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Developing Drugs for Tissue-Agnostic Indications: A Paradigm Shift in Leveraging Cancer Biology for Precision
Nathan D Seligson1,2, Todd C Knepper3, Susanne Ragg4
1Department of Pharmacotherapy and Translational Research, University of Florida, Jacksonville, Florida, USA.
Abstract:
Targeted therapies have reshaped the landscape of the development of cancer therapeutics. Recent biomarker-driven, tissue-agnostic clinical trials represent a significant paradigm shift in precision cancer medicine. Despite their growth in preclinical and clinical studies, to date only a few biomarker-driven, tissue-agnostic indications have seen approval by the US Food and Drug Administration (FDA). These approvals include pembrolizumab in microsatellite instability-high or mismatch repair deficient solid tumors, as well as both larotrectinib and entrectinib in NTRK fusion-positive tumors. Complex cancer biology, clinical trial design, and identification of resistance mechanisms represent some of the challenges that future tissue-agnostic therapies have to overcome. In this Review, we present a brief history of the development of tissue-agnostic therapies, comparing the similarities in the approval of pembrolizumab, larotrectinib, and entrectinib for tissue-agnostic indications. We also explore the future of tissue-agnostic cancer therapeutics while identifying important challenges for the future that drugs targeting tissue-agnostic indications will face.
Insights
Tissue-agnostic cancer therapies, like pembrolizumab and NTRK inhibitors, offer precision medicine. Future development faces challenges in complex biology and resistance mechanisms.
Area of Science:
- Oncology
- Precision Medicine
- Cancer Therapeutics
Background:
- Targeted therapies have revolutionized cancer treatment.
- Biomarker-driven, tissue-agnostic trials represent a major advance in precision cancer medicine.
- Few tissue-agnostic indications have received US Food and Drug Administration (FDA) approval.
Purpose of the Study:
- To review the history and development of tissue-agnostic cancer therapies.
- To compare the approval pathways of key tissue-agnostic drugs.
- To explore future directions and challenges in this therapeutic area.
Main Methods:
- Review of historical data on tissue-agnostic therapy development.
- Comparative analysis of FDA-approved tissue-agnostic indications (e.g., pembrolizumab, larotrectinib, entrectinib).
- Discussion of challenges including cancer biology, clinical trial design, and resistance.
Main Results:
- Pembrolizumab (for MSI-high/dMMR solid tumors) and NTRK inhibitors (larotrectinib, entrectinib) are approved for tissue-agnostic use.
- These approvals highlight a shift towards biomarker-driven, tumor-agnostic treatment strategies.
- Significant hurdles remain for broader adoption and development.
Conclusions:
- Tissue-agnostic therapies are a growing frontier in precision oncology.
- Overcoming complex biology and identifying resistance mechanisms are critical for future success.
- Continued research and innovative clinical trial designs are essential for advancing tissue-agnostic cancer therapeutics.
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