One of the most misunderstood ideas in medicine is a single word: heal. With cancer, the idea of a cure is particularly strong. It can be a ritual that brings people together. It can be a source of focus for the mind, calm for the heart, and hope for the future.
But a patient is unlikely to hear this word from a doctor. “It’s very rare for us as oncologists to say to the patient, ‘You’re cured.’ Right now, all we can tell our patients is that they are in remission,” says Jason Aboudi Mouabbi, assistant professor of general oncology and medical breast oncology at MD Anderson Cancer Center. from the University of Texas.
[Related: This chart shows how far we’ve come in fighting cancer]
Remission is when all signs and symptoms of cancer have completely disappeared, According to the National Cancer Institute; cancer cells are not detectable by scans, exams, blood tests and other tests.
“But that doesn’t mean the cancer is completely gone, but we can’t see it. So we have to assume that there are no more,” says Mouabbi. “We don’t use the word healing until [you’re in] remission for five years.
Even the five-year mark is an imperfect standard. The estimate may be less accurate for certain diseases, such as breast cancer. And to be “cancer free” isn’t as simple as you might think either. This sentence goes beyond remission: it means that there are no cancerous cells in the body at all. As a cure, it’s essentially impossible to achieve. Although the cancer is unlikely to return after five years, there is always a chance that it will return, as malignant cells can remain dormant and undetected.
When a person is sitting in a doctor’s office, holding their breath and the hand of their loved one, their goal isn’t exactly to be healed. It’s doing whatever it takes to get better, despite many obstacles, like the exorbitant cost of care. It’s going into remission, after weeks and months of treatment. Here are the different strategies that oncologists use to achieve this these days.
The latest options for cancer treatments
The inherited treatment for cancer, of course, is chemotherapy. Beyond that, the main options are targeted therapy, radiation therapy, surgery, and immunotherapy. the National Library of Medicine treatment list also includes hyperthermia, hormone therapy, laser therapy, photodynamic therapy, and cryotherapy.
Chemo, the oldest and often used strategy to fight a wide variety of cancers, is getting an update. “Many therapies [now] are targeted at genetic alterations within a cancer, and they would still fall under the class of chemotherapy,” says Karen Knudsen, CEO of the American Cancer Society. For example, chemotherapy can directly attack colorectal tumors and melanomas linked to a mutation in a gene called BRAF.
“Even our cells have a lifespan,” says Mouabbi. “Eventually they must die and new cells must replace them.” But when the body tries to replenish the cells and doesn’t follow the rules, the microscopic structures continue to divide. If they don’t stop, “that’s when the cancer comes,” says Mouabbi. Targeted cancer therapies attempt to correct these errors at the genetic level, especially mutations.
[Related: A ‘living’ cancer drug helped two patients stay disease-free for a decade]
Targeted treatments called antibody-drug conjugates focus on cancer cells while leaving the rest of the body’s cells alone. Unlike chemotherapy, this allows healthy cells to stay that way. “When it targets this protein [on the cancer cell], a payload is only released in cells to which the antibody binds,” says Mouabbi. It has revolutionized breast cancer management, he adds, and is being studied for other types of cancer.
Trastuzumab, commercially called Herceptin, is another targeted therapy that is informed by a patient’s biology. Some cancer cells create an excess of a protein called HER2. This therapy focuses on this protein, which causes a particularly aggressive form of breast cancermore a type of stomach cancer and gastroesophageal cancer.
The Food and Drug Administration recently approved innovative radiation therapy that targets prostate cancer, which accounts for 5.7% of all cancer deaths. It will kill a estimated at 34,500 people this year, almost as many people as the residents of Beverly Hills, California.
One of the most promising radiotherapies is proton therapywhich might be safer than phototherapy, a 2020 study of nearly 1,500 US patients found. Although both are radiation-based approaches, they work differently: Photon therapy sends high-energy x-rays or gamma rays into the body, while proton therapy uses positively charged particles to break down DNA. Proton therapy “has the potential to reduce damage to surrounding normal tissue,” says Knudsen (trials are still underway to investigate this).
Cancer surgeries, which physically remove the tumor, “are constantly being improved,” says Knudsen. One of the main goals of medical researchers is to reduce side effects by improving the timing of chemotherapy before surgery. “For some cancers, [doing] initial chemotherapy can shrink the tumor, making surgery easier to do with fewer adverse patient outcomes,” Knudsen adds.
This type of treatment trains the immune system to find and identify cancer cells, which guides drugs into the body to slaughter the invaders. The immune system’s job is then to find the cancer cells, but sometimes it doesn’t do it perfectly.
A breakthrough type of immunotherapy is CAR (Chimeric Antigen Receptor) T Cell Therapy, which puts the immune system to work to fight cancer. T cells in the blood are basically trained to attack cancer cells. A recently completed phase 3 clinical trial which studied 180 patients in the United States for about two years found that CAR-T therapy was effective in people with large B-cell lymphoma (the most common type of non-Hodgkin’s lymphoma). Combined with a dose of an mRNA vaccine, CAR-T therapy could one day work in patients with other types of cancer, another very early clinical trial suggests.
Another treatment removes the disguise that hides cancer cells from your immune system. “Checkpoint Inhibitors block that camouflaging process, so it allows your own immune system to potentially see the cancer, i.e. you, gone bad,” says Knudsen.
Prevent cancer before it attacks
Of course, the best way to fight cancer is to not let it grow and spread in the first place. Beyond lifestyle choices like diet and exercise, there are ways to reduce the risk of disease with a vaccine.
“We have a real opportunity to eliminate cervical cancer as we know it through HPV vaccination, as well as 50% of head and neck cancers,” says Knudsen. “It’s something we can control.”
[Related: A single HPV vaccine dose can protect against cervical cancer]
the The Centers for Disease Control and Prevention recommends that all preteens—not just girls—get the HPV shot, the most common STD. It’s a “cancer vaccine,” says Knudsen. “No one wants to think they’ll end up seeing their child or someone they love…develop this disease because they haven’t been vaccinated.”
Meanwhile, researchers at Duke University are working on another type of cancer vaccine that uses mRNA– much like COVID vaccines – to defeat a common type of breast cancer (HER2-positive). Rather than targeting an infectious agent like HPV or SARS-CoV-2, this immunotherapy vaccine technology, currently in a phase 2 clinical trial, would protect people with genetic mutations that increase their risk of developing certain cancers. This covers a range of diseases beyond breast cancers, including lung, prostate and colon cancers.
“We’re not really limited, if we can demonstrate the concept,” lead researcher Herbert Kim Lyerly, an immunologist at Duke University, says. “It’s almost like having an electric car – you can imagine a minivan, a truck, a sports car. All of these different versions can be adapted to individual cancer types as we become successful with the prototypes we develop.