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By Dr. Andrew Odhiambo
Consultant Physician & Medical Oncologist

As a Medical Oncologist practicing in Nairobi Metropolis, the question I get asked the most is:
“Is there any option other than chemotherapy? I’ve heard only bad things about it.”

Other popular phrases include:

“Chemotherapy is so toxic!!!”
"I hear chemotherapy kills you faster than the cancer itself!!”
"I want the other one that comes in tablets, …I don't want chemo"

My answer is always, “Yes, there is another option!” We now have this new type of cancer treatment we call targeted therapy. And yes, we have immunotherapy as well which can also be classified as a form of targeted therapy but works differently. It modifies your immune system which then kills the cancer cells. This article intends to shed more light about this new (not so new really) treatment. I will tackle immunotherapy in one of my future articles. Chemo isn’t that bad either. All you need is an experienced Medical Oncologist or Clinical Oncologist to oversee your treatment and manage the effects early. You also need to be empowered. To read more about chemotherapy read my past article click here. It is important to know that we now have a majority of these targeted therapies in Kenya. You don’t have to fly overseas to get them. I will use my usual Q & A format to make it easy to read. Here we go!

What is targeted therapy?

These are cancer drugs that target specific genes or proteins involved in cancer cell growth and survival. These drugs may also modify the environment in which cancer cells thrive making their survival shorter, for instance, they can deny cancer cells blood supply to grow. Most of them come in tablet/oral formulation though some may still be in intravenous (IV) form. The majority are useful in advanced or stage 4 cancers to improve one’s survival. They are not typically designed to cure cancer but keep it suppressed for as long as possible. A common example that we use in stage 4 colon cancer is called “Bevacizumab”. It targets the gene/protein called “VEGF” that makes blood vessels grow quickly and feed cancer cells. This drug blocks the VEGF gene/protein thereby shortening the survival of colon cancer cells. Many others targeted therapies work in a similar manner.

Is targeted therapy used for all cancers?

The answer is no. Not all cancers benefit from targeted therapy. Many cancers still depend largely on chemotherapy for optimal survival. Targeted therapy is however gaining a lot of traction lately. It takes many years of research before a drug is approved for cancer treatment. For many cancers like colon cancer, lung, kidney, bladder, skin, breast, and pancreas, we have several approved targeted drugs. As mentioned earlier, targeted therapy is mostly useful for those with stage 4/advanced cancer though some are used also for stage 3.

How do I know if targeted therapy is for me?

Many times, your oncologist will offer you targeted therapy an option in accordance with the treatment guidelines. It is important to ask your oncologist whether you qualify for targeted therapy, especially if you have advanced or stage 4 cancer. Sometimes, special tests will be done on your cancer biopsy sample to determine whether you may qualify for targeted therapy or not. Some cancers may benefit from targeted therapy without any such prior testing. Targeted therapy may not work if the tumour doesn't possess the target. It’s also important to understand that the mere presence of the target doesn’t necessarily mean that the tumour will respond to the targeted therapy. Even if it responds well, sometimes this may not last long and varies from drug to drug as well as cancer type. Cancer cells can over time develop resistance and become much stronger than the targeted therapy. Therefore, you may need to change to a different drug.

What are some examples of targeted therapy?

Below is a table of commonly used targeted therapies and which cancers they can be used to treat. Sometimes we may combine chemotherapy and targeted therapy to get a better effect. As scientists, we are still trying to predict which patient will benefit from targeted therapy or not.

How much does it cost in Kenya?

The cost will vary significantly with the drug and whether you are purchasing the original or generic/biosimilar. The typical range is about 180USD per month for generics of sorafenib (SORANIB) to over 4000 USD for the original sorafenib (NEXAVAR). See table above for some price estimates in USD and comparisons between originals and generics/biosimilars in Nairobi.

Where can I find targeted therapy?

Targeted therapy is available in most major hospitals like Nairobi Hospital Cancer Centre, Agakhan, MP Shah Hospital, and Kenyatta Hospital among others. Availability of stock may vary with prevailing circumstances. Ask your oncologist where you can access them. Both private insurance and NHIF come in handy to partially or fully offset the cost.

Who can prescribe targeted therapy for me and what are the common side effects?

This should be prescribed by an oncologist trained to prescribe and manage targeted therapy. This is preferably a Medical Oncologist or a Clinical Oncologist. Always remember to get information on potential side effects and how to monitor and manage them. Your oncologist may change the dose based on appearance of some side effects.

What are some of the common side effects?

Side effects will vary from drug to drug. Some are shared and some are unique to a particular drug. The most common side effects include but not limited to: (List not exhaustive)

  • Diarrhoea
  • Skin rash/dry skin
  • Skin lightening especially in black Africans
  • Liver inflammation
  • High blood pressure
  • Fatigue
  • Mouth sores
  • Loss of appetite.

It is very important that you keep a treatment journal and record all your side effects and discuss them with your oncologist so that they are managed quickly to avoid them getting worse. In case they occur, your oncologist may change the dose or stop the therapy. Continued communication with your Medical Oncologist is very important.

This article is not exhaustive as there are several targeted therapies in the market for different types of cancer. In one of my next articles, I will tackle immunotherapy. I hope this has helped you understand more about targeted therapy. If you have any further questions you can message me (on my website or Facebook page) or tweet me @odhis1.

Yours truly,

Dr. Andrew Odhiambo
Twitter: @odhis1
FB Page: Dr. Andrew Odhiambo
Copyright 2020

Disclaimer: My views are my own and I shall bear no responsibility for any actions that are influenced or arise from my blog

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