Cancer treatment has come far, fast: Better prevention, early detection, new treatment
Cayden Addison was 3 when he was diagnosed with leukemia and doctors began hammering his small body with chemotherapy.
Despite the terrible side effects and a near-death experience, two years of chemo only bought him about nine treatment-free months before his cancer returned in February.
By then, though, doctors had another tool.
Instead of blasting him with powerful chemotherapy, they were able to direct treatment to his immune system, turning its specialized cells into targeted missiles to attack the tumor cells. Other than a few days of nausea, he had almost no symptoms, his mother, Courtney told a Washington, D.C., audience Wednesday, gathered to hear an update on progress against cancer from the American Association for Cancer Research.
A half century of taxpayer-funded research is paying off for families like the Addisons, of Chesapeake, Virginia, the AACR noted in its annual progress report.
Not only can the Addisons hope that this time their cancer nightmare may truly have an end date but the latest round of treatment doesn't seem to have left Cayden, who turns 7 next week, with any additional health problems.
"We should not have to trade off having long-term side effects for the rest of their lives just to save our babies," Addison said. "They deserve better."
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Using the immune system to fight cancer
Progress against cancer has been remarkable.
More than 70% of children with cancer now survive long term and among adults, death rates have fallen by one-third since 1991, avoiding an estimated 3.8 million deaths, thanks to prevention, early detection and new treatments.
Progress has picked up momentum in recent years with advances in immunotherapy, basic tumor biology and genetics, said AACR President Dr. Philip Greenberg.
In the past year alone, 14 new cancer drugs have won federal approval and the uses of an additional 12 have been expanded to new tumor types or cancer stages.
"It's just a time of such enormous opportunity," said Greenberg, who heads the program in immunology at the Fred Hutchinson Cancer Research Center in Seattle.
One of the biggest advances has been in immunotherapy: turning a person's own immune system against their cancer.
A decade ago there was just one checkpoint inhibitor approved to treat one type of cancer, melanoma. Checkpoint inhibitors essentially remove the brake that cancer put on the immune system, allowing it to fight off tumors. Now there are 11 approved checkpoint inhibitors addressing 20 different tumor types.
A different type of immune therapy called CAR-T, which was first approved in 2017, is now used to treat six different forms of blood cancer and "more are coming," Greenberg said in an interview after the formal briefing. In some cases, CAR-T, which stands for chimeric antigen receptor T-cell, is so good at teaching the immune system to recognize and kill off cancer cells that cancer disappears never to return.
On Thursday, Dr. Carl June, of the University of Pennsylvania, and Dr. Michel Sadelain, of Memorial Sloan Kettering Cancer Center, credited with developing CAR-T therapy, were one of three groups awarded a 2024 Breakthrough Prize in life sciences. The prizes, which are billed as the "Oscars of Science," honor "impactful scientific discoveries" and come with $3 million awards.
Now that CAR-T has proven itself, June said Wednesday, there has been an explosion of interest, with hundreds of companies running more than 1,000 human trials in many tumor types, along with auto-immune conditions, heart disease and even infections.
"It's all pretty gratifying to see that happening," said June, who has not decided how to spend his share of the prize money.
As with other cancer treatments, challenges remain.
With blood cancers there were obvious targets to train the immune system against, but with other tumor types, it's harder to find "dream targets" that are just on the cancer cells and not also on healthy cells, June said. Killing them would cause unacceptable side effects. Scientists are working to find ways to be as specific as possible.
In solid tumors, CAR-T cells seem to get tired out quickly, working for only a short time, instead of the months or years that they work in blood cancers.
The approach also needs to be made cheaper and by a more mechanized process to make treatments more accessible, June said. "They're all solvable. It's a matter of the timescale," he said. "But (we've had) a lot of progress in the first 10 years of CAR-T cells and and we're going to see these things all get solved."
The same mRNA technology used in COVID-19 vaccines is also proving promising in early cancer trials, offering another potential new way to use the immune system against cancer.
Moderna announced Wednesday that it plans to start a late-stage trial in melanoma and a mid-stage trial in lung cancer along with its partner Merck.
