Recognizing the Dedicated Effort to Treat Emesis
Hello. I am Mark Kris from Memorial Sloan Kettering Cancer Center in New York City. Today I want to comment on the American Society of Clinical Oncology's picks for the top five advances in modern oncology. These were chosen by the cancer community to mark ASCO's 50th anniversary.
The first four of these are predictable: All of us who treat solid tumors continue to be absolutely amazed by our ability to cure testis cancer;the treatment of chronic myelogenous leukemia has been changed by targeted therapy; combination chemotherapy regimens are used to treat lymphomas and Hodgkin disease; and vaccines have been developed to prevent cervical cancer.
But today I want to spend a few minutes speaking about the fifth advance: the development of the antinausea drugs. This represents the work of many physicians, nurses, and pharmacists over many decades. Those with as much gray hair as I have can remember a day when we did not have effective antiemetics; when the administration of a drug—a course of cisplatin (Platinol®), for example—meant a multiday stay in the hospital, not to deliver the treatment but to address the severe nausea and vomiting that came on as a result of the treatment and the illness.
How did this change come about? From a concerted effort by very dedicated and focused researchers. The first antiemetic that actually worked was metoclopramide (Reglan®), which was discovered by Richard Gralla, who is now at the Albert Einstein Hospital in the Bronx, New York. The development of that agent showed that it could be effective; the fact that it was effective at high doses suggested that serotonin antagonists could be effective. Thus, when specific serotonin antagonists were available, the research processes and methods that Gralla and others had piloted were quickly used to show that serotonin antagonists were very effective and that their effects could be enhanced by dexamethasone. Later, when the NK1 antagonists became available, research showed that adding an NK1 antagonist to dexamethasone and a serotonin antagonist made an even greater difference for our patients. Now, patients who are receiving even high-dose cisplatin have no nausea and vomiting. This is a tremendous accomplishment.
Back before the development of these effective antiemetics, when you asked patients which adverse effect of cancer and cancer treatment they feared most, it was always nausea and emesis. Sadly, that answer is the same today. Nausea remains a problem, and I will return to that. But I believe that we need to give a special shout-out to the pioneers in that area. I am quite proud to say that many of those pioneers were fellow colleagues and researchers with me in the lung cancer field. These include Richard Gralla, who I mentioned; Paul Hesketh, who is now at the Lahey Clinic in Boston; the late Steve Grunberg; the group in Perugia, Italy: Fausto Roila, Maurizio Tonato, and Enzo Ballatori; many prominent lung cancer researchers, such as David Gandara and Ron Natale; and prominent breast cancer researchers, including Edith Perez. All played critical roles in discovering these drugs, proving that they worked, and getting them to the patients. They should be congratulated. They have completely changed the face of cancer care.
Ranking this development up there with the discovery of targeted therapies or the treatment of testis cancer and the ability to cure testis cancer speaks to the importance of this development. It was a great group effort.
Congratulations to all of those investigators who made this development possible. It was truly a worldwide group effort and has made a tremendous difference to our patients undergoing cancer treatment.
Hello. I am Mark Kris from Memorial Sloan Kettering Cancer Center in New York City. Today I want to comment on the American Society of Clinical Oncology's picks for the top five advances in modern oncology. These were chosen by the cancer community to mark ASCO's 50th anniversary.
The first four of these are predictable: All of us who treat solid tumors continue to be absolutely amazed by our ability to cure testis cancer;the treatment of chronic myelogenous leukemia has been changed by targeted therapy; combination chemotherapy regimens are used to treat lymphomas and Hodgkin disease; and vaccines have been developed to prevent cervical cancer.
But today I want to spend a few minutes speaking about the fifth advance: the development of the antinausea drugs. This represents the work of many physicians, nurses, and pharmacists over many decades. Those with as much gray hair as I have can remember a day when we did not have effective antiemetics; when the administration of a drug—a course of cisplatin (Platinol®), for example—meant a multiday stay in the hospital, not to deliver the treatment but to address the severe nausea and vomiting that came on as a result of the treatment and the illness.
How did this change come about? From a concerted effort by very dedicated and focused researchers. The first antiemetic that actually worked was metoclopramide (Reglan®), which was discovered by Richard Gralla, who is now at the Albert Einstein Hospital in the Bronx, New York. The development of that agent showed that it could be effective; the fact that it was effective at high doses suggested that serotonin antagonists could be effective. Thus, when specific serotonin antagonists were available, the research processes and methods that Gralla and others had piloted were quickly used to show that serotonin antagonists were very effective and that their effects could be enhanced by dexamethasone. Later, when the NK1 antagonists became available, research showed that adding an NK1 antagonist to dexamethasone and a serotonin antagonist made an even greater difference for our patients. Now, patients who are receiving even high-dose cisplatin have no nausea and vomiting. This is a tremendous accomplishment.
The Worst Adverse Effect Then and Now
Back before the development of these effective antiemetics, when you asked patients which adverse effect of cancer and cancer treatment they feared most, it was always nausea and emesis. Sadly, that answer is the same today. Nausea remains a problem, and I will return to that. But I believe that we need to give a special shout-out to the pioneers in that area. I am quite proud to say that many of those pioneers were fellow colleagues and researchers with me in the lung cancer field. These include Richard Gralla, who I mentioned; Paul Hesketh, who is now at the Lahey Clinic in Boston; the late Steve Grunberg; the group in Perugia, Italy: Fausto Roila, Maurizio Tonato, and Enzo Ballatori; many prominent lung cancer researchers, such as David Gandara and Ron Natale; and prominent breast cancer researchers, including Edith Perez. All played critical roles in discovering these drugs, proving that they worked, and getting them to the patients. They should be congratulated. They have completely changed the face of cancer care.
Ranking this development up there with the discovery of targeted therapies or the treatment of testis cancer and the ability to cure testis cancer speaks to the importance of this development. It was a great group effort.
Congratulations to all of those investigators who made this development possible. It was truly a worldwide group effort and has made a tremendous difference to our patients undergoing cancer treatment.