED PREVIOUSLY
Cyclophosphamide (Cytoxan ®)DISCUSSED PREVIOUSLY
PrednisoneDISCUSSED PREVIOUSLY
Dexamethasone (Decadrone ®)DISCUSSED PREVIOUSLY
DISCUSSED PREVIOUSLY
Leukemia (Chronic Myeloid Leukemia)Hydroxy urea (hydroxycarbamate, Hydrea ®)Discoloration of skin and nails, fertiilty may be affected
Cytarabine (Ara-C)DISCUSSED PREVIOUSLY
Imatinib (Gleevec ®)Risk of anemia, hemorrhage, heartburn, fertiility may be affected, elevation of transaminase, bilirubin and lactate dehydrogenase
BusulfanLung Damage
Cyclophosphamide (Cytoxan ®)DISCUSSED PREVIOUSLY
Vincristin (Oncovin ®)DISCUSSED PREVIOUSLY
Omacetaxine (Synribo ®)Thromocyteopenia, neutropenia, kidney problems, fever
Non Small Cell Lung CancerCisplatinDISCUSSED PREVIOUSLY
CarboplatinDISCUSSED PREVIOUSLY
Paclitaxel (Taxol ®)DISCUSSED PREVIOUSLY
Albumin- bound Paclitaxel (nab-Paclitaxel, Abraxane ®)DISCUSSED PREVIOUSLY
Docetaxel (Taxotere ®)DISCUSSED PREVIOUSLY
Gemcitabine (Gemzar ®)DISCUSSED PREVIOUSLY
Vinorelbine (Navelbine ®)DISCUSSED PREVIOUSLY
Irinotecan (Camptosar ®)DISCUSSED PREVIOUSLY
Etoposide (VP- 16 ®)DISCUSSED PREVIOUSLY
Vinblastine DISCUSSED PREVIOUSLY
Pemetrexed (Alimta ®)Anemia, increased risk of infection, flu like symptoms, fertility problems
Bevacizumab (Avastine ®)DISCUSSED PREVIOUSLY
Cetuximab (Erbitux ®)Hypersenstivity reactions like shortness of breath, difficulty breathing
Melanoma CancerDacarbazine (also called DTIC)Slight risk of leukemia, fever, low blood counts leading to increased the risk of anemia
TemozolomideCentral neurotoxicity, edema, shortness of breath and other allergic reactions
Nab-paclitaxelDISCUSSED PREVIOUSLY
PaclitaxelDISCUSSED PREVIOUSLY
Carmustine (also known as BCNU)Anemia, low blood pressure, retinal bleeding, pulmonary toxicity, slight risk of blood cancer in long run
CisplatinDISCUSSED PREVIOUSLY
CarboplatinDISCUSSED PREVIOUSLY
VinblastineDISCUSSED PREVIOUSLY
Non Hodgkin LymphomaCyclophosphamide (Cytoxan®)DISCUSSED PREVIOUSLY
ChlorambucilRisk of infection, anemia, leukemia, infertility, pulmonary toxicity
Bendamustine (Treanda®)DISCUSSED PREVIOUSLY
Ifosfamide (Ifex®)DISCUSSED PREVIOUSLY
PrednisoneDISCUSSED PREVIOUSLY
Dexamethasone (Decadron®)DISCUSSED PREVIOUSLY
CisplatinDISCUSSED PREVIOUSLY
CarboplatinDISCUSSED PREVIOUSLY
OxaliplatinDISCUSSED PREVIOUSLY
Fludarabine (Fludara®)Lung problems, infections, anemia
Pentostatin (Nipent®)Muscle ache, itching, cough, anorexia, upper respiratory track infection
Cladribine (2-CdA, Leustatin®)Anemia, myelosuppression, neutropenic fever
Cytarabine (ara-C)DISCUSSED PREVIOUSLY
Gemcitabine (Gemzar®)DISCUSSED PREVIOUSLY
MethotrexateDISCUSSED PREVIOUSLY
Pralatrexate (Folotyn®)Decreased white blood cells, elevated liver enzyme, abdominal pain, upper respiratory track infection, shortness breath
Pancreatic CancerGemcitabine (Gemzar®)DISCUSSED PREVIOUSLY
5-FUDISCUSSED PREVIOUSLY
Irinotecan (Camptosar®)DISCUSSED PREVIOUSLY
Oxaliplatin (Eloxatin®)DISCUSSED PREVIOUSLY
Albumin-bound paclitaxel (Abraxane®)DISCUSSED PREVIOUSLY
Capecitabine (Xeloda®)DISCUSSED PREVIOUSLY
CisplatinDISCUSSED PREVIOUSLY
Paclitaxel (Taxol®)DISCUSSED PREVIOUSLY
Docetaxel (Taxotere®)DISCUSSED PREVIOUSLY
Irinotecan liposome (Onivyde®)DISCUSSED PREVIOUSLY
Erlotinib (Tarceva®) Shortness of breath, coughing, infection, eye irritation
Octreotide (Sandostatin®)Flu like syndrome, abdominal pain, constipation, flu-like syndrome
Lanreotide (Somatuline® Depot),Anemia, effects blood sugar levels
Prostate CancerDocetaxel (Taxotere®)Allergic reactions and peripheral neuropathy
Cabazitaxel (Jevtana®)Allergic reactions and peripheral neuropathy
Mitoxantrone (Novantrone®)Can cause leukemia several years later
Estramustine (Emcyt®)Increased risk of blood clot formation
Doxorubicin (Adriamycin®)DISCUSSED PREVIOUSLY
Etoposide (VP-16)DISCUSSED PREVIOUSLY
Vinblastine (Velban®)DISCUSSED PREVIOUSLY
Paclitaxel (Taxol®)DISCUSSED PREVIOUSLY
Carboplatin (Paraplatin®)DISCUSSED PREVIOUSLY
Vinorelbine (Navelbine®)DISCUSSED PREVIOUSLY
Thyroid CancerTositumomab and Radioactive Iodine (RAI) (Bexxar ®)Low blood pressure, cough, soar throat, hyopthyrodism, aches and pain

thyroid hormone (levothyroxine) pillsExtreme fatigue, chest pain, eye pain, dizziness    

Signal Transduction Pathways

Signal Transduction Pathways
RTK, GPCR, GF, Cytokine, Wnt, Death Factors & Shh pathways