(Part 3) The “Defanging and Taming” of the Cancer Beast.

Publish date:2022-01-05

(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.

New Modalities and Approaches
New concepts in cancer treatment proved effective:
  • Recruiting patient’s own immune system to fight tumor
Most prominent is immunotherapy, especially the immune checkpoint inhibitors (IO).
From the single indication in 2014 (melanoma), IO has now indications in over 15 cancers.

Moreover, this brings 3 major benefits:
  1. For those with late stage cancers: Long term survival possible in some advanced cancers for first time (historical 5yr-survival in stage 4 NSCLC only 5.5%, now some data showing 23.3%).
  2. For those with earlier stage cancers: for some cancers, IO may significantly reduce the chance of cancer recurrence after surgery.
  3. IO is generally well tolerated, with less frequent side effects (for example: in lung cancer severe side effects: 26% vs 53% (IO vs. chemo))

In other words, instead of a rapidly fatal condition with huge suffering, stage 4 lung cancers patients – some of them can achieve long term survival and possibly cure. The treatment also better tolerated and better QOL.
On the other hand, many patients even with earlier stage cancers will suffer from subsequent recurrence even though the surgery had been successful. For certain cancers, with the advent of IO, some of these recurrences can now be prevented.

Another important new modality is antibody-drug conjugates:
  • Selectively delivery of traditional toxic drugs to target & kill cancer cells.

Some agents (Kadcyla, Enhertu) have shown unprecedented effectiveness even in heavily pre-treated cancers: Enhertu achieves 60% response in heavily pretreated cases that failed other treatments.

Other examples of new modalities and approaches include Particle therapy for many cancers with reduced side effects and greater effectiveness (heavy particles) and treatment Fields 交替電場 (brain tumours)

Source: Clinical Oncologist, Dr. Conrad Lee