In 1971, Dr Judah Folkman first described a process called tumor angiogenesis, which enables cancer to grow and proliferate by forming new blood vessels whose only purpose is to support the growth of that cancer.

This was a radical idea for its time and it took years of research and reproducible results before the scientific community accepted and adopted it as fact. Validation of Folkman’s work however has now gone well beyond the lab. In fact, some of the most heralded anti-cancer agents of recent time like Avastin and Nexavar are based on the premise of Folkman’s discovery. Though his work began almost four decades ago, it would begin a trend in the fight against cancer that continues to grow to this day.

Folkman and others helped usher in a new era in cancer care. These newer therapies worked on specific aspects of the disease, at the cellular level, and came to be known as tailored or targeted therapies. Unlike their predecessors that essentially eradicated most cells indiscriminately, targeted therapies acted on specific sites within the cell, working to shut down the processes that enable cancers to grow. As an added benefit, these newer therapies, though not without side effects, were often easier to tolerate than traditional forms of chemotherapy.

In recent years, targeted therapies have quickly grown to dominate the anti-cancer landscape. Recent media research suggests the market for targeted therapies is expected to reach US$70 billion by 2013, which is more than all other forms of therapy (chemotherapy, hormone therapy and immunotherapy) combined.  Many, like the drug Avastin, have already become blockbuster products with sales well over $2 billion dollars per year.

Even more impressive is the fact that some of these new agents are available in oral or pill form. Oral chemotherapy is not a new concept. Some very common and widely used agents like Cytoxan (commonly used in breast cancer) and Xeloda (used across many kinds of cancer types) are available in oral formulation. But for many years oral formulations were the exception and not the rule. Now, according to the National Comprehensive Cancer Network (NCCN), oral formulations of oncology drugs account for 10% of the market. That number is expected to jump to 25% by 2013 – and fully 85% of these drugs will be targeted agents.

However, the most exciting aspect of targeted therapy may have less to do with formulation and more to do with effectiveness. As we approached the late 1990s, many believed that targeted therapies were going to be the long awaited cure for cancer.  In fact, in 1998 Nobel laureate and co-discoverer of DNA, Dr. James Watson, was quoted in the New York Times as saying “Judah (Folkman) is going to cure cancer in two years”.

That hasn’t happened, but targeted agents are proving to be very effective in the fight against cancer. For example, when certain targeted agents are combined with traditional chemotherapy drugs for the treatment of advanced colon cancer, it has resulted in longer survival rates versus chemotherapy alone. And while a few months may not seem significant in the overall picture, for a cancer patient, every extra day is a gift.

In his later years, while reflecting on his research career, Folkman referred to the fine line that exists between persistence and obstinance. In most areas of research, if a concept is tested for a number of years without producing some definitive result, it is often abandoned. Folkman pushed through the five- and ten-year marks without any meaningful results but he just kept pushing. It took nearly thirteen years before a significant breakthrough was made in his labs, and a subsequent paper was published in the journal Science. This was his turning point – the point where skepticism was transformed into enthusiasm for the field he had created – and overnight, many of his harshest critics became his toughest competitors in the race for the cure. When it comes to health issues as big as cancer the trends may not start quickly, but when they do, you can be sure they’ll be around for years to come.