You could say that cancer research has progressed in a similar way to science and the journey of nuclear physics. In April 1932, Cockcroft and Walton split the atom to confirm Einstein’s theory of relativity.

Before then, the atom was considered the smallest piece of matter – an indestructible entity – which made up everything in our universe.

But a few decades later, it was discovered that protons and neutrons, which made up the atom, were made of even smaller particles, thereby pushing science and our understanding of life further than ever before.

Following the guiding principles of science, humanity was able to follow cancer’s trail and discover more details about its molecular make-up, closing in on the disease, breaking it down into its building blocks and uncovering its mechanisms of action.

Through a deeper understanding of the disease and its molecular structure, we are able to develop groundbreaking medicines to create better patient outcomes and eventually discover a cure.

Cancer continues to be a notoriously difficult to treat disease with a high level of unmet medical need. In 2020, there were almost 10 million cancer deaths and more than 19 million new cases. Globally, cancer is responsible for one in six deaths.

While significant progress has been made for treating cancer, from removing tumours surgically to radiotherapy and chemotherapy, cancer always seems to be one step ahead.

The considerable cancer burden, however, has grown despite our progress. Indeed, it is still one of the most common reasons for mortality in Europe.

While we often think of cancer as one disease, cancer is a heterogenous disease. Based on the tissue of origin, histology and immunohistochemistry subtypes, molecular or genetic differences or even the microenvironment a tumour growth – just to name a few – makes each tumour unique and influences the options of treating it.

This heterogeneity makes it obvious why it’s complex to develop a universal treatment.

A deeper understanding of an individual cancer’s molecular make-up is key for understanding and later treating the disease. Through genomic technologies, researchers have been able to identify biomarkers expressed by cancer cells that provide further information about a patient’s individual cancer.

Biomarkers, as an objective and quantifiable measure of a physiological process, pathological process or response to a treatment can be monitored and help to assess how a cancer grows or how a cancer may respond to therapy.

Current developments in cancer therapy are moving away from traditional methods of chemotherapy killing cancer cells in favour of more targeted therapies. While chemotherapy has the ability to divide rapidly, it also damages healthy cells that are dividing too.

In contrast, these targeted treatments include angiogenesis inhibitors, which block the formation of new blood vessels that feed and nourish the cancer cells.

There are also checkpoint inhibitors which can trigger the immune system to attack and kill cancer cells.

Meanwhile, proteasome inhibitors, block vital proteolysis processes and signal transduction inhibitors, which disrupt cell signals so that they change the actions of the cancer cell. These treatments all work in different ways to break down cancer cells.

For targeted therapies, biomarkers such as gene mutations or the over-expression of proteins such as the human epidermal growth factor receptor 2 (HER2), are used to stratify patients according to the likelihood of responding to a particular therapy.

These therapies are developed to target specifically the cancer cells and mostly leave normal, healthy cells alone.

Sometimes the protein or gene used as a biomarker is the target too – for example, the HER2 protein on the surface of cancer cells. In other cases, the biomarker just informs clinicians how dependent a cancer cell is on a certain pathway that might be blocked by the targeted therapy, e.g., mutations in the breast cancer genes (BRCA1 and 2).

The routine use of biomarkers has opened a route to providing more tailored care and improved patient outcomes.

It’s fair to say, we’ve come a long way from categorising and treating cancer.
While the progress we have made has been groundbreaking, however, we must continue to advance cancer care. Like in physics, there are always new boundaries to cross in medicine.

And who knows – perhaps we’ll discover a universal target that eventually opens the door to finding a cure for cancer after all.

With careful research and collaboration between researchers, clinicians and industry, I remain positive that we can continue to turn the coal of today into the diamonds of tomorrow.

Markus Kosch is Head Oncology Europe and Canada at Daiichi Sankyo.
Go to daiichisankyo.co.uk