Just as COVID-19 vaccines train the immune system to identify a protein on the surface of the infectious virus and destroy it, an mRNA vaccine can identify proteins made by mutated cancer cells, Moderna CEO Stéphane Bancel said in Tuesday interview.
"What we code is those mutations to teach them to your immune system so your immune system can eat them like Pac-Man," he said.
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Persistent challenges
Such scientific advances have dramatically improved outcomes for some cancer types. Breast cancer deaths fell by 43% between 1989 and 2020, saving roughly 460,000 lives. Lung cancer deaths declined just under 1% a year between 1995 and 2005 but fell 5% annually between 2014 and 2020, thanks to a drop in smoking along with the development of new treatments.
But some other cancers, particularly pancreatic cancer and glioblastoma brain tumors, "still have horrible 5-year rates," Greenberg said. "It is changing. It can change, but it won't change unless there's continued support to drive investment in cancer research."
In the U.S., this year, nearly 2 million people will be newly diagnosed with cancer and more than 600,000 are expected to die. Some cancer types are increasing in frequency, including early-onset colon cancer, pancreatic cancer and uterine cancer, in part because of rising rates of obesity, according to AACR.
In 2019, American cancer patients paid more than $16 billion out of pocket for cancer care and lost an additional $5 billion in “time costs," AACR reported.
Disparities in care remain an ongoing issue. Greenberg particularly highlighted disparities among people living in rural areas who do not have access to clinical trials. "The rural community has been very ineffectively reached by progress in cancer," he said.
The AACR announced Wednesday that it will form an alliance with the nation's cancer centers to address issues such as disparities in care, clinical and basic scientific research, training and public communication.
"One of the failures of the scientific community has been communicating to all these populations what the opportunities are, what the advantages are and to create trust in the cancer research enterprise," Greenberg said. "What people need to recognize is how incredible the opportunities are."
Cancer Moonshot
President Joe Biden has said he wants to cut cancer deaths in half within 25 years, a project called the White House Cancer Moonshot.
On Wednesday, the president's Cancer Cabinet met to announce new actions federal agencies are taking toward that goal, along with related commitments from the private sector. The new actions include:
$240 million in additional investment this year to accelerate cancer prevention, detection and treatment.
Establishment of a nationwide health network to bring cancer clinical trials to underserved communities.
Investments to reduce the impact of smoking and promote smoking cessation.
A push to collect more data on cancers that strike military veterans and to provide more virtual care for veterans.
The Moonshot program also announced new commitments from nongovernmental organizations to support people with cancer with out-of-pocket medication costs, stress management, smoking cessation, bring clinical trials to more diverse populations and help patients navigate the medical system, among other efforts.
Funding request
Government support has been crucial to the progress against cancer, but the cancer community worries Congress won't continue to generously fund scientific research. From 2010 to 2019, federal funding contributed to the development of 354 out of 356 newly approved drugs, many of which addressed cancer.
Thursday, the AACR and other advocates will lobby members of Congress to support continued financial support of cancer research. "We hate the idea of stalling the momentum," Greenberg said.
Money invested in research pays broader dividends, according to the AACR. Research funded by the National Institutes of Health stimulated $97 billion in economic activity and half a million jobs in fiscal year 2022. "It's a really good investment. It helped sustain the U.S. economy," he said.
The AACR in its report called on Congress to provide predictable annual funding growth over the next fiscal year, by adding $3.5 billion to the NIH budget and $2.6 billion to the National Cancer Institute's.
Bladder cancer patient Lesa Kirkman told the audience she planned to spend the day Thursday lobbying "anybody who will listen to me," about the progress in cancer treatments in her lifetime. "Because this is incredible."
When Kirkman, 61, of Niceville, Florida, was diagnosed in 2016, she was convinced it was a death sentence, because that's what cancer was when she was growing up.
She had two rounds of surgery and a standard treatment that unfortunately didn't work.
When her cancer came back in 2018, her oncologist referred her to a gene therapy trial that had so few side effects that she was able to launch and participate in a tennis team while in treatment. "I was able to live a full life throughout all my treatments," said Kirkman, who has been cancer-free since. "We're all thriving because of the research that has happened,"
Contact Karen Weintraub at kweintraub@usatoday.com.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
This article originally appeared on USA TODAY: Progress against cancer has been remarkable, but more needs to be done
