the times | Saturday June 11 2022 33
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emergence of a secondary cancer a couple of years
ago. That second cancer has so far required two
operations: the latest was a nifty piece of 21st-century
robotic keyhole surgery but the follow-on treatment
was a short, sharp blast of a 1970s chemo drug.
We have not yet reached the point where we are
saying goodbye to the older treatment modes.
Chemotherapy, radiotherapy and surgery (cutting
out a tumour is still the most direct way of
eliminating a cancer) will remain vital tools for
years to come. The new therapies will often be used
in combination with, not instead of, the old ways.
Cancer breakthroughs are a staple of health and
science news. But rarely does anyone ask how
these state-of-the-art medicines and techniques
are going to be delivered — and at what cost — to
the millions of people who are ill.
The NHS is bedevilled with staff shortages,
including among the radiologists vital to spotting signs
of cancer, and a workforce still exhausted from the
pandemic. Patients, their families and their GPs all
know that people will continue to die from cancer. We
only have to look at the courage of Dame Deborah
James, who has revealed that she is now having end of
life care for her bowel cancer, or the death from breast
cancer of her podcast co-host Rachael Bland in 2018.
Among all this pioneering research there is a
paucity of studies into improving quality of life and
palliative care for those facing their last days. These
are not the sexy topics that win scientific awards or
Big Pharma funding.
Most of the deaths from cancer in the future will
occur in poorer communities. The Asco conference
heard results from Canada showing recurrence rates
were twice as high in poor patients than wealthy ones.
In the UK, Macmillan distributed three times as many
hardship grants to cancer patients in the first three
weeks of May as it did in the same period last year.
The death toll will also fall hardest on low and middle-
income countries. The World Health Organisation
reports that comprehensive cancer treatment is available
in 90 per cent of high-income countries but fewer than
15 per cent of low-income countries. Five-year breast
cancer survival rates are 80 per cent in high-income
countries but run at 66 per cent in India and 40 per
cent in South Africa. Radical developments in
precision medicines are, at the moment, a first world
revolution. The costs of the new drugs puts most of
them out of reach of health authorities in poorer
nations; even here, NHS accountants frequently balk
at the prices being demanded by the pharma giants.
Speaking from Chicago, Lawler called on the UK-US
partnership — the powerhouses of cancer research —
to show global leadership. “How do you make sure that
precision medicine does not widen inequality?” he asks.
“It’s something we really need to address, to make sure
we develop approaches that are applicable right across
the cancer spectrum no matter where you live.”
Last year President Biden, whose son Beau died
from a brain tumour in 2015, echoed Nixon when he
launched Cancer Moonshot with the aim of cutting
death rates by 50 per cent in the next 25 years. Britain
has joined that ambition with a transatlantic summit
to “identify transformative research grand challenges”.
In fact it is not a single moonshot that is required
but multiple missions to reach cancer’s myriad
satellites. The good news is that those missions are
well under way and some have already reached their
goals. Cancer science is reaching for the stars and they
are now within touching distance.of anything else in terms of complexity.”
Two people with the same cancer might see it
develop differently and respond differently to the same
treatment. Two people with different cancers might
respond in the same way to identical treatments.
Cancer is too complex for there to be a magic bullet,
Godfrey says, and no single revolutionary
breakthrough comes close to a universal cure.
The astonishing results in the rectal cancer trial that
excited the audience in Chicago have to be placed in
context. The study involved a tiny sample of just 14
patients chosen for the trial because they had a
specific type of cancer.T
his path towards more bespoke medicine
comes with downsides. More individual
treatments go hand in hand with more
individualised screening. In the not-too-
distant future it will be possible for a 25-
year-old to be told from a blood sample or stool
sample (or maybe even via their smart watch) their
percentage risk of developing a particular cancer.
“You then open a whole other can of worms,” Davis
says. “If you were told you had a one in four chance of
developing a cancer in the next ten years and there
was some intervention you could do but that carried a
particular level of risk, then what would you do? The
development of more technology to analyse the
human body in a personalised way requires a large
number of professionals to help people understand
what all this information means for them.”
Nor are the new treatments free from side effects.
Manipulating the immune system to attack cancer is not
risk-free. My leukaemia medication suppresses the
immune system which, my doctors suspect, led to themake them ill then you sometimes question the value
of that. Some of the treatments we used in the past
were pretty toxic and we’re trying to move towards a
much more tolerable therapeutic regimen.”
Hundreds of billions of pounds have been spent
globally on cancer research since Nixon declared war
and introduced the US National Cancer Act in 1971.
Millions continue to die but the lofty ambition the
former president articulated still resonates.
Cunningham says whenever he catches a cab outside
his famous cancer hospital’s Chelsea building, the
typical taxi-driver gambit is: “So doc, have you cracked
it yet?”. He adds: “My answer is ‘not completely but real
progress is being made’. We are curing cancers but
we’re just not curing everybody yet. We should be
dead clear — we can cure cancer, we just can’t cure all
cancer and we can’t cure cancer at all stages.”
Cunningham remains optimistic. You have to be, he
says, if you’re the director of research. At Cancer
Research UK, the charity’s research information lead
Dr Sam Godfrey is a little more circumspect. Yes,
there is “brilliant science” and “renewed optimism” but
every development raises new questions.
“The biggest advances have been in the
understanding behind cancer,” Dr Godfrey says. “We
understand much more about how cancer builds,
survives and manipulates but with that comes a load
of other questions — we suddenly need to understand
the microbiome, the bugs that surround the tumours.
With everything we find we basically uncover more
that we need to know.
“The vast amount of intelligence, the big
breakthroughs we’ve made in understanding have
helped us realise what cancer is — the most complex
disease that humans face, bar none. It’s far, far ahead
Nixon declared
war on cancer
and Biden
has launched
a ‘cancer
moonshot’ but
it is multiple
missions that
are needed
“
ALAMY; BETTMANN ARCHIVE/GETTY IMAGESe a o r w s C o e y i s t a t iPresident Nixon signed the National Cancer Act at the White House in December 1971
putting $1.6 billion into a concerted effort to find the causes and cures of the disease