Failure – the first step to success

Not every journey towards discovery can start with a successful first step. That would be a very short journey. Captain James T. Kirk of the U.S.S. starship Enterprise even once suggested that it is only through the long, pain-staking, and seemingly inefficient process of trial and error and eventual progress, that wisdom is acquired. Success is only the end result; it is the failures that teach.

Trilaciclib’s journey is a good case in point. Trilaciclib is a drug that gets inside of cells and stops cells from dividing. It was initially hoped that it would be an effective anticancer drug, since cancer is known for unchecked cell reproduction (or division). But as usual, with cancer cells, when a drug interferes with one pathway responsible for cell division, the cancer cell opens up another pathway circumventing the blockade and keeps on dividing. Imagine using your shopping cart to block one aisle in a supermarket. People with their shopping carts can simply go down another aisle and be minimally affected by your blockade. That’s how it is with the constantly mutating cancer cell.

Here comes a revelation. Okay, trilaciclib may not be a great anticancer drug, but maybe it can stop something else. One common reason for a patient having to stop chemotherapy, is bone marrow toxicity. The bone marrow is made up of rapidly dividing blood and immune cells. A damaged bone marrow can’t produce all the blood and immune cells. This can be lethal. Interestingly, bone marrow cells are damaged by chemotherapy ONLY while dividing. If the bone marrow cells can be temporarily “frozen” and prevented from dividing, then the chemo won’t affect the bone marrow cells. Enter trilociclib. Imagine the patient receiving trilociclib half an hour before chemo. The bone marrow cells get “frozen,” and then the chemo is given. Since the bone marrow cells are not dividing, they are safe. The chemo does its thing, and a couple of days later, when the chemo drug is almost out of the system, then the bone marrow cells “wake up” and resume dividing. This novel treatment is called myelopreservation.

Early clinical trials have shown that temporary myelopreservation has permitted chemotherapy to continue with fewer disruptions. As a result, many of the patients did not get as sick from the chemo treatment, had healthier bone marrows and more shrinkage of the cancer, and ultimately lived longer. Trilociclib is awaiting Food & Drug Agency (FDA) approval.

So not all anticancer treatments are necessarily ANTI-cancer, and not all failures are the END.

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