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The Cancer: Revolution Under Way - Are We Near Cure?

07 Jan,2021

Dr Ravi Gaur

Dr Ravi Gaur, MD Director & Chair Medical Advisory Committee Oncquest laboratories Ltd, New Delhi.

 

For over many hundred years, attempts to understand cancer is full of disappointments and many questions remain unaddressed “Within five years, cancer will be removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Roswell Park Comprehensive Cancer Center. A century later, Where do we stand - Are we near Cure?  

 

Cancer research has made significant strides in the last one decade. Scientists firmly believe that, they are on the edge of a brighter era and as the research matures further, we are likely to see new treatment options emerge.

 

Today advance technologies are being used to discover new biomarkers for better understanding of cancer. As signposts provide information, direction, and guidance, so too are cancer biomarkers, which can reveal the complex, dynamic, and heterogeneous landscape of malignancies better. This information is critical for improving diagnosis, prognosis, and therapy.  But the journey to find the right biomarker, which is highly specific & sensitive and with high predictive value, is often a long and winding road.

 

Scientists are developing new diagnostic approaches like characterization of circulating cancer cells, the use of multiplexing PCRs to extract information from limited amounts of sample, and the application of evolutionary biology to detect early cell changes and much more.

Till about a decade back, the conventional genetic platforms were used, and they were taking several months to complete sample analysis. But now, with the availability & affordability of next generation sequencing (NGS) platforms, we can get such genetic information on cancer, in a matter of days. The mapping of the human genome in 2003, by NGS has contributed to vast amounts of information in our understanding of cancer. It has helped researchers to identify genes associated with cancer risk and profile the tumor, to plan the therapies that are likely to work best and that too at an affordable cost.

Target therapy, immunotherapy, and new technologies for screening

and to predict early spread of cancer, are growing at a rapid pace.

 

Now we all know that cancer is not one disease, but it is hundreds of diseases. Cancer is as individual as the person who has it, for example, if there are identical twins, both with prostate cancer. They may have been born with exactly the same genetic mutations, but one responds to therapy and one doesn’t. One may live and one may die…Why the outcome is different even for identical twins? Environmental impact may be the one reason. Although the twins were born with the same DNA, but throughout their lives they were exposed to different influences — i.e. pesticides, viral infections, smoking, unhealthy foods, radiation, or stress — which can switch normal genes on or off, such as the tumor-suppressor genes responsible for shutting down cancer cells when they begin to grow. This could affect the twins' individual response and risk to cancer. The interplay and role of all these factors in many types of cancer is better understood. Understanding these issues is now allowing us to optimize the treatment approach to each patient’s disease. Better algorithms will lead to finer the diagnosis and more precise therapies.

Now we understand that many tumors contain more than one type of cancer cell. While one type of cell may respond to treatment, other types can escape and continue growing. Even if 99% of the cells respond, the tumor can still grow from that 1%, that did not respond. To address this, combination of therapies are being used to hit the tumor with all the right killers to get rid of it.

Cancer cells has the ability to change their behavior and can find ways to protect themselves from treatment over time. A drug works well at first, but later the cancer becomes resistant, because the cancer cells have mutated, or changed genetically and tumour grows back. The new therapies are being introduced now all the time, so when the current treatment fails, patients can move on from one treatment to another.

 

Experts feel that cancer cure revolution is on the way and cancer care will dramatically change over next decade. Genomic Profiling, precision medicine, immunotherapy drugs, cell-based therapies can give medicine a new dimension. New epigenetic drugs could turn cancer cells normal. Some of the newer approach to treatment of cancer area s under - 

  • Precision medicine - Our Understanding and assessing each individual’s risk for Cancer, has become more precise. A more coordinated and systematic research hopefully will lead to more integrated, personalized care. Precision medicine is the vision that all people one day will be offered customized care, with treatments that match their genomic profile and personal histories. Such individualized therapy promises to be more effective with fewer side effects. Cancer patients are now benefiting from ‘targeted therapeutics ‘(drugs that target specific mutations in their cancer cells). We do not have many therapies that target cancer-causing mutations, but the results can be dramatic when such drugs are available This for sure, will revolutionize the cancer care.
  • Immunotherapy (a group of modified T cells) - is showing very promising result and is aimed at increasing the body’s own ability to fight cancer.  Our immune system is designed to recognize cells with new properties, as when infected with a virus. Our immune system needs to respond to the mutations building up in a cancer cell. A new class of drugs that increase ability to recognize and destroy cells carrying mutations, are being developed. Some patients with widely metastatic cancer have been rendered cancer-free with such therapies.
  • Epigenetic Therapy - Epigenetics is the study of how your behaviors and environment can cause changes that affect the way your genes work. Traditionally doctors treat cancer by surgery, chemotherapy and radiation to destroy cancer cells. Can cancer cells be transformed back to normal? Researchers are gone deep into epigenetic (an intricate system of biochemical adjustments, which cells use to regulate genes) and is changing our understanding of cancer and has led to the development of a number of new drugs. These drugs target epigenetic enzymes, which regulate a cell’s genetic programming. Rather than destroy cancer cells, the therapies seek to set the cells on a path back toward normal growth and development. New epigenetic therapies that reverse these changes are likely to be available for treatment in medical practice soon.
  • Metastasis check - For over 300 years, scientists have been striving hard to understand metastasis, the process that allows some cancer cells to break off from their tumor of origin and settle in a different tissue. Metastasis causes nine out of ten deaths from cancer. Research focused on metastasis is likely to generate new treatments to control distant spread of cancers. Characterizing circulating tumor DNA cells and liquid biopsies can address the challenge soon.

Needless to say, we are in an exciting phase and we every day are learning tremendous information on the molecular origins of cancers to achieve the best outcome. With use of IT, there is strong hope that the future research will be quicker as animal studies might be replaced by computer programs.  Computer models will be like individual patient and indicate which drugs will provide the optimal outcome.  There is a strong possibility that, the time-consuming human trials might be replaced with a more real time approach.

Today we are able to beat many cancers. Every day patients are surviving more, who would not have survived even five years ago. Every day patients are being cured with new advances that are coming along the line. However, we need to be careful, as we all know cancer is a moving target, you hold it at one end, it emerges from another.

Our new found insights and knowledge, has made us to believe strongly, that ‘ CANCER’ will now be read as  ‘CANCURE’ and soon we will beat the cancer comprehensively.

 

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