DEAR DOCTOR: Is it just me or has it been forever since we've seen any real advances in cancer treatments? The new miracle drugs work only in very specific cases and the rest of us cancer patients are left with 20th-century treatments. Are there breakthroughs we aren't hearing about?
DEAR READER: When it comes to big cancer breakthroughs, it can seem like there isn't much new to report. As you correctly point out, the newest treatments emerging from the fields of precision medicine and immunotherapy are geared to cancers with very specific characteristics. However, when it comes to the future of cancer treatment, there's a revolution in progress.
Powered by the decoding of the human genome, which has allowed scientists to explore the human body at the cellular level, our understanding of what cancer is, how it behaves and how to stop it is growing exponentially. One bright spot is recent research funded by the National Institutes of Health, which has collected detailed data about more than 10,000 tumors arising from 33 different types of cancer. The analysis of that data, known as the PanCancer Atlas, is found in a collection of 27 different scientific papers. The information contained within was 10 years in the making. Taken together, these papers outline the findings of more than 150 researchers and examine the selected cancers at the molecular level.
One important advance has been how we talk about various cancers. Rather than approach tumors based solely on the part of the body where they originate, the shift is to classify them based on their molecular similarities to one another. For instance, after analyzing the tumors in the database, it was discovered that one type of tumor with a specific genetic profile was located in 25 different parts of the body. According to the body-location way of thinking, this one tumor would have had multiple treatment approaches.
Researchers also found a marked diversity in the genetic glitches in the tumors they studied, in the ways that the tumors grow, and in the cellular pathways they either use or outright hijack to ensure their survival. This line of inquiry has made possible the creation of important sub-groupings of various cancers, which aids in the search for targeted treatments. It has also helped scientists to identify potential vulnerabilities in various types of cancer.
Instead of focusing on how to poison the rogue cells with radiation or chemotherapy, researchers are now looking at ways to starve tumors, weaponize the immune system and even rewrite the tumor's own genetic code. So-called "smart" cancer drugs, which just a few years ago seemed like a fantasy, are now in the testing stages. One promising line of inquiry is looking into ways to harness tiny microparticles to deliver cancer-fighting drugs directly to the tumor, and even to deliver tiny imaging agents for more precise visualization.
Many of the cancer researchers and oncologists we know agree that we are presently in the midst of a revolution into our understanding of this complex and challenging disease. The "war on cancer" that we grew up hearing about may not yet be won, but battle by battle, things have never looked better.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.