32 Saturday June 11 2022 | the times
Comment
T
he vast McCormick Place convention centre
in Chicago was thronged this week with
around 40,000 people attending the world’s
biggest cancer research jamboree. The
annual meeting of the American Society of
Clinical Oncology (Asco) in Chicago was taking place
in person for the first time since the pandemic.
The atmosphere was abuzz with oncologists,
research scientists and pharma executives; the air
thick with news of breakthroughs and brainstorms.
“Asco is where you go to hear the latest, to meet
colleagues and people you’ve worked with — I’ve met
people this week that I’ve been collaborating with for
the past three years but never actually met in person,”
says Mark Lawler, professor of digital health at
Queen’s University Belfast. “The excitement in the
room was palpable — especially around the
presentations on breast cancer and rectal cancer.”
Half a century after Richard Nixon declared a “War
On Cancer” and called for “the same kind of
concentrated effort that split the atom and took man to
the moon”, there is real belief that some cancers can be
cured, many managed and others treated more kindly.
The pioneering studies unveiled at Asco drew gasps
and even standing ovations in the conference hall. A
“small but mighty study” showed that a precision
immunotherapy treatment to target a specific genetic
defect in rectal cancer had produced a 100 per cent
response in the first patients to receive it. “I believe
this is the first time this has happened in the history of
cancer,” announced one of the study authors.
The drug giant AstraZeneca said results from trials
of its breast cancer therapy Enhertu, which latches on
to a protein on some tumours, were a “pivotal moment
in the history of breast cancer”. In another session, a
new blood test was unveiled which can detect if bowel
cancer patients have been cured by surgery and can
therefore avoid follow-up chemotherapy. It could be
available on the NHS within three years.
The NHS itself reported that it had carried out a
million cancer diagnostic tests at one-stop shops in
shopping centres and football stadiums, as it tackles
the patient backlog caused by the Covid-19 pandemic.
And BioNTech, which became a household name after
developing the Pfizer coronavirus vaccine, revealed it
had used the same mRNA technology for a potentially
preventative jab for pancreatic cancer, one of the most
aggressive forms of the disease.
After three years in which the worlds of medicine
and science had been dominated by coronavirus,
cancer — which claimed more than ten million lives
in 2021 — is back at centre stage. “It is easy to get
carried away about a lot of the things that come out of
scientific meetings and conferences, but it is actually
Advances show
tide is turning
at last in the
war on cancer
quite an exciting time,” says Dan Davis, professor of
immunology at the University of Manchester.
The turning point in the great oncological war was
the discovery of cancer immunotherapy, which
harnesses the power of the body’s immune system to
fight the disease. Immunotherapy added another
weapon to a medical arsenal that until then had
tackled cancer by cutting (surgery), poisoning
(chemotherapy) or burning (radiotherapy).
The realisation that the power of the body’s own
immune system could confront cancer dawned slowly
on the scientific community. In the 19th century the
American scientist William Coley used early forms of
immunotherapy to treat sarcomas. There were
indications in research in the 1940s that the immune
system had the potential to combat the disease.
Yet the prevailing medical wisdom remained, as
Davis puts it in his recent book The Secret Body, that
cancer was “invisible to our body’s defences”. Because
cancer cells were not alien to the body, it was thought
the immune system could not detect them.
That belief was shattered by the work of
immunology professor Jim Allison in Houston, Texas.
In the 1990s Allison’s efforts to better understand how
the immune system works led him to discover that he
could release the natural brakes on immune cells and
activate them to fight cancer cells. The resulting
therapies, known as “checkpoint inhibitors”, gave birth
to cancer immunotherapy and eventually led to
Allison winning 2018 Nobel prize for medicine.
Immunotherapy treatments are now in widespread
use and constantly evolving. As well as drugs that
activate or boost T-cells, there are cellular interventions
like CAR T-cell therapy in which the infection-fighting
cells are removed, genetically engineered to recognise a
cancer then re-injected to combat the disease.
Davis says he is aware of more than 3,000 clinical
trials in progress testing new medicines that work by
switching on or boosting the body’s immune cells.
“Lots of companies are developing new kinds of
antibodies that switch off these brakes on the
immune system,” he says. “It’s an exciting area. We
know it can work, the question is can we make it
work for more cancers and more patients and with
fewer side effects?
“We know a lot about how the immune system
works and therefore what therapies we can try but we
don’t yet know what is going to work. Across different
academic labs and across different companies the
global scientific community is placing lots of bets —
some will work, some will fail.”
As a cancer patient since 2010, I can testify that
some of those bets are definitely paying off. Change
for patients is tangible and life-saving.I was diagnosed with chronic lymphocytic leukaemia
in 2010 and the cancer literature at the time told me that
with a fair wind I might live another ten years. My early
conversations with doctors were about chemotherapy
to suppress the disease for a period with the only
chance of a cure being a bone marrow transplant,
which would carry a 20 per cent mortality risk.
Six months of chemotherapy in 2011-12 led to a five-
year remission before the leukaemia returned. In
those intervening years, however, my treatment
options changed radically. I now take a targeted
therapy drug called ibrutinib — one pill a day —
which my doctor at the Royal Marsden Hospital
predicted would keep the disease at a manageable
level. In fact it appears to have sent it into remission.
Ibrutinib is one of a family of drugs called kinase
inhibitors which block a type of enzyme on cancer cells
and prevents them from growing and multiplying.
These days at my haematology appointments, no one
talks about chemotherapy or transplants. Should the
ibrutinib stop being effective there is already a plan
in place for the next-generation drug.
“These drugs are unbelievable,” says Professor
David Cunningham, director of clinical research at
the Royal Marsden. “They are great examples of
targeted treatments but also a manifestation of
what’s happening across the whole spectrum of
cancer — precision diagnostics and therapeutics,
digital health innovations.
“It’s an exciting time. I’m coming to the end of my
career in oncology and I have seen great
transformation in the last ten to twenty years. We’re
beginning to see and understand the ways in which we
can target this disease more effectively and with fewer
side effects. It’s fine treating people but if you reallyirthadions
ing
se aal
bywe
ent—eyear rem
those in
options
therapy
which m
predict
level. In
Ibrut
inhibito
and pre
These
talks a
ibruti
in pla
“Th
Davi
the
targe
what’
cance
digital
“It’s a
careeri
transfo
beginni
can tar
side effHosts of the podcast You,
Me and the Big C (above,
from left) Rachael Bland,
who died in 2018, Lauren
Mahon and Deborah
James. Below, Professor
David Cunninghamweekend essay
There is no ‘magic bullet’ to defeat the array of cancers that
confront us but the speed at which new treatments are
emerging is causing excitement among specialists, says
Sean O’Neill, who has benefited from some of them himself