Review of targeted cancer therapies for the palliative care provider Part 1: Small molecules

The incorporation of 'targeted therapies' into standard cancer care has changed how clinicians treat cancer. Small molecule inhibitors, antibodies, and conjugated agents target cancer cells more specifically than traditional chemotherapy. These therapies can be used alone or in combination with chemotherapy in first-line, refractory, or relapsed settings. Although designed to spare normal tissue, these agents do have systemic toxicity. Notably, their toxicity profiles are distinct from those encountered with chemotherapy. These agents have demonstrated efficacy in terms of improved tumour response, survival, symptom control, and/or quality of life. Cancer treatment will continue to change as additional targeted agents are evaluated in clinical trials and are brought into standard medical care. The palliative care clinician is likely to encounter these agents with increasing frequency, making decisions to continue or discontinue therapy, adding targeted agents to improve symptoms, performance status, or quality of life, or advising patients to return to their oncologists for further advice as new agents become available. Presented here, Part I of this review focuses on small molecules. All but one of these agents are oral, and they are all relatively well tolerated. In the future, Part 2 will introduce antibodies and conjugated agents.

Duke Scholars

Author Daphne Ruth Friedman Medicine, Medical Oncology