What are the "high priority" basic anti-cancer drugs for oncologists in 82 countries?

The World Health Organization (WHO) has promulgated a version of the Standard List of Essential Medicines (WHO-EML) every two years since 1977, which incorporates the requirements of basic medical and health care, suitable dosage forms, reasonable prices, guaranteed supply and fairness to the public Medicines obtained
.

So, are the basic anti-cancer drugs listed by the WHO the same as the opinions of global clinical first-line oncologists? A study recently published in "The Lancet Oncology" (The Lancet Oncology) analyzes this
.

According to the paper, this is "the first study to compare WHO's essential medicines with the understanding of clinicians

The results show that whether it is WHO-EML or the world's first-line oncologists, the most popular "high-priority" basic anticancer drugs are mainly economic and traditional cytotoxic chemotherapeutics
.

In addition, classic targeted drugs such as trastuzumab, rituximab, imatinib; lung cancer targeted drug osimertinib; immunotherapy drugs pembrolizumab, nivoliuximab (also the earliest Two immune checkpoint inhibitors approved for marketing in China) were also included in the top 20 list

Screenshot source: Lancet Oncology

The continuous advent of targeted and immunotherapy innovative drugs has greatly improved the therapeutic effect of malignant tumors
.

At the same time, the number of anti-cancer drugs included in WHO-EML has also greatly increased (from only 7 in 1977 to 55 in 2019)

"High priority" basic anticancer drugs in the minds of oncologists

"High priority" basic anticancer drugs in the minds of oncologists

According to the results of the survey and analysis, in general, the top 20 “high priority” anticancer drugs selected by 948 oncologists from 82 different countries around the world were doxorubicin, cisplatin, paclitaxel, and pembrolizone, respectively.
Antibody, trastuzumab, carboplatin, fluorouracil, tamoxifen, capecitabine, cyclophosphamide, docetaxel, oxaliplatin, dexamethasone, nivolumab, rituximab Monoclonal antibodies, imatinib, gemcitabine, etoposide, osimertinib, and letrozole
.

▲Top 20 high-priority anti-cancer drugs selected by 948 oncologists (picture source: reference [1])

Among the top 20 “high priority” basic anticancer drugs selected by these oncologists, 12 (60%) are cytotoxic chemotherapy drugs, 4 (20%) are targeted drugs, and 2 (10%) are targeted drugs.
) Are immunotherapy drugs, and 2 (10%) are hormonal drugs
.

Among them, 13 (65%) were drugs approved by the US FDA before 2000

There are 7 “high priority” basic anticancer drugs that oncologists choose the most (more than 40%), which are doxorubicin (53%), cisplatin (50%), paclitaxel (45%), and Paclitaxel (45%).
Bolivizumab (44%), trastuzumab (42%), carboplatin (41%) and fluorouracil (41%)
.

Which cancer types are applicable to "high priority" basic anticancer drugs?

Which cancer types are applicable to "high priority" basic anticancer drugs?

At present, cytotoxic chemotherapeutics still occupy an important position in the treatment of malignant tumors.
Among the seven “high priority” anti-cancer drugs that oncologists choose the most, five of them are cytotoxic chemotherapeutics (involving anthracyclines).
Class, taxanes, platinum, and fluorouracil)
.

In addition, the anti-HER2 targeted drug trastuzumab and the immune checkpoint inhibitor PD-1 monoclonal antibody pembrolizumab were also selected

▪ Doxorubicin

Doxorubicin is an anthracycline antibiotic isolated from Streptomyces peucetius in 1969.
It has strong anti-cancer activity and can be used to treat soft tissues, osteosarcoma, and a variety of solid tumors.
(Breast cancer, small cell lung cancer, ovarian cancer, bladder cancer, thyroid cancer)
.

In addition, doxorubicin can also be used to treat acute lymphoblastic leukemia, acute myeloid leukemia and Hodgkin's lymphoma

▪ Cisplatin and carboplatin

Platinum drugs Cisplatin and carboplatin are currently one of the most widely used chemotherapeutics in clinical practice.
They are widely used in the treatment of non-small cell lung cancer, ovarian cancer, cervical cancer, esophageal cancer, gastric cancer, colorectal cancer and head and neck tumors.
And other common malignant tumors
.

Cisplatin can be used as a single agent or in combination with other anticancer drugs for induction therapy and neoadjuvant therapy
.

Currently in the treatment of adult cancer patients, the indications approved by the FDA for cisplatin involve advanced ovarian cancer, testicular cancer and bladder cancer

Carboplatin is a second-generation platinum drug, mainly used in the treatment of gynecological tumors (such as ovarian cancer, cervical cancer, etc.
) and respiratory tumors (such as lung cancer, nasopharyngeal cancer, etc.
)
.

▪ Paclitaxel

As a classic taxane drug, the current indications for paclitaxel approved by the US FDA include:

1.
Adjuvant treatment of lymph node-positive breast cancer;

2.
Treatment of metastatic breast cancer after the failure of the anthracycline-containing combination therapy program;

3.
Adjuvant treatment of anthracycline-containing drugs for the treatment of metastatic breast cancer that recurs within 6 months;

4.
Treatment of AIDS-related Kaposi's sarcoma (second-line);

5.
Not suitable for combined treatment of patients with non-small cell lung cancer by surgery and/or radiotherapy;

6.
Combined with cisplatin for the treatment of ovarian cancer;

7.
Combined with cisplatin for the sequential treatment of advanced ovarian cancer
.

▪ Pembrolizumab

The advent of immunotherapeutic drugs has brought breakthroughs in the field of tumor drug treatment.
Immune checkpoint inhibitors (such as PD-1/PD-L1 monoclonal antibodies) have shown great advantages in the treatment of various malignant tumors
.

As one of the earliest PD-1 monoclonal antibodies approved for marketing, pembrolizumab was first approved by the FDA for accelerated approval for the treatment of advanced melanoma in September 2014
.

Thereafter, daclizumab and Pabo Li approved indications many more different types of cancer, such as melanoma, non-small cell lung cancer, head and neck squamous cell carcinoma, renal cell carcinoma, urothelial cancer

Compared with the 2017 version, the 2019 version of WHO-EML included immunotherapy drugs in the list for the first time, and this time pembrolizumab was selected as a "high priority" basic anticancer drug, which once again reflects the importance of immunotherapy in the field of tumor treatment Status
.

▪ Trastuzumab

As a classic anti-HER2 targeted therapy drug, trastuzumab is widely used in the entire management of HER2-positive breast cancer (early neoadjuvant, adjuvant, and advanced treatment) and the treatment of HER2-positive gastric cancer
.
In addition, trastuzumab combined with Pertuzumab regimen, and the trastuzumab-based antibody-drug conjugate T-DM1 are also widely used in the treatment of HER2-positive breast cancer
.

▪ Fluorouracil

The currently approved indications for fluorouracil involve gastric adenocarcinoma, pancreatic cancer, breast cancer, and colorectal adenocarcinoma
.
In addition to being used for systemic treatment, fluorouracil has also been approved by the US FDA for the local treatment of a variety of skin diseases, such as superficial basal cell carcinoma
.

Reference

[1] AdamFundytus et al, Access to cancer medicines deemed essential by oncologists in82 countries: an international, cross-sectional survey, The Lancet Oncology(2021).
DOI: https://doi.
org/10.
1016/S1470-2045(21 )00463-0