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Getting to the Core of Cancer

What makes an apple an apple? It isn't the texture, skin, shape or even the taste. It's the core. People can peel off the apple's skin, rip off the stem and even eat all the fruit, but if the core is replanted, more apples can grow in its place.

Emerging Research on Cancer Stem Cells

Emerging research suggests that cancer is similar to the core of an apple in many ways. Cancer is a heterogeneous disease, meaning there are many different types of cells that make up the cancer. A small population of these cells, called cancer stem cells, have the ability to regrow themselves, keeping the cancer alive even after the majority of the infected cells have been destroyed. Because of this, it's thought that cancer stem cells may be the reason cancers return, even after patients are in remission.1 For example, in some leukemias (or blood cancers), many patients who go into remission will relapse within a few years.2,3,4,5 Cancer doctors are looking for treatments that can prevent the return of the disease, but in some types of cancer such treatments have not been discovered.

The Role of the Hedgehog Pathway

The Hedgehog (Hh) pathway, which is named for the spiky appearance of fruit fly larva which lack the Hh gene when observed under a microscope, was first discovered in the 1970s. This pathway plays an essential role in the development of human embryos and is responsible for helping our cells form different parts of our bodies. Changes in the Hedgehog pathway may lead to the creation and ongoing existence of cancer stem cells.1

Researchers are exploring the potential of investigational treatments called smoothened (SMO) inhibitors, which help regulate the Hedgehog pathway, making it more difficult for stem cells to survive.

It is thought that treatments that target the cancer stem cells will prevent the return of the cancer,1 similar to how destroying the core of the apple will prevent future growth.

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At Pfizer, we're committed to identifying and researching new approaches and pathways that may hold the key to addressing these difficult to treat cancers, and we look forward to working with the community and our partners to continue to bring innovative medicines to patients in need.

1Amakye A, Zainab, J, Dorsch, M. Unraveling the therapeutic potential of the hedgehog pathway in cancer. Nature Medicine. 2013:19(11):1410-1422.

2Appelbaum FR, Gundacker H, Head DR, et al. Age and acute myeloid leukemia. Blood 2006; 107(9): 3481-5.

3Estey E. Acute myeloid leukemia and myelodysplastic syndromes in older patients. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2007; 25(14): 1908-15.

4Kantarjian HM, Thomas XG, Dmoszynska A, et al. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2012; 30(21): 2670-7.

5Verma D, Kantarjian H, Faderl S, et al. Late relapses in acute myeloid leukemia: analysis of characteristics and outcome. Leuk Lymphoma 2010. 51(5): 778–782.