Targeted treatments are frequently referred to in everyday language as “smart chemotherapy”. This expression is used to describe the methods that, unlike the “the drug distributes to a wider area in the body” approach in conventional chemotherapy, aim for the drug to show a more selective effect according to the biological characteristics of the tumour. There is an important nuance here. When we say “targeted”, we are not talking about a single type of drug; monoclonal antibodies, antibody-drug conjugates, some carrier systems and biomarker-focused planned approaches can be talked about under the same heading.
This content is for general information purposes. Variables such as the type and stage of the cancer, the pathology findings and the person’s general health condition can directly affect the treatment decision. For an individual assessment, the opinion of the oncology team is essential.
What Should We Understand When We Say Smart Chemotherapy?
Conventional chemotherapy drugs tend to target rapidly dividing cells. For this reason, besides tumour cells, rapidly renewing normal tissues such as the hair root, the digestive system mucosa and the bone marrow can also be affected. Targeted approaches, on the other hand, aim to make use of a receptor, protein, signalling pathway that can be more prominent in the tumour cell, or some characteristics belonging to the tumour microenvironment.
The aim here is to increase the likelihood of the drug reaching the tumour and to be able to contribute to reducing some unwanted effects. This does not mean “only the tumour is affected”. The more accurate expression is that an increase in selectivity is aimed for.
Where Does the Logic Come From, Finding the Target and Directing the Drug?
Targeted applications are basically shaped around two ideas. The first is to detect a “recognisable” feature of the tumour and to aim to act on the cells carrying that feature. For example, certain receptors can be seen to be present at a higher level in some tumours. In this case, treatment planning is evaluated together with the presence and level of the target.
The second idea is to change the way the drug is carried in the body. Carrier systems such as liposomes or nanoparticles can differentiate the drug’s behaviour in circulation and can contribute to tolerability in some scenarios. In some approaches, these two ideas can also be seen together.
At this point, the question “why is the same result not obtained in every patient” comes into play. Because tumours can be heterogeneous. That is, even within the same tumour, different cell groups can carry different characteristics. In addition, tumour biology can change over time. For this reason, biomarker tests and regular monitoring hold an important place in targeted approaches.
In Which Groups Are Targeted Applications Gathered?
One of the groups most frequently coming to mind when “smart chemotherapy” is said in everyday language is monoclonal antibodies. These drugs, by binding to a certain protein on the tumour cell, can aim to affect the signalling pathways associated with that cell or to touch mechanisms that can contribute to the regulation of the immune response. Since it is not suitable in every cancer type and every patient, the presence or level of the target protein is most often evaluated.
Another important approach is antibody-drug conjugates. In this method, while the antibody behaves like an “address label”, the strong drug load carried by the antibody is aimed to be delivered to the target cell more selectively. Although theoretically it can provide a more intensive delivery to the target, the possibility of an effect on off-target tissues does not completely disappear, and the side-effect profile can vary according to the drug used.
Carrier systems are also an important part of this field. Some liposomal or nanoparticle-based formulations can contribute to tolerability in some patients by changing the distribution of the drug. However, saying that every carrier system will provide the same level of benefit in every clinical scenario would not be correct. The areas of use and suitability are determined according to the clinical situation.
Some patients also mean, by the expression “smart chemotherapy”, orally used targeted drugs. These drugs may not have the same mechanism as conventional chemotherapy. For this reason, clarifying which treatment class is being talked about in the physician consultation is useful.
For Whom Can It Be Considered, How Is the Treatment Decision Shaped?
Targeted applications generally come into consideration more in tumours carrying certain characteristics, rather than being “standard for everyone”. The main reason for this is that the presence of the target or the confirmation of the relevant biomarker may be required. A high level of a certain receptor, a certain gene change or a certain protein expression in the tumour tissue can affect the options.
The treatment decision is not made by looking only at the test result. The stage of the disease, previously received treatments, accompanying diseases, organ functions and the person’s quality-of-life goals are evaluated together. In some situations, targeted treatment can be talked about on its own, while in some situations it can be planned together with chemotherapy or other treatments. Here, instead of a single “correct scheme”, there is a decision process in which the evidence and personal conditions are addressed together.
Why Are Biomarker and Genetic Tests Talked About So Much?
The personalised approach is most often mentioned together with biomarker tests. Pathology examination, immunohistochemistry tests and some molecular methods can help to reveal the targetable characteristics of the tumour. However, not every test is necessary in every patient. Which test will be meaningful is determined according to the cancer type, the stage and the clinical question.
Two incorrect expectations are frequently seen here. The first is the thought that “if it is positive, I will definitely see benefit”. The test result shows that some options can be evaluated, but it does not give a definite result on its own. The second is the thought that “if it is negative, there are no options left”. A negative result can show that planning over that target may be limited; however, approaches aimed at different mechanisms or different clinical options can come into consideration.
Are the Side Effects Fewer, or Do They Differ More?
A frequently heard sentence for targeted approaches is “the side effects are fewer”. This can sometimes be correct, but the more accurate expression is often “the side-effect profile differs”. While some problems seen more frequently in conventional chemotherapy may decrease, different effects specific to targeted drugs can be seen. For example, skin findings, digestive system complaints, blood pressure changes, a rise in liver enzymes, situations requiring monitoring related to heart functions or infusion-related reactions can come into consideration at rates varying according to the drug. In antibody-drug conjugates or some targeted drugs, effects requiring monitoring related to the eyes, lungs or nervous system can also be talked about depending on the drug.
For this reason, a generalisation such as “smart chemotherapy does not cause side effects” is not correct. The safest approach is not to neglect regular check-ups and to establish early communication with the physician team when a new symptom arises.
Are Smart Chemotherapy and Immunotherapy the Same Thing?
In everyday conversation, these two concepts can be confused. Immunotherapy is a different treatment class that aims to support the immune system’s fight against cancer. There can be points of intersection with targeted treatments, but it is not exactly the same concept. In some cancer types, these treatments can be planned together or sequentially. Which approach will be suitable is again related to the tumour type, the biomarkers and the general clinical picture.
Frequently Asked Questions
Does smart chemotherapy replace conventional chemotherapy?
In some situations it can be evaluated on its own, and in some situations it can be planned together with chemotherapy or other treatments. This decision varies according to the characteristics of the disease.
Does everyone have the same test for targeted treatment?
No. Which biomarker or molecular test will be meaningful is determined according to the cancer type, the stage and the clinical question.
If a target is found, will the treatment definitely work?
The detection of a target makes it easier to evaluate some options, but it does not mean a definite result on its own. It is interpreted together with the clinical picture.
Are there no side effects at all?
Side effects do not completely disappear. The more accurate expression is that the side-effect profile can differ according to the drug. Regular monitoring and early reporting are important.
Are immunotherapy and smart chemotherapy the same?
They are not the same. They are different treatment classes. In some situations they can be used together or sequentially.
This text is for general information purposes and does not replace a medical assessment. How targeted treatments are evaluated in your situation is planned by the physician team together with the tumour type, stage, pathology and biomarker results. You can convey your questions within the scope of general information through the contact channels on drhasanmorcali.com.
