Science versus cancer

Cancer is already the second biggest cause of death worldwide and one in five of us will develop it before the age of 75. It’s a growing problem, too. The number of new cancer cases registered each year is expected to reach 29.4 million by 2040, more than doubling from 2018 levels.¹

Encouragingly, the medical industry appears poised to make several scientific breakthroughs which, together, could strike a major blow against the disease.

In the US public sector alone, some USD6.4 billion is spent on cancer research each year. President Biden’s administration has made oncology a priority, pledging to cut cancer mortality by at least 50 per cent over the next 25 years.

Screening and early diagnostics are crucial, as they are key to lengthening patients’ life expectancy.

Take lung cancer. Just 15 per cent of cases are diagnosed during stage one – when cancer cells are only present in one small area and haven’t yet spread – largely because the symptoms are often silent. Nearly half of cases aren’t diagnosed until stage four, by which time cancer has spread to at least one other organ. The late diagnosis has serious implications for life expectancy: around 55 per cent of lung cancer patients diagnosed during stage one survive for at least a year, but the rate drops to just 5 per cent for stage four.

Treatment progress

Treatment options are improving alongside better diagnostics. One is a technique that allows for a deep examination of the genome of a patient’s tumour so that a detailed molecular profile can be produced. The tumour can then be targeted with therapies that interfere with the specific proteins which that specific cancer produces. This can be particularly useful in the treatment of later stage cancers, for which surgery is risky and also unlikely to remove all of the disease.

Then there is immunotherapy, which seeks to deploy the patient’s own immune system to fight the disease. The aim is to teach the immune system to recognise and attack cancer cells. There are various approaches. One involves the use of cytokines, antibodies modified to recognise cancer cells, and cancer vaccines. Another method is cell therapy, through which the cells of the patients are brought to the lab and modified to improve their ability to fight cancer.

Immunotherapy is not a new treatment. It was first attempted in the 1890s, when the surgeon William Cole tried to activate the immune system against cancer.   Almost a century passed, though, before the US Food and Drug Administration (FDA) approved the first immunotherapy agent, using artificial cytokines – proteins that send signals to the immune system, governing how its cells grow, mature and respond.

Modern immunotherapy emerged in 2011 with the invention and approval of therapeutic checkpoint inhibitors.³ Immune checkpoints act as the brakes of the immune system, and tumours often interfere with them to shut down immune responses. The inhibitors block cancer proteins from interfering with the checkpoints, enabling the immune system to continue attacking diseased cells. In just over a decade, seven checkpoint inhibitors have been approved by the FDA, treating a dozen different cancer types, including melanoma and lung cancer. More are in development.

Another weapon in the battle against cancer is cell therapy. Here, human cells are modified to improve their cancer-fighting ability. More specifically, the therapy involves collecting the patient’s T-cells – white blood cells of the immune system – and modifying them in a lab and injecting them back into the bloodstream where they can start to attack the cancer. The modified, super-charged cells are known as CAR-T cells.

To-date six CAR-T cell therapies have been approved, notably for leukaemia in children and lymphoma in adults. The treatment is still very expensive and complex, as it’s produced for each individual patient. But there are potentially cheaper, off-the-shelf versions in clinical trials.⁴

Other research avenues include vaccines – potentially using mRNA technology pioneered for Covid immunisations – and the use of artificial intelligence and data mining to not only facilitate more personalised therapies but also to better identify those at risk of cancer, enabling more targeted screening and increasing chances of early diagnosis.

Such scientific efforts are already paying off. Even as numbers of cancer cases have continued to rise, the number of deaths from the disease has declined to 144 per 100,000 population in the US in 2020 from 201 in 1999.  Over the current decade, some seven million lives could be saved through effective and targeted application of science, according to the World Health Organisation.

The research impetus is strong, backed by significant investment from both governments and the private sector. On this trajectory, in 10 years, it may be possible not only to detect cancer before visible tumours have formed, but to also treat with early intervention and prevent further development.