You may have seen some “wonder drug” news stories over the holiday break about compounds targeting p53 – many outlets picked up this New York Times story. The first paragraph probably got them:
For the first time ever, three pharmaceutical companies are poised to test whether new drugs can work against a wide range of cancers independently of where they originated — breast, prostate, liver, lung. The drugs go after an aberration involving a cancer gene fundamental to tumor growth. Many scientists see this as the beginning of a new genetic age in cancer research.
Now, to read that, you might think we’re talking mutated p53, which is indeed found in a wide variety of cancers. It’s the absolute first thing you think of when you think of a defective protein that’s strongly associated with cancer. And everyone has been trying to target it for years and years now, for just that reason, but without too much success. If you know drug development, you might have seen this article and done what I did – immediately read on wondering who the heck it was with a broad-based p53 therapy and how you missed it.
That’s when you find, though, that this is p53 and MDM2. MDM2 is one of those Swiss-army-knife proteins that interacts with a list of other important regulatory proteins as long as your leg. (Take a look at the last paragraph of that Wikipedia link and you’ll see what I mean). Its relationship with p53 has been the subject of intense research for many years now – it’s a negative regulator, binding to p53 and keeping it from initiating its own transcriptional activity. Since a lot of that transcriptional activity is involved with telling a cell to kill itself, that’s the sort of thing you’d normally want to have repressed, but the problem in some tumor lines is that MDM2 never gets around to leaving, allowing damaged cancerous cells to carry on regardless.
So, as that newspaper piece says, there have been several long-running efforts to find compounds that will block the p53/MDM2 interaction. The first big splashes in the area were the “Nutlin” compounds, from Roche – named after Nutley, New Jersey, much good did it do the research site in the end. The tangled history of Nutlin-3 in the clinic is worth considering when you think about this field. But for some kinds of cancer, notably many lipsarcomas, this could be an excellent target. That link discusses some results with RG7112, which is one of the drugs that the Times is talking about. Note that the results are, on one level, quite good. This is a tumor type that isn’t affected by much, and 14 out of the 20 patients showed stable disease on treatment. But then again, only one patient showed a response where the tumor actually became smaller, and some showed no effect at all. There were also twelve serious adverse events in eight patients. That’s not the sort of thing that you might have expected, given the breathless tone of the press coverage. Now, these results are absolutely enough to go on to a larger trial, and if they replicate (safety profile permitting), I’d certainly expect the drug to be approved, and to save the lives of some liposarcoma patients who might otherwise have no options. That’s good news.
But is it “the beginning of a new genetic age in cancer research”, to quote Gina Kolata’s article? I don’t see how. The genetic age of cancer has been underway for some time now, and it’s been underway in the popular press for even longer. As for this example, there are several types of cancer for which a p53/MDM2 compound could be useful, but liposarcoma is probably the first choice, which is why it’s being concentrated on in the clinic. And as far as I know, the number of cancer patients with mutated p53 proteins well outnumber the ones with intact p53 and overexpressed MDM2. These new compounds won’t do anything for those people at all.
I sound like such a curmudgeon. But shouldn’t there be some level of press coverage in between total silence and Dawn Of A Glorious New Era? I suppose that “Progress Being Made On Tough Drug Target” isn’t the sort of hed that makes Page One. But that’s the sort of headline that research programs generate.