"The Lancet" Sub-Journal: In 82 countries' survey of oncologists, what are the "high-priority" basic anticancer drugs?

▎The content team editor of WuXi AppTec.
The World Health Organization (WHO) has promulgated a version of the Standard List of Essential Medicines (WHO-EML) every two years since 1977, which incorporates basic medical and health needs, suitable dosage forms, reasonable prices, Drugs that can guarantee the supply and are fairly accessible to the public
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 So, are the basic anti-cancer drugs listed by the WHO the same as the opinions of global clinical first-line oncologists? A study recently published in "The Lancet Oncology" (The Lancet Oncology) analyzes this
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According to the paper, this is "the first study to compare WHO's essential medicines with the understanding of clinicians
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The results show that whether it is WHO-EML or the world's first-line oncologists, the most popular "high-priority" basic anticancer drugs are all economical and traditional cytotoxic chemotherapeutics
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In addition, classic targeted drugs such as trastuzumab, rituximab, imatinib; lung cancer targeted drug osimertinib; immunotherapy drugs pembrolizumab, nivoliuximab (also the earliest Two immune checkpoint inhibitors approved for marketing in China) were also included in the top 20 list
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Screenshot source: Lancet Oncology The continuous advent of innovative targeted and immunotherapy drugs has greatly improved the therapeutic effect of malignant tumors
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At the same time, the number of anti-cancer drugs included in WHO-EML has also greatly increased (from only 7 in 1977 to 55 in 2019)
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The current international cross-sectional survey is carried out in the form of an online questionnaire.
A total of 948 clinical oncologists (median age 47 years) from 82 countries met the requirements and completed the survey
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 Oncologists’ "High Priority" Basic Anticancer Drugs According to the survey and analysis results, overall, the top 20 "high priority" anticancer drugs selected by 948 oncologists from 82 different countries around the world are as follows: Doxorubicin, Cisplatin, Paclitaxel, Pembrolizumab, Trastuzumab, Carboplatin, Fluorouracil, Tamoxifen, Capecitabine, Cyclophosphamide, Docetaxel, Oxaliplatin , Dexamethasone, nivolumab, rituximab, imatinib, gemcitabine, etoposide, osimertinib and letrozole
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▲Top 20 high-priority anti-cancer drugs selected by 948 oncologists (picture source: reference [1]) Among the top 20 “high-priority” basic anti-cancer drugs selected by these oncologists, there are 12 (60 %) are cytotoxic chemotherapy drugs, 4 (20%) are targeted drugs, 2 (10%) are immunotherapy drugs, and 2 (10%) are hormone drugs
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Among them, 13 (65%) were drugs approved by the US FDA before 2000
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In addition to osimertinib, 19 of these 20 drugs (95%) are currently in WHO-EML
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 There are 7 “high priority” basic anticancer drugs that oncologists choose the most (more than 40%).
They are doxorubicin (53%), cisplatin (50%), paclitaxel (45%), and Paclitaxel (45%).
Bolivizumab (44%), trastuzumab (42%), carboplatin (41%) and fluorouracil (41%)
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 Which cancer types are applicable to "high priority" basic anticancer drugs? At present, cytotoxic chemotherapeutics still occupy an important position in the treatment of malignant tumors.
Among the seven “high priority” anti-cancer drugs that oncologists choose the most, five of them are cytotoxic chemotherapeutics (involving anthracyclines).
Class, taxanes, platinum, and fluorouracil)
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In addition, the anti-HER2 targeted drug trastuzumab and the immune checkpoint inhibitor PD-1 monoclonal antibody pembrolizumab were also selected
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 ▪ Doxorubicin Doxorubicin is an anthracycline antibiotic isolated from the light gray strain of Streptomyces peucetius in 1969.
It has strong anti-cancer activity and can be used to treat soft tissues and osteosarcoma , A variety of solid tumors (breast cancer, small cell lung cancer, ovarian cancer, bladder cancer, thyroid cancer)
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In addition, doxorubicin can also be used to treat acute lymphoblastic leukemia, acute myeloid leukemia and Hodgkin's lymphoma
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At present, its liposome formulation has also been approved by the FDA for the treatment of ovarian cancer, AIDS-related Kaposi's sarcoma, and multiple myeloma that have failed platinum-based chemotherapy
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 ▪ Cisplatin and carboplatin-platinum drugs Cisplatin and carboplatin are currently one of the most widely used chemotherapeutics in clinical practice.
