Adjuvant trials of targeted agents: the newest battleground in the war on cancer

Two of the great successes in the many decades-long 'war on cancer' are the emergence of adjuvant chemotherapy regimens with lifesaving potential and the subsequent wave of 'targeted' therapies addressing the unique vulnerabilities of particular tumor types. The first intersection of adjuvant treatment and targeted treatment resulted in a spectacularly positive outcome as the addition of the anti-HER2 humanized monoclonal antibody trastuzumab to the standard adjuvant chemotherapy essentially halved the relapse rate among women with HER2+ tumors. Subsequent studies of adjuvant trastuzumab have confirmed its dramatic efficacy in a variety of chemotherapeutic contexts and have been instructive in elucidating some of the challenges ahead for newer targeted agents. The recent negative experience with bevacizumab in the adjuvant colon cancer setting suggests pitfalls and limitations of the current approach to developing adjuvant regimens. A change in thinking may be required to gain the substantial benefits implied by the trastuzumab experience in the broader context of the targeted treatments. The case for a revitalized industry/academia/government partnership to address these challenges is compelling, with the potential for enormous patient and societal benefit. In order to bring potentially lifesaving benefits of this new generation of cancer drugs to patients more rapidly, changes to our 'war strategy' appear necessary.