Nomenclature. For me, the word inspires visions of a congregation of garden gnomes, maybe a village of mushroom houses nestled in a forest of hydrangeas and ferns.
Alas, it’s nothing so dreamy and picturesque – but rather the process of naming things. The pharmaceutical world has a complicated system of nomenclature – there’s even a federally established council called the United States Adopted Naming Council (USANC) that is dedicated to approving names for generic drugs.
I have this picture in my head of a group of garden gnomes sitting around a table looking at a baby chemical compound.
“He looks like a Charlie to me.”
“Don’t be absurd – he’s a tyrosine kinase inhibitor. You can’t call him Charlie. He shall be called Sunitinib.”
While Charlie might be easier to say – the choice of Sunitinib is not random – it’s designed to show what the drug is and what it does. For the savvy cancer patient or caregiver, having a vague idea of how it works is useful. Because drugs tend to have lots of different names and it can be confusing.
Shortly after my husband was diagnosed with stage 4 kidney cancer, I was chatting in an on-line patient group. Someone mentioned how well their husband had done on RAD 001. I was euphoric. This was a drug that I had never heard of. It might be something new and interesting to try – it’s called RAD – it must be wonderful. But, the fellow caregiver quickly explained that RAD 001 was nothing new. It was in fact Everolimus, which is also known as Afinitor. And it’s been FDA approved for kidney cancer for quite some time. How could the same drug have so many names??
I realized I needed to figure this out so I wouldn’t be confused again. It wasn’t a simple process and it took a bit of research. Overtime I became a bit of an expert on generic names. I began throwing them at out at our oncologist just to show how well I could pronounce them.
“Could we combine it with bevicizumab?
I’d then turn to my husband and explain in my clearly superior voice that bevicizumab was generic for Avastin. He’d roll his eyes at me.
As I got better, I’d just shorten them – what about Bev and Pazo? Like two old friends visiting for dinner.
For those of you who haven’t yet met Bev and Pazo and feel like you’re at a cocktail party of drug names that you don’t know – here is a basic illustration of how the process of nomenclature works and why we end up with so many names. I’ll use one of the most commonly prescribed kidney cancer drugs as an example.
Sutent was originally known by its chemical name SU11248. Patients who were enrolled in phase 1 trials of the drug, likely knew it by that name.
As the drug showed efficacy the sponsor of the drug, Pfizer, filed an application for a generic name. The generic name that was agreed upon was Sunitinib. The suffix in the name tinib refers to the fact that it is a Tyrosine Kinase Inhibitor (TKI). TKIs are fairly new types of targeted drugs that are being used in a variety of cancers today. Another example in kidney cancer is Inlyta (generic name: Axitinib).
When the drug was approved by the FDA, Pfizer chose the brand name of Sutent for the drug. But you’ll find that most doctors still use the generic name when talking about the drugs. The reason for this is not just to confuse you – but rather because eventually the patent will run out on the drug and the generic name will become much more important again.
Of course, it’s not always that simple – there are numerous overlapping suffixes – sometimes one company buys a drug from another company resulting in multiple chemical names. But, the example is a good general description.
If you’re sufficiently bored, or just deranged like me, you might enjoy reading lists of different suffixes and trying to figure out which drug fits with what. I personally like this from the NIH.
If you’re neither bored nor deranged, a simple little cheat sheet is often useful. Below is the one that I made up for kidney cancer drugs. But, similar lists would be easy to make for other cancers drugs.
Sutent = Sunitinib
Votrient = Pazopanib
Nexavar = Sorafenib
Inlyta = Axitnib
Avastin = Bevacizumab
Afinitor = Everolimus
Torisel = Temsirolimus
Knowing the names is important – and not just so you can pretend like you’re an oncologist on TV. It might make a difference in finding a new clinical trial or an important new treatment opportunity!