“The central characteristic of an enduring idea is that both it and its uses evolve over time.”
John Stuckey, McKinsey
And so it goes for cancer research too.
Over the last few decades we have gone from the typical slash, burn and lash treatments associated with surgery, radiotherapy and chemotherapy to a more focused, more integrated and relatively more benign approaches to killing cancer cells than the Hiroshima approach of old.
That’s not to say that they are not still a living hell for patients though, but at least there is a better chance of just surviving the regimen given the old drugs targeted not only the cancer cells but also normal cells too. Many patients, it has to be said, often died from the horrors of the treatment, not the cancer itself.
So what has changed?
Well, for a start as we learn more about the biology of the disease, we can approach the whole paradigm in a completely different way. From bench to bedside has started to see some real inroads in certain cancers aided by greater knowledge and understanding.
Basic research from the 1960’s onwards evolved a sequence of events in chronic myeloid leukemia (CML), for example, starting with the discovery of the Philadelphia chromosome by Nowell and Hungerford. Eventually, this lead to the creation of a drug designed specifically to target the particular mutated kinase that was causing the white blood cells to run amok like a central heating system inappropriately turned on high in the middle of the summer. This drug, Gleevec, is now the mainstay of CML treatment and has given many patients a real chance of getting their lives back and feeling like a normal human being again instead of a cancer patient.
There are other excellent examples around such as the breast cancer drug that targets the HER2 gene, overexpressed in approx. 30% of breast cancers. Previously, it was associated with a poorer prognosis, but now the advent of Herceptin has changed all that, for both women with early and late stage HER2 positive breast cancer, their lives have been significantly extended by targeting the cause of their disease.
Avastin has completely changed the face of colorectal cancer. Jonah Folkman first described the importance of the vascular endothelial growth factor (VEGF) receptor in some solid tumours and hypothesised that inhibiting this receptor pathway would prevent the tumour from growing new blood vessels (angiogenesis), a process essential to its survival. He turned out to be correct and a new therapy evolved as an effective way to treat colorectal patients by adding Avastin to standard chemotherapy.
These are wonderful success stories, but research never stands still, it continues to evolve as our knowledge and understanding of basic biochemical processes evolves.
Science and medicine in harmony can be a truly beautiful thing sometimes.