Evolving treatments of cancer: From remission to cure
Dr Balkrishna Padate, MD (Med), MRCP (UK), FRCPath (UK), CCST (UK), Director and Head of Hematology, Hemato-Oncology and BMT (Bone Marrow Transplantation), Nanavati Max Superspeciality Hospital
The medical history of cancer began millennia ago. Historical findings of patients with cancer dates back to ancient Egyptian and Greek civilizations, where this disease was predominantly treated with radical surgery, which was ineffective, leading to death of patients. Despite advances in the diagnostic, medical and interventional fields, the number of new cases of cancer are increasing every year.
Over the centuries, important medical discoveries have allowed to identify the biological and pathological features of tumors. This however did not contribute to the development of effective therapeutic approaches until the end of the 1800s, when the discovery of X-rays and their use for the treatment of tumors provided the first modern therapeutic approach in medical oncology. A real breakthrough took place after the Second World War, with the discovery of cytotoxic anti-tumor drugs (chemotherapy) for the treatment of cancer. Since then, there has been an exponential growth of studies concerning the use of new drugs for cancer treatments.
The second fundamental breakthrough in the field of oncology and pharmacology took place at the beginning of the 1980s with the molecular and cellular biology studies, which allowed the development of specific drugs for the molecular targets in cancer, giving rise to the targeted therapy. Both chemotherapy and targeted therapy have significantly improved the survival and quality of life of most of the cancer patients inducing complete tumor remission. Unlike the classic chemotherapy approach, which acts on both normal cells and cancer cells, the targeted therapy and new selective inhibitors are able to affect only cancer cells with minor side effects toward the normal cells.
Cancers that respond to treatment are not considered as outright cured, because there is always a potential that they could come back. Instead, they are referred to as being in complete remission (CR), meaning there is no detectable cancer in the body at that time. In terms of what the future holds for curing cancer altogether, some experts believe that the evolving treatments may, one day, make this a reality.
Cancer cells often find ways to escape both treatments and the immune system. Cancer is a disease, which evolves as it progresses, meaning that late-stage cancers can become very hard to treat successfully. Cancer cells continually change and acquire new mutations. These new mutations may give rise to new characteristics, such as the ability to spread more freely. Such changes in cancer cells mean that a tumor that responded to treatment at first, has found ways to resist cancer drugs and continue to grow.