They are widely used in the treatment of non-small cell lung cancer, ovarian cancer, cervical cancer, esophageal cancer, gastric cancer, and colorectal cancer.
Common malignant tumors such as cancer and head and neck tumors
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Cisplatin can be used as a single agent or in combination with other anticancer drugs for induction therapy and neoadjuvant therapy
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Currently in the treatment of adult cancer patients, the indications approved by the FDA for cisplatin involve advanced ovarian cancer, testicular cancer and bladder cancer
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In addition, the combination of cisplatin and other drugs can also be used for the treatment of malignant tumors that dominate in women, such as breast cancer, cervical cancer, endometrial cancer, and gestational trophoblastic tumors
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Carboplatin is a second-generation platinum drug, mainly used in the treatment of gynecological tumors (such as ovarian cancer, cervical cancer, etc.
) and respiratory tumors (such as lung cancer, nasopharyngeal cancer, etc.
)
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 ▪ As a classic taxane drug, paclitaxel is currently approved by the FDA for the following indications: 1.
Adjuvant treatment of lymph node-positive breast cancer; 2.
Treatment of metastatic breast cancer after the failure of a combination therapy with anthracyclines ; 3.
Treatment of metastatic breast cancer that recurred within 6 months of adjuvant therapy containing anthracyclines; 4.
Treatment of AIDS-related Kaposi's sarcoma (second-line); 5.
Not suitable for surgery and/or radiotherapy for non-small cell lung cancer Combined treatment of patients; 6.
Combined cisplatin for the treatment of ovarian cancer; 7.
Combined cisplatin for the sequential treatment of advanced ovarian cancer
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 ▪ The advent of pembrolizumab immunotherapeutic drugs has brought a breakthrough in the field of tumor drug treatment.
Immune checkpoint inhibitors (such as PD-1/PD-L1 monoclonal antibodies) are reflected in the treatment of various malignant tumors A huge advantage
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As one of the earliest PD-1 monoclonal antibodies approved for marketing, pembrolizumab was first approved by the FDA for accelerated approval for the treatment of advanced melanoma in September 2014
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Thereafter, daclizumab and Pabo Li approved indications many more different types of cancer, such as melanoma, non-small cell lung cancer, head and neck squamous cell carcinoma, renal cell carcinoma, urothelial cancer
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Compared with the 2017 version, the 2019 version of WHO-EML included immunotherapy drugs in the list for the first time, and this time pembrolizumab was selected as a "high priority" basic anticancer drug, which once again reflects the importance of immunotherapy in the field of tumor treatment Status
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 ▪ Trastuzumab As a classic anti-HER2 targeted therapy, Trastuzumab is widely used in the whole management of HER2-positive breast cancer (early neoadjuvant, adjuvant, and advanced treatment) and the treatment of HER2-positive gastric cancer
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In addition, trastuzumab combined with Pertuzumab regimen, and the trastuzumab-based antibody-drug conjugate T-DM1 are also widely used in the treatment of HER2-positive breast cancer
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 ▪ Fluorouracil The currently approved indications for Fluorouracil involve gastric adenocarcinoma, pancreatic cancer, breast cancer and colorectal adenocarcinoma, etc.

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In addition to being used for systemic treatment, fluorouracil has also been approved by the US FDA for the local treatment of a variety of skin diseases, such as superficial basal cell carcinoma
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Related reading From the transformation of chemotherapy to gene therapy, ASCO reviews 50 years of anti-cancer milestones and breakthroughs in the next 10 years.
ASCO counts 2020 anti-cancer progress: precision treatment of gastrointestinal cancer and lung cancer shines, and multiple combination therapies prolong survival.
Yale Cancer Center team : In the next ten years, these strategies are expected to cure non-small cell lung cancer.
Source: 123RF Reference Materials [1] AdamFundytus et al, Access to cancer medicines deemed essential by oncologists in82 countries: an international, cross-sectional survey, The Lancet Oncology( 2021).
DOI: https://doi.
org/10.
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