Living with cancer

Eliminating suffering and death due to cancer is now not only possible, but the National Cancer Institute in the US has set it as a goal. 

This is a pivotal time in the fight against cancer. Since the National Cancer Act of 1971, the United States has made conquering cancer a national priority. The great strides made in research have led to the understanding that cancer, once a seemingly mysterious and unconquerable foe, is a disease process whose mechanisms can be elucidated and controlled.

Based on such progress and possibilities, I have issued a challenge to our entire cancer community: to eliminate suffering and death due to cancer in the US by 2015. We may not eliminate cancer, but by accelerating progress to prevent, detect and control cancer, we can pre-empt its tragic outcome.

Our ever-increasing understanding of the genetic, molecular and cellular aberrations involved in the onset and progression of cancer is providing the targets for intervention that can help us develop personalised, integrated, mechanism-based interventions. The example of the recent successes in chronic lymphocytic leukemia (CLL) and gastrointestinal stromal tumour (GIST) by using a targeted kinase inhibitor is only the first chapter in a rapidly unfolding story.

Already we have seen rapid drug approval by our Food and Drug Administration (FDA) of an angiogenesis inhibitor, proteosome inhibitor, and epidermal growth factor receptor inhibitor: Avastin, Velcade and Erbitux, respectively. Many other success stories are expected, with potentially profound impact on reducing cancer deaths. Understanding metastasis of cancer and the interaction of the cancer cell with its microenvironment and host alone can save millions of lives.

Unraveling the origins of cancer has led to the understanding that the outcome of the disease is a highly complex process. We are now at a magic moment when the expansion and integration of our knowledge is accelerating at a breathtaking pace. We must manage this scientific and clinical enterprise. Our strategy is to embrace, integrate and expand a continuum based on Discovery, Development and Delivery. Accelerated discovery will generate new information about cancer at the genetic, cellular, individual and population levels. This knowledge will guide the development of new therapies that are targeted, specific and individualised. In addition, we will develop more specific methods of detection and prediction of cancer behaviour based on the genomic and proteomic signatures of tumour types. Diagnostic devices will no longer detect just physical presence but will “visualise” the molecular biology of the disease.

To achieve our goal, we must deliver these new interventions. Delivery will no longer merely be the application of an intervention, but we will monitor and modulate the biologic impact of that intervention in real time. Monitoring tumour shrinkage on a chest X-ray three months after treatment will give way to visualising tumours with devices such as PET scanning and short-lived isotopes. These detect alterations in gene expression, signaling pathways and creating the ability for precise, individualised targeted therapies. Largescale team research projects will combine diverse groups of experts to fuse their insights and develop innovative strategies. Advanced bioinformatics platforms, such as the cancer Biomedical Informatics Grid (caBIG), will connect and support the biomedical research community.

New technologies like nanotechnology will complement genomic and proteomic research and accelerate our ability to prevent, detect and treat cancer (see Databank). The onset of premalignant and malignant transformation will be detected at the molecular level long before the anatomic presence of a tumour is discernible. This will permit less drastic methods of elimination. A greater understanding of the human biology of cancer revealed from patients will complement and stimulate new laboratory investigations in vitro and in silico, linking delivery back to discovery in the continuum. Tomorrow’s patients will know their susceptibility to cancer and the lifestyle factors needed to keep healthy. Together with their physicians they can develop a personalised pathway to successful cancer prevention.

To achieve our 2015 goal of eliminating the suffering and death due to cancer, we must act now to foster strategic opportunities. Our focus on molecular epidemiology and gene/environment interactions will help determine populations at risk. An emphasis on integrative cancer biology will permit a systems approach to understand the cancer process. An integrated clinical trials system with a common bioinformatics grid will rapidly test and validate new strategies for early detection, prevention and prediction of cancer.

In short, the new research paradigm of scientific discovery, rapid development, and delivery of effective interventions to all populations hinges on: interdisciplinary science; an integrated, multifaceted set of tactics; immediate application of new technologies; information sharing; and close links to health delivery systems.

There is one critical element in this pathway to progress that underpins the success and pace of the initiative – the application and development of innovative technologies. The development of tools in genomics, proteomics, molecular imaging, bioinformatics, nanotechnology, and other advanced technologies is a critical step. The US NCI will pursue a complementary strategy to our Discovery, Development and Delivery continuum, namely, the creation of a National Advanced Biomedical Technologies Initiative for Cancer. This effort will wed academic centres of cancer research and care with centres of technology development, to apply and develop essential tools to complete the task.

The National Cancer Act of 1971 put the process in motion and today we have the opportunity and the responsibility to fulfil the promise. Cancer is not a national problem, but rather a global one. We are privileged to do our part and share with the world the opportunity to make cancer a disease that we will live with, rather than die from. We must and will maintain the momentum. We owe it to all of those who will be diagnosed with cancer in their lifetime.

©OECD Observer No 243, May 2004

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