The era of smart drugs is now beginning in cancer treatment. The known side effects of chemotherapy are also eliminated with smart drugs that are for now only used in certain groups of patients, and only find and kill cancerous cells.

One of the most important developments in cancer treatment, 'targeted smart drugs' leaving normal cells unharmed; as a result, does not cause side effects such as low blood count, hair loss, nausea and vomiting. It also contributes to the prolongation of the patient's life span.

What is smart medicine? What role does it play in cancer treatment?
We call targeted drugs, 'smart drugs', which are produced to block the functions of cells that become abnormal. These drugs directly target the cancer cell. There are some structures bind to specialized molecules in normal cells, which we call receptors. We can think of them as an antenna that enables the communication of the cell. These receptors have a communication system that receives the signals of cells and functions as they receive these signals. The cells also response to these signals. Cancer cells, on the other hand, perceive and respond more to the signals about the cell's proliferation, growth or spread elsewhere. This perception can be either through receptors or through pathways. These paths sometimes deteriorate or increase; as a result, cell functions become more numerous, cancer cells begin to multiply rapidly. That's what we call 'targeted drugs' that are trying to interfere the distorted mechanisms of these proliferation cells.

Are there any types of these drugs?
Targeted drugs are generally divided into two groups. We call drugs monoclonal antibody-based drugs that work in the form of binding receptors or locking/blocking their functions. In the second large group, there are drugs consisting of smaller molecules and blocking the increase of these intracellular functions as a result of the signals from the nucleus within the cell with receptor or without receptor. These drugs affect mainly inside of the cell. Monoclonal antibodies are mostly given by serum, while others are in tablet style.

What is the differences between classical chemotherapy and targeted therapy?
Cancer cells multiply more than normal cells. Classical chemotherapy is more effective on proliferation cells. It finds and blocks the cells during the proliferative phase and kills them. Targeted drugs, on the other hand, specifically act on the cancerous cell whether a cell multiplies or not, or work to block structural differences in cancer. That is the biggest difference between them. As a result of this difference, there may be side effect differences between the two treatments. Since the classical chemotherapy drugs block all dividing cells, it also destroys normal dividing cells. Bone marrow cell, mouth mucosa cell, hair cells are groups of cells that rapidly multiply. Therefore, since chemotherapy blocks them, the side effects are more common around here. Such as blocking the bone marrow, hair loss, scars in the mouth, damage in digestive system or diarrhea…

How can the drug detect the different structure in the cancerous cell?
There are normally two or three antennas in a cell, and there are 100 or even 1000 of these antennas in the cancer cell. The drug given which sticks to these antennas, of course, sticks not on cells with two antennas but cells with hundreds thousands antennas. Therefore, sedatively blocks it more.

In what types of cancer can smart drugs be used?
Smart drugs are now used in almost every type of cancer. At first, there are anti-estrogens, which are actually smart drugs that we know as hormone therapy for women for years. These smart drugs has been used for almost 30-40 years. These are similarly receptors that stimulate the cell and bind estrogen. By competing with these receptors, they block the binding of estrogen and thus the stimulation of the cell. This is also a smart drug, simply. However, there are many new, targeted drugs related to breast cancer at the moment. These drugs can also be used in many types of cancers such as colon cancer, stomach cancer, several types of lung cancers, in many types of soft tissue, bone marrow, lymphoma, pancreas cancers. But not yet in every case. We are trying to block them as soon as we notice structures that are different from normal cells or abnormal pathways. On the other hand, new drugs are being developed. Therefore, targeted drug development is currently the focus of much new treatments. New discoveries on classic treatments are now reduced, yet research on smart drugs is much more.

How high does smart drugs increase the success rate in treatment?
In classical chemotherapies, certain response could be obtained in certain types of cancer, meaning that the patient's life span was prolonged. Especially in advanced stages of disease... Our goal is to succeed in the treatment of advanced tumors. We are often able to treat early-stage tumors with surgery, supportive treatments, chemotherapy, hormonal therapy. Some types of cancer can also be solved by classical methods, even if they are advanced. With the addition of targeted drugs on them, the chances of treatment increased a little more. However, many advanced types of cancer cannot be fully cured. Cure means that the patient is healing, that he is no longer ill. In these cancers, chemotherapy can prolong life expectancy for a certain period of time, while targeted drugs have contributed additional to these treatments. For example, a patient with hepatic metastasis of colon cancer lived for 3-6 months, but now with this new chemotherapy, this period has been extended to a few years and five years with the addition of smart drugs. These periods can be extended further with the newly developed drugs. But even if it is a smart drug, the group of diseases given cure are still not at the desired level. However, life expectancy can be extended up to 20-25 years in diseases such as myeloma and leukemia.

In other words, can't it be said that “the disease is over” in advanced cancer?
In most advanced cancers (except still some groups), early levels of small cell lung cancers can be cured, albeit 3-5%. Disease is no longer seen in some parts of ovarian tumors, testicular tumors, in some of the lymphomas with chemotherapy and smart drug treatments. But there are some types that radical solution has not been found yet. In these cancer types, it is tried to prolong the life expectancy and ,of course, also to cure. At least we are trying to make sure the patient live for many years as if he/she has a chronic illness such as blood pressure or diabetes. Our goal is for them to live for a long time without shaking up their bodies and breaking away from their daily lives with drugs that they can handle. However, we think that in the future these patients will also be provided with complete cure.

What does smart drug use bring to the patient?
Smart drugs provide the patient with an additional life span. In one type of lung cancer, the patient's life span with just a simple drug without having any chemotherapy can increase from a year or two to four or five years. Terminally ill patients can live eight months with a drug, sixteen months or even two years with a second drug. As these develops, so will the life expectancy of patients.

Do smart drugs have side effects, like classical chemotherapy?
Classical chemotherapies cause severe low blood cell counts as the bone marrow suppresses, increasing the tendency to infections. That's not the case with smart drugs. That's the biggest difference between them. In targeted drugs, skin rashes are the most common side effects. Sometimes there are problems with blood pressure. Healing of wounds can be delayed, clotting can be easier, nose bleeds can be seen. Sometimes there's a change in hair color. Kidney functions, blood pressure, liver functions can be affected. Although they have different side effects from chemotherapy, they will become more tolerable as they are used under physician control and experience increases. Smart drugs seem to dominate the future.

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