By Dr. Mark McKee
We live in fortunate times. In our history, there has never been a time when more therapeutic approaches have existed to help patients with cancer. For as many treatment options as there are now, even more are on the horizon, potentially offering hope to the millions who receive this diagnosis and immediately fear the future.
Multidisciplinary treatment, combining surgery, radiotherapy, and medical therapy, is curative for many patients with early cancer. Even for some types of advanced cancer, long remissions can be achieved that likely represent cures. The tumor cells are eliminated and do not return over a period of years – 3 years, 5 years and even 10 years, depending on the type of cancer and how aggressive it is. But this is not true for the majority of advanced cancers, and we know that there are tumors that can come back even after that 10-year timeframe.
What did those years mean for the patients whose cancer returned? Were their lives relatively normal during that time? Were they essentially living with a chronic disease? This could be a starting point to reframe how we think about “cure” and what constitutes successful outcomes in the context of cancer.
Perhaps an appropriate analogy is HIV. When patients were diagnosed with HIV in the 1980s and early 1990s, death was virtually certain because there were not yet effective medicines to treat it. With the introduction of protease inhibitors in the mid-1990s, followed quickly by a number of additional types of medicines, HIV went from a death sentence to a chronic disease, allowing those infected to live relatively normal, healthy lives.
So, could this also be a goal for many cancers? The question turns us to a discussion about what constitutes a successful outcome. If we were to ask health care professionals, regulators, patients and others what they believe is the right type of benefit to receive from cancer treatment, we would get many different answers.
Classically, shrinking the tumor is the one most people think of first. But more important are the outcomes used for registration of new medicines and validation of other types of treatments, and those are extending patient survival from cancer and extending the survival of patients without cancer progression. This doesn’t necessarily mean the tumor goes away. In most cases, it means the patient is continuing to live, in spite of the disease, with chronic cancer.