"Public interest in innovations in oncology is high,
and not only on the eve of World Cancer Day, which is celebrated on February
4th. It seems there are no publications
left whose news feeds don't feature reports about miracle cures or 'breakthrough
developments' that are supposedly about to save humanity from cancer.
The high level of interest in this topic is understandable:
almost every family has or has had someone who has been affected by cancer in
some way. However, simplistic interpretations of progress in this field of
medicine can play a cruel trick on us, creating the impression that scientists
and doctors are searching for some kind of universal "cure for
cancer," and that until it is found, "nothing has changed."
Meanwhile, the progress in treating oncological diseases is enormous! It just
doesn't look the way most people imagine it.
There are more than a thousand types of cancer. And if we
delve deeper into the molecular and genetic profile of tumors, we can identify
tens of thousands of their varieties. Today in Russia, methods of such
diagnostics are widely available within the oncological care system. They allow
doctors to personalize anti-tumor therapy to the maximum extent. And they allow
scientists to find new ways to combat malignant neoplasms, which are then
implemented in the form of new anti-cancer drugs and entire classes of
medications.
At the end of the 20th century, for example, in addition to
oncological surgery and radiation therapy, our arsenal included classic cytotoxic
chemotherapy. Scientists developed new chemotherapy drugs that had one goal –
to destroy tumor cells. However, along with the tumor cells, other rapidly
dividing human cells were also destroyed: for example, blood cells. Therefore,
in those days, the art of the oncologist was to choose a chemotherapy regimen
that would inflict maximum damage on the tumor but not kill the patient. And
that was progress; we could treat disseminated cancers..." patients whose
tumor cells have spread throughout the body.
And just when it seemed that the limits of what was possible
had been reached, a new class of drugs emerged. Thanks to the development of
molecular genetic diagnostics, which allowed us to identify mutations in tumor
cells, targeted therapy appeared. Targeted drugs work on a different principle:
they detect mutant cells in the tumor and destroy only them, thereby preventing
the tumor from growing and spreading throughout the body. This is a tremendous
breakthrough! But can such therapy be considered universal? No! Not every tumor
has mutations.
In other words, these drugs are not indicated for all cancer
patients; for some, they will be useless. But for those who do have such
mutations, we can significantly prolong their lives. In our oncology center, we
have patients with stage four lung cancer, for example, who have long since
surpassed the five-year survival mark. Just a decade and a half or two decades
ago, the life expectancy for such patients did not exceed 6-8 months.
At a certain point, it again seemed that the capabilities of
oncologists had reached their limit. But then the era of immunotherapy arrived
– a whole class of drugs with which we learned to correct the body's immune
response to the threat of tumor cell spread. There are various immunotherapies
– in some cases, it is advisable to influence the protective mechanisms of the
tumor itself, and in others, to activate the cells of the human immune system,
restoring its ability to attack the "evil."
Has immunotherapy become a "magic bullet"? No.
Because not every tumor has high immunogenicity, and it is not always possible
to sustainably stimulate the body's own anti-tumor immunity: a human being is a
complex biological system. Thus, this class of drugs is also not universal, but
thanks to it, a cohort of patients has emerged whose lives we can significantly
prolong, and in some cases, even cure. I am now talking about people with
melanoma – This refers to a disease that was incurable 20 years ago, or to
patients with certain types of lung cancer, or certain types of kidney cancer.
Today, we are moving forward again. The importance of
studying the tumor microenvironment has become evident. New research in this
area suggests that the microenvironment not only affects the effectiveness of a
particular therapy, but also has "predictive power," allowing us to
predict in advance which type of medication will be more effective and which
will most likely be useless for the patient, only worsening their quality of
life and delaying the administration of truly effective drugs in their case.
Sometimes, progress in oncology looks precisely like the personalization of
therapy, allowing us to achieve the maximum effect with the available means.
But familiar innovations are also on the horizon. The
prospect for the next five years is the emergence of a new class of drugs:
antibody-drug conjugates (ADCs, a class of high-precision biopharmaceutical drugs.)
The principle Their actions involve the safe delivery of very high doses of
chemotherapy drugs to the tumor. A person cannot tolerate the intravenous
administration of high doses of chemotherapy drugs, and once in the
bloodstream, they pose a deadly threat. What's the solution? To create a drug delivery
system that "unpacks" the poison inside the tumor. And today,
scientists have learned to synthesize such delivery systems – but for them to
work, it's crucial to be able to recognize specific receptors on tumor cells
that, like beacons, will attract these securely packaged "bombs" to
the tumor. And this is not just one single discovery, but the continuous work
of scientists and clinicians, a process that allows for the discovery of new
receptors.
The possibilities of surgery are no less impressive. It
would seem that this is the oldest method of fighting tumors, but much has
changed here as well. Not from a technical point of view – there are
practically no unresectable, technically inoperable tumors left for us.
Progress is being made in the direction of close cooperation between surgeons
of different specialties. It is no coincidence that there are departments of
cardiovascular surgery and organ transplantation.
All this allows us to help patients who were considered
incurable in the recent past. For example, there are neoplasms, not always
malignant, but life-threatening due to their growth into vital organs – the
heart, pulmonary trunk, pulmonary arteries. This refers to leiomyomatosis,
which most often affects young women aged 30-40 years. A team of surgeons
consisting of oncologists, cardiac and vascular surgeons allows these patients
to be cured and forget about the disease.
There is also another very important cohort of patients from
the point of view of providing oncological care – people over 55 years old.
They make up 70-80% of patients in oncology centers and dispensaries. Most of
these people have co-existing cardiovascular diseases, and for this reason they
cannot begin anti-cancer treatment because they would not tolerate it.
In such cases, we prepare patients for our therapy by
performing stenting, bypass surgery, and heart valve replacement, and only
after that do we implement the full course of anti-cancer treatment.
Cardiovascular surgeons can quickly respond to serious cardiovascular
complications of anti-cancer treatment, allowing the patient to continue
therapy for the underlying disease.
Thanks to cooperation with cardiovascular surgeons at our
center, we can treat patients with so-called competing diseases. Sometimes a
person comes to us, for example, with a bleeding colon tumor and simultaneously
with severe heart ischemia. In such a case, staged treatment is impossible: no
matter which pathology we start with, it will pose a threat to the patient's
life, and then a simultaneous operation is performed for both diseases.
The introduction of organ transplantation into the work of
the oncology center also provides new opportunities to continue anti-cancer
treatment. Imagine a person whose disease we can successfully control, but whose
liver function is sharply reduced due to multiple courses of toxic
chemotherapy. Or metastases in the liver have replaced the liver tissue with
tumor nodes: theoretically, we can continue anti-cancer therapy, but the person
will not tolerate it. Previously, we would have been forced to stop treatment;
today, such patients become candidates for transplantation, and for this they
do not need to leave their specialized medical institution.
In other words, there is no single "magic pill for
cancer," but every year we can help more and more patients, preserving not
only their lives but also their quality of life.”
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