We’re pleased to see a widespread reaction to two articles which have been published in ecancermedicalscience this month - Cancer treatment in the last 6 months of life: when inaction can outperform action, by Bishal Gyawali and Saroj Niraula and Repurposing drugs in oncology (ReDO)—selective PDE5 inhibitors as anti-cancer agents, by Pan Pantziarka et al.

The latter describes how the class of drugs currently prescribed to treat erectile dysfunction has the potential to be included in new trials for anti-cancer drugs.  Dr Pantziarka and co-authors, from the Repurposing Drugs in Oncology (ReDO) project, identify that selective phosphodiesterase 5 (PDE5) inhibitors, which include sildenafil, tadalafil and vardenafil (brand names Viagra ®, Cialis ® and Levitra ®), show a wide range of mechanisms of action in different cancer types, such as glioblastoma multiforme - a rare disease where clinically meaningful advances are desperately needed.

The paper also explores the challenge of finding new agents able to cross the blood-brain-barrier which severely limits the range of drugs which can treat brain tumours. There is some evidence that drugs not currently licenced for cancer treatment, like the PDE5 inhibitors, are able to increase permeability so that drug delivery to brain tumours is improved - thereby potentially opening the door to new therapeutic options for patients.

With the high cost of new cancer drugs a huge political issue faced by governments across the world, this could be a real breakthrough - as Dr Pantziarka said “"It would be ironic if the key to improving outcomes from some of the most expensive drugs in oncology comes from repurposing some of the cheapest non-oncology drugs."

As this article is clearly of high general interest, we ran a successful press campaign to make sure that it reached as many readers as possible.  Our press release and infographic were picked up by a large range of international news outlets - many of these were in India, an area which would significantly benefit from lower cost oncology drugs. The press release was translated into multiple languages, demonstrating the worldwide interest in this issue.  The article has been read over 1600 times and has a score of 200 on Altmetric, a platform which tracks the impact of articles across the internet, which is in the top 5% for all articles published in featured journals.

The other article attracting attention this month, Cancer treatment in the last 6 months of life: when inaction can outperform action, details the difficult discussions which oncology professionals need to have regarding a peaceful life-death transition for their patients.  This controversial topic has caused a vigorous discussion on Twitter, with over 400 tweets discussing the importance of taking the focus off survival, and concentrating rather on the quality of days remaining towards the end of life.

Bishal Gyawali (Harvard Medical School) and Saroj Niraula (University of Manitoba) make a strong argument for the futility of paying over $9500 every month for a drug that extends survival by less than two months for patients who are in the last six months of their lives.  They review regulatory approvals of new drugs in the last five years and the ethical considerations involved in testing active cancer treatment on terminal cancer patients. 

The twitter debate caused by the publication of this article is still ongoing, with a wide range of tweeters agreeing with the need for healthcare professionals to engage with this topic, as well as the sharing of personal stories of friends and family who have perhaps suffered needlessly due to the pursuit of survival regardless of quality of life. The article has been viewed nearly 1500 times in a week, and has an Altmetric score of 162.

We are proud to be publishing science which has such impact on the cancer community, both for healthcare professionals and for patients and their families.  This would not be possible without committed, inspirational authors such as Pan Pantziarka and Bishal Gyawali, whose support for ecancer is essential in achieving our mission of breaking down barriers to cancer communication and education worldwide.