What’s behind the survival increase?
Cancer is a notoriously complicated disease and every single step taken to understand it better accumulates into a bigger picture. If our knowledge of the disease and how to treat it is a jigsaw, the puzzle has millions of invaluable pieces, so it’s not quite right to talk about single events which changed the course of this disease. For example, in 2001, clinical trial results showed that a drug called imatinib transforms a usually fatal leukemia into a manageable condition. It works in people who have a protein called the Philadelphia chromosome, which was discovered decades earlier, in 1960.
Treatments such as surgery, chemotherapy, and radiotherapy were discovered a long time ago, but they are still being improved. Surgeries have become less invasive. One of our projects focuses on a type of radiotherapy which can even hunt down cancer cells that have broken away from the prostate and spread around the body, with potential for less side effects than current radiotherapy. We also have two projects aiming to improve hormone therapy, by keeping it working for longer in more men.
One of the most fundamental shifts in cancer is that we’ve moved towards a much greater understanding of the very detailed biology that drives it. A huge international research programme over 12 years called The Cancer Genome Atlas kicked off in 2006 and has transformed our understanding of cancer – and the mountains of data generated from over 20,000 tumours spanning 33 cancer types are available for free, for any cancer researcher in the world to use to drive research even further. We now know that ‘cancer’ is a group of diseases, not a single disease, but we are able to draw comparisons based on biological details such as the signals cells send to the cells around them, the intrinsic, tiny changes which drive tumours, and this allows us to learn from different cancer types.
Tamoxifen is a tablet which was originally intended as a contraceptive, but its effects on estrogen activity led to it being approved for breast cancer in the late 1970s, making it one of the first therapies to be targeted to cancer cells. It can sometimes be used to treat breast swelling and pain in men who are on hormone therapy for breast cancer.
Finally, it would be wrong to talk about the improved outcomes for cancer without mentioning some of the non-cancer inventions which have also changed the state of play. Antibiotics and anesthesia have made surgeries safer. Improvements in medical imaging have been transformative, allowing us to see tumours more clearly and diagnose and treat them more accurately. Steroids are sometimes used to treat cancer itself, depending on the type, and are often used to reduce symptoms and side effects such as pain, fatigue, and as anti-sickness drugs.