Ready to Catapult Into the Future
Louis Weiner, M.D., director of the Georgetown Lombardi Comprehensive Cancer Center, reflects on the progress made since the National Cancer Act was passed 40 years ago. But his focus is targeted on ways to ensure the advances continue since the “opportunities are so tremendous.” He answers a few questions:
What was the state of cancer treatment earlier in your career?
I completed my medical oncology training in 1984. My area of emphasis, then and now, was gastrointestinal cancer treatment. And I can tell you that at that time there was only one drug that showed very minor anticancer activity in people with metastatic colon cancer, had a life expectancy of roughly 10 months. We now have six approved drugs for colon cancer. And the average survival has been pushed out to more than two years.
Now that is hardly cause for celebration, but when you think about the number of people who have been able to achieve important personal goals by having an extra year of high quality life available to them, it is very important.
We are now in 2011, 40 years after the signing of the cancer act, and we understand with greater precision the genes that are mutated or abnormally regulated. And in almost all common cancers we’re beginning to understand the interaction between genetic features and environmental exposures. We have had great successes in the early detection and prevention of certain cancers. We have witnessed the birth of less toxic and more effective chemotherapy treatments for many cancers, which have led to improved survival in many situations, and cures in other cases. We have witnessed the development of effective and less toxic immunotherapy treatments and antibody therapies for cancer. We now use minimally-invasive surgical procedures, and combined modality treatments, where surgeons and medical oncologists and radiation specialists work together as teams to provide optimal care for patients. We’ve seen the flourishing of survivorship programs, because — most importantly — more people are living after they develop cancer.
What does that mean in terms of lives saved?
If somebody has a poor risk colon cancer—a risk associated with a more than 50 percent chance of relapse and death following surgery—we can improve the odds and cure for those patients to about 70 percent. That doesn’t sound like a lot until you multiply it by the 50,000 people a year who are diagnosed with that stage of cancer. And now you’re talking about 15,000 people a year who are walking around alive and well and destined to be cured who would have not survived otherwise.
And I think that the future is actually quite bright. We now have, through the revolution and understanding of molecular origins of cancer, a whole new set of targets and an era of targeted therapy that has begun going after those specific molecular abnormalities that cause certain cancers and drive those cancers. I think that it’s fair to expect that this improved knowledge will inevitably give us the power to do even more to take care of our patients and improve their outcomes, and to even prevent cancer from developing in some cases. To paraphrase an old song, there’s no cancer like no cancer.
What do you worry about most?
I worry about the possible waning of public funding for the research that is vital to move forward. The budgetary woes that we are currently experiencing are being acutely felt in the support of biomedical research. And without fundamental research progress, we’ll be slowed. The true cost of saving money in the short term will be unnecessary deaths in the future. I worry about that a lot.
So what needs to be done?
The first and most important thing right now, in my mind, is to ensure that the resources remain available to conduct transformative research. That involves Congressional action, influencing policy makers, ensuring that the National Institutes of Health and the National Cancer Institute have sufficient resources to do the job that they’re capable of doing.
A diminution in support of those critically important activities at this time is especially tragic because as the target and as the goals come into plainer and plainer view for us all, we now find that the resources to accomplish those objectives are being taken away.
What is the most important thing do in the future for continuing this research?
I think the great opportunity that lies before us is the ability to integrate the molecular information about cancers with clinical outcomes, so that we can understand the relationship between molecular abnormalities that we see in the test tube to those that actually occur in real human cancers. That would help us understand which ones of these are driving or are associated with the cancers that our patients develop and with their outcomes. So we can identify in a more precise way newer and better targets.
And what do we need in order to get there?
I think what’s happened is that we find ourselves now on a platform that can really catapult us to a whole new level in the field of cancer research and cancer care, but it’s going to require new, expensive, but ultimately cost effective approaches. But the problem is that the systems don’t exist right now to facilitate the completion of the construction of the catapult. It’s a frustrating time because the opportunity is so tremendous.
Cancer remains a formidable challenge. But countless Americans are alive today because of the transformations in cancer research and care that have occurred over the past 40 years. With continued support this progress will accelerate, and we will prevent many cancers, detect other cancers when they are small and easily managed, and more effectively treat those cancers that are more advanced. And, when we think about the impact that even one person’s cancer can have on his or her family, friends and colleagues, these improvements will truly change the way we all live. And achieving this goal need not and should not take another 40 years. Who could ask for a better result than that?
By Renee Twombly, GUMC Communications