While there have been major advances in drug development in recent years, systemic treatments like chemotherapy remain the standard of care for most patients. As anyone who has been through chemotherapy knows, it affects the whole body aggressively and causes serious side effects, taking a physical and emotional toll. But chemotherapy might become a thing of the past as novel approaches to cancer treatment account for the vast majority of new cancer medicines: around 80% of cancer medicines being developed are likely to be 'first-in-class' products, meaning they are unlike anything currently available.
One example is CAR-T cell therapies, a form of immunotherapy which helps the body fight back against cancer, in this case, blood cancers. There are around 44,000 new cases of blood cancers across Europe every year, and globally in 2013, around 600,000 people died from blood cancers. For this new approach to treating them, scientists engineer immune cells to target specific types of blood cancer, harnessing the power of the body's own immune defences to tackle the cancer.
These new medicines have the potential to revolutionalise blood cancer care. While chemotherapy can be aggressive, it also fails. Around 50% of patients will relapse, leaving them with few treatment options. By contrast, CAR-Ts may prove lifesaving, increasing life expectancy by nearly 70 years. They may also allow patients to enjoy a better quality of life, both during and after treatment, living more healthily for longer.
Another way of approaching cancer differently is simply a question of combining more than one medicine in order to target different biological mechanisms and increase the chance of the patient's cancer being kept under control, or even curing it. In the treatment of Non-Small Cell Lung Cancer, which is the third most common form of cancer, it is possible to use a combination of immunotherapies - which improve the patient's immune response - and targeted therapies - that destroy the cancer cells or prevent them from spreading - to increase the chances of success.
Scientists have succeeded in unravelling the sequence of the human genome - decoding the genetic building blocks that make up our bodies - and research has been underway to establish how genes could be edited to cure or prevent disease. Cancer is a disease that mutates genes to allow cells to grow and multiply without the body's normal checks and balances kicking-in. Now, gene editing is being used to program a patient's own immune cells to target and destroy cancer cells.
Creating breakthrough medicines is a key step, but we also need to be able to diagnose cancer in the first place. Traditionally, diagnosis is made by collecting tumour tissue through performing a biopsy, which can be invasive and uncomfortable. This could be all about to change. The advent of 'liquid biopsies', where a blood sample can be used to detect and examine particles of DNA shed from tumours into the blood. Not only could this simple technique detect cancer far earlier, it could be used to tailor the patient's treatment, paving the way for so-called 'personalised medicine'. The downside to this is that we might be rather further off from it being a routine solution.
Professor Peter Johnson, Cancer Research UK's Chief Clinician and director of the Southampton Cancer Research UK Centre, put this in some perspective. 'Research into this area has been going on for a number of years, but what we have recently developed is the ability to analyse DNA so that we can see the finer detail of a tumour's response. The current potential for this sort of technology is being able to track a patient's response to treatment according to resistance,' he explained. This would enable a doctor to tailor a patient's treatment according to how their treatment is working. 'There is lots of research going on now into how liquid biopsies could lead to earlier diagnosis of cancer - for example via the Illumina Grail programme - but this will take a few years to become a reality.'
While the groundwork is in place and the cogs are turning on scientific advancement, these innovations will mean nothing unless patients can access them. As new treatments become available, it will be more important than ever for the NHS to have the right skills and processes to ensure patients can benefit from these new treatments. Having a system that can identify who has cancer, identify the precise type of cancer and treat patients with the right treatment for that person is key. This needs to be supported with access to funding for these new treatments.
England's chief medical officer, Professor Dame Sally Davies, recently published her annual report, which focused on the potential of genomics. She stressed that the importance of retaining access to research data across the globe for the UK's continued success in genomics. Crucially, she was critical of the attitude in the NHS whereby genomics is thought of 'as a thing far in the future, or even worse, a potential burden rather than a boon.'
Professor Johnson takes an optimistic view of the NHS response to innovation: 'There is no doubt that we are in an era of molecular medicine, and there is a general sense that genomics is the future.' However, he was clear that there are operational issues that will need to be addressed in order to embed this potential within the NHS. For example, when it comes to cancer diagnosis, it is important that when biopsies are performed they are handled in such a way that scientists can extract as much information from them as possible, which requires efficient lab work. He particularly stressed the need for those data experts: 'There is a huge amount of data generated and we will need data specialists who can process it. The data involved in this work makes histopathology look easy by comparison.' But he is confident that the system will rise to the challenge: 'We have an enormous opportunity to make the most of these new medicines and techniques, so we will have to do it,' he says.
The NHS will need to embrace innovation wholeheartedly and be prepared to put in place the infrastructure to make it work if we are really to achieve a future where cancer isn't a byword for fear.
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