Anti-Tumour Agents: The Next Generation

Around 2.9 million cases of cancer are diagnosed in Europe each year. This extensive disease burden results in over 700,000 annual deaths – a mortality count that is expected to increase as the European population ages. Lymphomas and leukaemias, the two most common types of blood cancer, account for 200,000 of these cases, and are responsible for over 120,000 annual deaths. This is only 12,000 fewer than the deaths attributable to breast cancer (1).

Fortunately, however, the recent paradigm shift in our understanding of many underlying molecular cancer pathways and chemotherapeutic mechanisms has rapidly expanded the pharmacological approaches that are open to haematological oncologists. Gleevec (imatinib mesylate), for example, was specifically developed in order to prove that targeted therapy was a realisable concept and is now commonly used in the treatment of chronic myeloid leukaemia.

This article examines some of the current innovations in blood-cancer targeted pharmacotherapy, concentrating on the cancer types where treatment advances could culminate in the most significant prognostic improvements: diffuse large B-cell lymphoma; follicular lymphoma; lymphoblastic lymphoma; acute lymphoblastic leukaemia and chronic lymphocytic leukaemia. Whilst different approaches, such as radiotherapy, stem cell transplantation and immunotherapy, are also treatment options in this area, this article focuses on pharmacological approaches.

NON-HODGKIN’S LYMPHOMAS

The non-Hodgkin’s lymphomas (NHLs) comprise a heterogeneous collection of lymphoproliferative malignancies, which are most common in people aged over 55 years. While the incidence of most other cancers is decreasing, the incidence of NHL is on the rise. During the 1970s and 1980s, worldwide NHL incidence rose by three to four per cent per year. This rise has slowed in the 1990s, but an annual increase of one to two per cent is still being recorded (2). The two most common types of NHL are diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL).