It’s not always easy to recognize that we live in a golden age. Too often we fail to appreciate the amazing things going on around us because we‘re so caught up in day-to-day activities and pressing demands that we presume that the extraordinary is rather ordinary.
So it may be with cancer treatment in 2012. And the future looks to be even better – not necessarily easier, simpler, or cheaper, but unequivocally better.
Here are five reasons why.
Divide and conquer
Incredible progress in cancer biology has allowed us to identify many new subtypes of cancer, based not only on the organ or tissue where they arise but also on the malfunctioning genes within them. Increasingly, we recognize the specific causes and natural histories of different cancers – and the need for treatments tailored to each one.
This is in sharp contrast to the way cancer was treated in the past, when the same therapies were prescribed for everyone with the same cancer. It’s much more complicated to characterize three kinds of breast cancer, a dozen types of leukemia, six varieties of lung cancer, and innumerable sarcoma subsets. But this “divide and conquer” approach gives us a road map that has immensely clarified the appropriate treatments and research questions for oncologists.
Blockbusters in subsets
For decades, we have hoped for a “magic bullet” treatment that would cure every cancer. But what have emerged are many important “smart bomb” therapies, which have unprecedented effectiveness in carefully defined subgroups of patients.
Consider these remarkable response rates:
- the drug Vemurafanib produces a measurable response in 70 percent of patients with melanoma tumors linked to a faulty B-RAF gene;
- crizotinib has a 70 percent response rate for lung cancers associated with the gene ALK;
- trastuzumab-DM1 has a 65 percent response rate in a type of breast cancer known as HER2-positive;
- imatinib has a 90 percent response rate in chronic myelogenous leukemia (CML) associated with a faultyPhiladelphiachromosome.
None of these are chemotherapy in the traditional sense, nor do they have chemotherapy-type side effects. They do not make your hair fall out. They do not make you throw up. They have their own side effects, but those pale in comparison to most of the traditional treatments offered for cancer. And there are dozens of drugs in the pipeline with huge potential.
Patients are our partners
The greatest reward of being an oncologist is the long-term partnership that forms between the clinical team and the patient and the patient’s family. The trust our patients give us is personally gratifying, but it also creates better care through patient-centered initiatives and patient participation in clinical research. Without that partnership and trust, there would be no progress in cancer care.
Great information is a click away
It’s impossible to overestimate how the information revolution has improved cancer treatment. New discoveries spread through the web within minutes. Doctors and patients can find articles in a second that used to require hours of library work. Clinical colleagues share hundreds of emails a week with one another to coordinate clinical care, or tune in to webcasts from experts – previously available only in limited access at conferences – at any time they want.
Like all change, this one poses challenges. Traditional journal publishing is struggling to maintain a business model that works. Lots of information is processed through the prism of for-profit enterprises all too eager to put their own spin on the news. The sheer volume of information can be overwhelming. But breakthroughs and insights are everywhere, and now are accessible to everyone instantly.
The best is yet to come
We’re training the next generation of clinicians and investigators, who are drawn to oncology by a commitment to caring for patients with compelling clinical needs, and by the exhilarating progress that is happening in the clinic and laboratory. Our field is fortunate to attract such talented young people who invigorate the clinics and labs, and who will be critical to bringing progress to patients in the years to come.