ASCO 2015
Exciting update on the Repurposing Drugs in Oncology (ReDO) project
Dr Gauthier Bouche - Anticancer Fund, Strombeek-Bever, Belgium
What is the ReDO project?
ReDO stands for Repurposing Drugs in Oncology. It’s a project that’s aimed at looking at the evidence for some old drugs, usually generic drugs, which are used for other indications than cancer, for example diabetes or hypertension, and that could be useful against cancer, usually in combination with other therapies used for cancer.
What are the advantages of repurposing old drugs?
Repurposing old drugs, the main advantage is that because we have a lot of information about the safety of those drugs it’s easy to use them in cancer patients. We have no concern about the safety; we know a lot of information about their side effects, contraindications and so on. It goes then quicker, you can go quickly to the patient, while for new compounds you need to do all the preclinical work, toxicity and so on while here we can directly administer those drugs to cancer patients. So it goes faster. The other interesting thing is that because those drugs are old they are cheap and, as you probably know, the cost of cancer, new cancer drugs, is skyrocketing which is problematic for all economies in the world, even for the high income countries. So by using those old generic drugs we could address part of that problem.
Can you give an example of such a compound?
There are many, I would maybe use one which is used against hypertension. It’s a beta blocker, it’s called propranolol and it has been shown to potentially be of interest in breast cancer, colorectal cancer and many other cancers. The mechanism of action could work for many different solid tumours and there is some retrospective evidence, so coming from people taking the drug for hypertension but those patients had also cancer, showing that the patients who had cancer and were taking that drug had a better outcome. There is also some preclinical work in mice showing that using propranolol in some tumour models could be of benefit.
Who takes on the repurposing? Drug companies or academia?
Pharma, clearly, is only interested in repurposing of the drugs they own but even then usually they don’t try to repurpose a non-anti-cancer drug in cancer because it costs a lot, it’s complicated and there’s a pricing issue, meaning that if you have priced your drug for another indication it’s hard to price it again at a higher price in cancer afterwards. So pharma companies are not really interested in drug repurposing. For the generic drugs I just mentioned there is no way to make money out of it. You can try hard but it will never work unless you modify the formulation or then you have to increase the dose, then there’s a possibility there. But in most cases it’s not possible. Then it’s foundation charities, government, we would like government to do more repurpose trials. This is also one of the reasons why we started the ReDO project, just to raise awareness and try to find additional partners to do the trials.
What are the bottlenecks?
The main one, I would say, is that it’s not very sexy. Those drugs are old, they have a mechanism of action which is well described for their primary indication. For the new indication, which would be cancer, it’s less clear, the mechanism of action. So when you talk to cancer researchers they usually like to know exactly how it works and we don’t have that information. So that’s one. So at first we thought that we could go directly to clinical trials into patients but in the end we realised that it’s probably important to do preclinical work in parallel to clinical work to have a better package for the drug and its [?? 4:35] cancer.
