In this era of great medical advancement, how far the customised cancer therapy is helping? Like for instance.. In the treatment of Hodgkin's lymphoma.. Although monoclonal antibodies are used, oncologists still suggest conventional chemotherapy like vinblastin, bleomycin etc.. But these are really painful for a cancer patient. Can't this conventional chemo be avoided at least in cases where customised treatment is available??
When thinking in customized treatment, this idea leads us to genetic treatment, maybe if this is fully available we can think not to use chemo. MAB treatment goes to support conventional Chemo treatment, to avoid conventional chemo we need to get some data to take a based on evidence medicine decision,
Dear Kanugala
The answer to your question is 'yes but gradually'. That I mean it is going to take few more years to completely abandon the old fashioned cytotoxic drugs. In the field of Haematology, MAb and various designers drugs are slowly replacing traditional cytotoxic drugs. For instance, in chronic myeloid leukaemia the use of cytotoxic drugs has become obsolete since the introduction of tyrosine kinase inhibitors. In various lymphoid malignancies, MAb are slowly replacing traditional drugs. Even in solid tumours (eg. breast cancer), antibody therapy is replacing rather crude cytotoxic drugs. The future of cancer chemotherapy will be dominated by antibodies and small smart molecules targeting specific proteins. Another mode of therapy that is fast developing is engineered immune cells like CAR-T cells
Chemotherapy is still very much necessary in the treatment of cancer. The use of monoclonal antibodies can be added to potentiates its effect, though can't be given as a form of monotherapy.
Regarding customized/personalized medicine...
To achieve this, several studies need to be done to determine which will be the best therapeutic option/options for a specific patient. Although this studies have become less expensive, they are still not affordable by most cancer patients. However, a recent study published on the lancet oncology (Pishvaian et al, 2020) evaluated the outcome of pancreatic cancer patients receiving personalized medicine derived from molecular profiling and find that these patients have better overall survival. This suggests that personalized medicine can have a substantial effect on these patients' survival.
Regarding conventional chemo vs targeted therapy (e.g. monoclonal antibodies, receptor antagonists, etc.)...
I think this has to do with many factors like availability, cost, effectiveness, resistance, cancer type, stage, etc.
Additionally, conventional chemotherapy has been studied thoroughly, in part due to the fact that a specific drug could be used to treat many types of cancers. On the other hand, targeted therapies like monoclonal antibodies, are commonly design to treat specific types (or subtypes) of cancers, resulting in a wide variety of treatments that need a big number of particular subjects to test its efficacy.
Considering this, it could result difficult to replace a treatment scheme with widely proven efficacy with something else. Moreover, many times the endpoint in this context is to increase the patients' odds of surviving over its quality of life during the course of the disease.
In my opinion, this interchange of therapeutic options should be a well-informed medically-advised patient's decision, putting in perspective overall survival expectancy vs quality of life.