(On overview of progress in cancer management)
In this series, we will look into different aspects of how, since the new millennium, science and progress have been made a positive impact in our fight against cancer.
Increased acceptance of screening in several common cancers will bring about earlier detection and much improved chances of cure. More established types of screening include those for breast cancer, colon cancer, prostate cancer and liver cancer in hepatitis carriers. Newer modalities such as low dose CT scan can pick up lung cancers earlier when they can be successfully resected by surgery.
New target therapy Drugs
The biggest impact on cancer outcomes has been new drugs.
Remarkable scientific and technological breakthroughs allowed first, identification of key molecular cancer drivers in difference cancers, then secondly, the development of specific drugs that target these drivers.
Along with identification of markers come the realization of tumour heterogeneity and the need for individualization of cancer therapy.
Targeted treatments often more effective than conventional chemotherapy but sometime can be used in combination with chemo also. Overall, increase treatment options and better survival.
Two major contributions: Better cure for curable, Better survival for incurable.
Eg: EGFR and ALK lung cancers. (Stage 4 NSCLC historical 1-yr survival in 2004 was only 33%, but with stage 4 EGFR-mutants on latest TKI, 1-yr survival almost 90%)
Eg: Adjuvant Herceptin (addition of this reduces recurrence by 50% after successful breast cancer surgery for Her2 type tumours)
Adjuvant TKI reduces lung cancer recurrence by 80% after surgery
Many (but not all) target therapies have fewer side effects cf. conventional chemotherapy.
So, overall, with better understanding:
- Higher cures in curable cancers
- Better survival in incurable cancers
- Increased options
- Fewer side effects (some)
Instead of rapidly fatal condition with huge suffering, even advanced cancer patients can live relatively normally with disease well controlled for very long time with little symptoms or side effects from treatment. More like chronic disease now.
Source: Clinical Oncologist, Dr. Conrad Lee