From Receptors to Microenvironments: The Evolution of Cancer Treatment

Medicine is a practice informed by scientific advancements, continuously evolving as our understanding of diseases deepens. In cancer treatment, this evolution has been marked by significant progress over the last 50-60 years.

Early Days: Targeting the Estrogen Receptor

The identification of the estrogen receptor as crucial in certain cancers ushered in an era of targeted therapies. Treatments focusing on this receptor emerged, with drugs like Tamoxifen initially showing promise. However, resistance developed, prompting further investigation into underlying mechanisms.

Understanding Resistance and Pathway Targeting: A Second Generation

Researchers discovered that HER2 positivity played a significant role in resistance to estrogen receptor-targeting therapies. This led to the classification of cancers into three subtypes: estrogen receptor positive, HER2 positive, and triple negative. Further research delved into the pathways activated by these receptors, identifying new targets like the PI3CA-AKT-mTOR pathway for treatment.

Beyond Tumor Cells: The Microenvironment and Third Generation Therapies

Recognizing that tumor cells don’t exist in isolation but interact with their surrounding microenvironment, researchers turned their focus to this crucial aspect. Two key components emerged: androgenesis (a well-established concept) and the immune system’s role in controlling tumor growth. This led to the development of therapies targeting these elements, including immune checkpoint inhibitors.

A Continuous Journey

The journey from targeting estrogen receptors to manipulating the tumor microenvironment showcases the continuous evolution of cancer treatment. As our understanding deepens, new targets and therapeutic strategies are constantly being discovered, paving the way for more effective and personalized approaches to managing this complex disease.

This article has been reviewed and edited by Dr JP Minart