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Targeted therapies and biological modifiers in urologic tumors: pathobiology and clinical implications
Antonio Lopez-Beltran1, Ziya Kirkali, Liang Cheng
1Unit of Anatomic Pathology, Department of Surgery, Faculty of Medicine, Cordoba, Spain. em1lobea@uco.es
Abstract:
Most conventional anticancer drugs act by preventing cells from dividing or have toxic effects on dividing cells, but the toxic effects on the normal cells in the body limit the dosage to a level below that which is effective for complete response. There has been a search for more specific agents that have a much greater effect on cancer, rather than on normal cells. Several new anticancer agents are in early development, and some are in clinical practice. Many of these new therapies require histological or molecular pathological testing to determine the therapy effectiveness. Aspects of the new targeted therapies for specific cancers are therefore of increasing relevance to both molecular and anatomic pathologists, including the biology behind, the eligibility criteria (by histology or molecular assays), specimen requirements, response assessment, and biologic or histological aspects of secondary resistance. Methodologies in this field are immunohistochemistry and fluorescent in situ hybridization, but PCR-based methods have great potential. The role of the pathologist in applying all of these new therapeutic targets to urologic tumors remains limited at present time, but in the future it should parallel their role for other cancers where targeted therapy has been more successful. The current status of biological and clinicopathological aspects of targeted therapy in prevalent urologic tumors is reviewed.
Insights
Targeted anticancer therapies offer greater efficacy against cancer cells with fewer side effects than conventional drugs. Pathologists play a crucial role in assessing eligibility and response to these novel treatments, especially in urologic tumors.
Area of Science:
- Oncology
- Pathology
- Molecular Biology
Background:
- Conventional chemotherapy's efficacy is limited by toxicity to normal cells.
- There is a growing need for targeted anticancer agents with greater specificity for cancer cells.
- New targeted therapies are emerging in clinical practice and early development.
Purpose of the Study:
- To review the biological and clinicopathological aspects of targeted therapy in urologic tumors.
- To highlight the increasing relevance of targeted therapies for molecular and anatomic pathologists.
- To discuss the role of pathologists in the application of targeted therapies for urologic malignancies.
Main Methods:
- Review of current literature on targeted therapies in urologic oncology.
- Discussion of diagnostic methodologies including immunohistochemistry, fluorescent in situ hybridization, and PCR-based methods.
- Analysis of eligibility criteria, specimen requirements, and response assessment for targeted therapies.
Main Results:
- Targeted therapies require specific histological or molecular pathological testing for patient selection.
- Pathologists' involvement in targeted therapy for urologic tumors is currently limited but expected to grow.
- Understanding secondary resistance mechanisms is crucial for optimizing targeted treatment strategies.
Conclusions:
- Targeted therapies represent a significant advancement in cancer treatment, demanding specialized pathological evaluation.
- The role of pathologists is essential for the successful implementation of targeted therapies in urologic cancers.
- Future research should focus on expanding the pathologist's role in guiding targeted treatment decisions for urologic tumors.
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