Where Do We Stand in the War on Cancer? The Biggest Advances in 2007
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During his 1970 inaugural address, American President Richard Nixon declared a War on Cancer. Promising to allocate at least $100 million in funding to investigate the causes for what was then the second-leading cause of death in the United States, Nixon followed through in 1971 by signing the National Cancer Act. Key objectives of this act included infusing basic sciences research funding, ramping up clinical trials and making the National Cancer Institute a free-standing body under the National Institutes of Health.
Nearly forty years later, physicians and scientists are making great strides in better understanding the etiology, management and treatment in all forms of cancer. Recently, the American Society for Clinical Oncology released a report entitled, Clinical Cancer Advances 2007: Major Research Advances in Cancer Treatment, Prevention, and Screening. This annual review, which is available as a .pdf, podcast, and slideshow at the People Living With Cancer website, includes the following highlights:
Primary Liver Cancer Patients Get the Option for Systemic Treatment: Until recently, surgical techniques were the first line of treatment in liver cancer patients because response to chemotherapy was so poor. In 2007, results of a large study showed that advanced liver cancer using sorafenib (Nevaxar), a targeted chemotherapeutic, lived 44 percent longer than patients who did not.
Kidney Treatments: The standard of care for kidney cancer has been for the most part unchanged for the last decade. This past year, however, presented several strong studies suggesting that the targeted therapeutic bevacizumab (Avastin) may be a viable new treatment option for kidney cancer patients.
MRI over Mammograms? 2007 also gave us new guidelines for using MRI, or magnetic resonance imaging, as a diagnostic tool for breast cancer in a high-risk population. Research is still being done on whether it is an effective screening tool.
HPV Not Just Linked to Ovarian Cancer Anymore: Two major studies released last year showed a strong correlation of HPV, or human papillomavirus, to head and neck cancer. Vaccines for HPV, now being marketed to young females as a preventative measure against ovarian cancer, may be also be helpful for head and neck cancer, although studies are currently still in progress.
Menopausal Hormone Replacement Therapy Linked to Breast Cancer: A pair of studies this year suggested that the recent decline in breast cancer incidence may actually be linked to the recent decline of HRT use in menopausal women.
Preventative Measures for Lung Cancer Metastasis: Lung cancer claims the most lives of any other cancer, and individuals with lung cancer that has metastasized, or spread, to the brain historically have a poor prognosis. For the first time ever, cancer research scientists presented a new method of preventative treatment called “whole brain radiation therapy” that may significantly decrease invasion and metastasis to this area.
For cancer patients and their caregivers, it is certainly encouraging to know that every day, physicians and scientists are still coming up with new ways to better understand and treat cancer. Hopefully, this year will give us even more amazing victories that bring us even closer to the total eradication of this devastating disease.
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The Individuality And Uniqueness Of Each Cancer Patient
The needed change in the “war on cancer” will not be on the types of expensive drugs being developed, but on the understanding of all the drugs we already have. The system is “overloaded” with drugs (hundreds of them) and “underloaded” with the wisdom and expertise for using them.
As the increasing numbers and types of anti-cancer drugs are developed, oncologists become more and more likely to misuse them in their practices. There is seldom a “standard” therapy which has been proven to be superior to any other therapy. When all studies are compared by meta-analysis, there is no difference. What may work for one, may not work for another. Few drugs work the way we think and few physicians/scientists take the time to think through what it is they are using them for.
The new “targeted” therapeutics have been providing mostly smaller benefits to patients than the conventional cytotoxic agents. Chemotherapy is recommended according to guidelines generated by statistical data. According to the FDA, the response rate of a patient that follows these guidelines is approximately 20%. According to NCI, those who benefit substantially from “targeted” drugs is approximately 10-20%.
These “smart” drugs do not work for everyone, and a system to determine the efficacy of these drugs in a patient is the first crucial step in “personalizing” treatment to the individual. It is highly desirable to know what drugs are effective against “your” particular cancer cells before these toxic agents are systemically administered into your body. Having a good tumor-drug match not only would improve survival rates, it would be cost-effective.
With today’s “cookie-cutter” approach to chemotherapy, we have no idea which cancer patients will benefit from a course of treatment, you don’t know in advance who is going to respond. It is time to explore other avenues of research for cancer treatment.
Physicians are confronted on nearly a daily basis by decisions that have not been addressed by randomized clinical trial evaluation. The number of possible treatment options supported by completed randomized clinical trials becomes increasingly vague for guiding physicians. More and more clinical trials have not produced more clear-cut guidance but more confusion.