World Cancer Day 2017 - and a tale of three Presidents of the United States

Posted by es328 at Feb 06, 2017 10:14 AM |
Following World Cancer Day 2017 on 4 February, Professor Martin Dyer (pictured) discusses the ongoing fight against the disease in relation to three Presidents of the US

With all the shenanigans going on just now, you could be forgiven if you missed the fact that this last Saturday (4th February) was World Cancer Day (1).  This initiative is organised by the Union for International Cancer Control (UICC) and has the hashtag #WeCanICan.  Its very laudable aim is to “explore how we might reduce the global burden of cancer” and there are all manner of activities that you can engage with on their website and on those of our more local charities, such as Cancer Research UK and Hope Against Cancer.  And of course, you can donate; please give generously, as we always do in the UK.

Why should we get involved?

The statistics are stark.  Globally, there are, according to the UICC (and I guess they should know, since they are the experts) 14 million new diagnoses of cancer per annum, resulting in 8.2 million cancer deaths, 4 million deaths occurring in younger people aged between 30 and 69 (Globally, life expectancy at birth is now 70 years).  In comparison, there are 37 million people infected with HIV world-wide.  Here, the advent of highly effective combinations of anti-retroviral drugs has transformed this once fatal infection into a chronic but manageable condition.  Can we transform outcomes for patients with advanced malignancies using new, similar “precision medicines” that target malignancy specifically?  In other words, can we treat malignancy like an infection?  The simple answer, to quote the recently-departed POTUS is that “Yes, we can” –  but only in some malignancies, some of the time.  However, in contrast to the War on Drugs, we are now (after many false starts) really and truly beginning to win the War on Cancer, which some may recall was initiated by another less illustrious POTUS in December 1971.

There are several reasons for this optimism.  Firstly, although still dwarfed by the military-industrial complex, there is now a massive multi-billion dollar academic-biomedical-industrial complex, capable of producing new drugs at unprecedented speed.  The sequencing of the cancer genome has revealed many new “targets” for us to aim at.  Moreover, we can now sequence tumour DNA from patients within a matter of days, allowing matching of new targeted drugs to malignancies with specific genetic alterations.  (More fundamentally, this technology will shed light on how we get cancer in the first place.)  We can “reawaken” the immune system so that it recognises and destroys the malignancy as “foreign” using stimulating antibodies; if successful, (and so far, it is only successful in a fraction of cases), this remarkable approach can induce long-term immunity and thus cure.  We can refocus the immune system using genetic manipulation of T-cells in the laboratory and reinfuse these cells into patients and again in some instances, induce cures even in multi-relapsed, otherwise untreatable cases.

What are the problems in this brave new world?  Firstly, we now have a massive multi-billion dollar academic-biomedical-industrial complex, where much is driven not by intellectual curiosity or altruism (2) but by the prospect of massive financial gain.  It costs US$3 billion to bring a new drug to market (you may well ask why), but the rewards of success are commensurate.  The prices of the new precision medicines are beyond the reach of all healthcare systems, causing some patients to bypass the system using crowdfunding.  This problem can only become more pressing as combinations of two, three or more precision medicines will be necessary to effect significant, long-lasting changes.  The current POTUS has stated recently that the pharmaceutical industry is “getting away with murder” in terms of drug costs .  It will require all his considerable negotiating skills if he is to bring the costs down but this is imperative if the amazing advances are to be made available to all on the planet not just to the rich elite.

“Curing cancer” is a global, once-in-a-civilisation endeavour.  We have looked to the USA as the source of so much innovation, of so much hope.  The US “Cancer MoonshotSM” initiative lead by the last POTUS and his vice-president Joe Biden, epitomises their nation’s ambition to compress a decade’s worth of research into five years.  Much remains to be done if we are to relegate cancer to a chronic manageable condition.  All too often cancer remains #WeCantICant.  I should know.  I am an expert.  Like Joe Biden, my son died from an aggressive brain tumour.

 

(1) If you attended the Foxes match on Sunday, hopefully you will have seen a report in the centre-fold of the programme of some of our ground-breaking activities here in Leicester – probably the best thing that afternoon.

(2) Gertrude Elion won the Nobel Prize in 1988 for development of cancer medicines.  In her words "I had no specific bent toward science until my grandfather died of cancer.  I decided nobody should suffer that much."

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