By Richard C. Frank, MD
I recently attended the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago. With 30,000 members from around the world, ASCO is the leading organization of professionals involved in the care of patients with cancer. The main focus of the meeting is for researchers and clinicians to report on and learn about new therapies to treat cancer or new ways of thinking about the biology of the disease. As with any large, scientific meeting of this kind, there is an enormous amount of information, from very substantial advances to “incremental’ ones, as well as many failed efforts.
I viewed the meeting from two perspectives. The first was to look at the big picture and report to you my impressions of whether or not we are winning the war on cancer. The second was as a practicing oncologist, with boots on the ground, asking if my patients are significantly better off because of what I learned at the meeting.
The “war on cancer,” a term coined in the 1970’s by the Nixon administration, is actually not quite a war but thousands of different battles, being waged in the lab and in the clinic. There are hundreds of different types of cancers and each will ultimately have its cure. There will not be one cure for all of cancer. But, the strategy to treat most cancers is becoming rather uniform. As scientists discover the main genes that drive a cancer cell to grow, pharmaceutical companies develop specific drugs to block those genes (actually, the proteins they give rise to). The new drugs are “targeted therapies,” chemically designed to block the function of one or a few important targets in a cancer cell. Major advances in targeted therapy have already led to the cure of certain cancers, such as chronic myelogenous leukemia (CML) using imatinib (Gleevec), Her2 positive breast cancer using trastuzumab (Herceptin) and non-Hodgkin’s lymphomas using rituximab (Rituxan).
Many of the studies discussed at the conference used new drugs to fight cancer; others combined existing drugs in new ways. But, disappointingly, there were no announcements of new cures or major advances in treating the most difficult to treat cancers, which include the advanced stages of bladder, colorectal, esophageal, kidney, lung, ovarian, and pancreatic cancers and brain tumors. Some studies were “positive” but only added a few weeks or months of life. Several “negative” studies were also announced. Other approaches are clearly needed.
Fortunately, new drugs that target the immune system are leading to very promising results. For example, when the immune-targeting drugs ipilimumab (Yervoy) and nivolumab (anti-PD-1) were combined to treat patients with metastatic melanoma, 30% of patients experienced an over 80% reduction in their tumors, which were long lasting. These therapies are being applied to other cancers.
Interestingly, and of interest to many, there were several studies using herbal or other natural supplements to treat or prevent cancer. Several of these did appear promising, for example using a combination of herbal supplements to treat recurrent prostate cancer.
In terms of the war on cancer, although the ASCO 2013 meeting was characterized mainly by small advances, I do believe we are making forward progress, winning some battle skirmishes. Still, we are far from victory over the cancers that remain incurable.
As for the patients I see every day, engaged in their own unique battles, the meeting did not change much of how I presently care for them. It did however encourage me to continue to be a strong advocate for research and to guide cancer patients into clinical trials that may help them or others in a similar situation.