By Dr. Gary Gordon
In recent years we have significantly advanced our understanding of cancer biology and treatment for patients with some tumor types. That includes cures and major improvements in survival for patients with testicular cancer, some types of leukemia and certain types of breast cancer, among others. But for most cancers – and for the millions of patients around the world who are battling this disease – we still have much work to do.
If our objective is to cure people with cancer, then we know that it’s likely going to take combinations of approaches to achieve this goal. Combinations that leverage how each drug works will let us enhance the response to therapy and should prevent the emergence of resistance to treatment. Some of the best outcomes have been in settings where patients received combination therapy.
It’s a very exciting time to be involved in cancer research. Scientists across industry, academic and other institutions are advancing incredibly innovative approaches to cancer treatment: activating the body’s immune system to recognize and fight tumors; using antibodies as warheads to deliver small doses of very toxic chemotherapies directly to the tumor and sparing healthy tissue; targeting treatment to cancer stem cells, the root cells of the tumor; and much more.
And as the approaches are advancing, so, too, is our knowledge of tumor biology. We know that most tumors start because of mutations, and those mutations continue to develop as tumors progress, whether a patient is on or off treatment.
Those mutations are what make each tumor genetically unique and cause them to respond differently to various medicines. But even under some treatments, tumors can continue to mutate and become resistant to therapies. This is true of even some of the most successful treatments, which means that next-generation approaches are needed.
As we look at combining new approaches to treatment, there are reasons for optimism. First, we now have the tools to understand the biological pathways that allow tumors to escape treatment. If we can figure out how to block enough of those paths, we can have more success in treating the cancer. And with our growing understanding of cancer biology, we can anticipate how certain treatments might pair, allowing us to put logical combinations together – combinations that may block these escape routes.
Second, we also are working to develop medicines that have tolerable safety profiles – medicines that we hope will lead to fewer side effects than conventional chemotherapies. As our understanding of new targets and approaches grows, so will our ability to find ways to combine them so that we do not compromise patients’ quality of life.
What this tells me, as both an oncologist and a researcher, is that the combination of greater understanding of tumor biology and our ability to develop more targeted medicines puts us on the cusp of bringing truly life-changing treatments to more patients with cancer. And that’s why we all are doing this difficult work.
In the months and years ahead, we will see the results from a number of clinical studies that are underway looking at combination treatment approaches in many different tumor types, and I am personally very optimistic.
We know that with diseases such as hepatitis C and HIV, where complex biology is involved, successful treatment involves combinations of medicines. Given all that we’ve learned about tumors and their genetic complexity, it stands to reason that it will be combination approaches that lead to truly meaningful breakthroughs and – our ultimate hope – cures for patients with cancer.
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