There's never been a better time to be hopeful about cancer. There's never been a moment when both preventing and treating different kinds of cancers has been more possible. And with more and more of us now experiencing what look like actual, honest-to-God cures, it's time to retire the concept of "the cure for cancer."
"An unprecedented 100% of rectal cancer patients in a small immunotherapy clinical tria had their cancer disappear after immunotherapy."
Last fall, Cleveland Clinic launched a vaccine clinical trial with the eventual goal of heading off triple-negative breast cancer in high risk patients. In late May, City of Hope cancer care and research center in Los Angeles and Australian biotech company Imugene announced their first first clinical trial using a cancer-killing virus in patients with advanced tumors. And then, earlier this week, there came astonishing news out of Memorial Sloan Kettering — an unprecedented 100% of rectal cancer patients in a small immunotherapy clinical trial had their cancer "disappear after immunotherapy — without the need for the standard treatments of radiation, surgery, or chemotherapy" — a trinity so horrendous to endure they're known to patients as "slash, burn and poison."
Is the longed for cure we've been waiting for right around the corner, then? Unfortunately, it's not that simple — because cancer is anything but simple.
"The cure" is a phrase that is fortunately less common than it was back in the 1969, when cancer researcher Sidney Farber took out a full page ad in the Washington Post issuing a challenge to the president; "Mr. Nixon: You can cure cancer," the ad read. Just a decade ago, the New York Times asked, "Is the Cure for Cancer Inside You?"
Though the rhetoric has become more nuanced since, the phrase refuses to go away entirely. There are initiatives like the Susan G. Komen "Race for the Cure" and Wacoal's "Fit for the Cure." There are biopharmaceutical companies making sketchy claims about a "universal cancer cure." And there are casual headlines in mainstream media outlets, like The Telegraph's recent musing about whether "the cure for cancer" is in your gut. When the Biden administration ambitiously declared earlier this year the relaunch of the Cancer Moonshot plan to "end cancer as we know it," they at least amended the goal to add a few words about "improving the experience of living with and surviving cancer."
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I sometimes cautiously describe myself as cured. After receiving a rapidly fatal diagnosis of metastatic melanoma and entering an innovative immunotherapy clinical trial, I have not presented any evidence of disease in ten years. But I'm careful to try to make clear that my cure was not the cure.
Cancer isn't one thing. It's over one hundred things, over one hundred variations on a theme of uncontrolled cell growth, all with their own particular expressions. There are four types of breast cancer, four types of melanoma. As Jonathan Chernoff, MD, PhD, Cancer Center Director at Fox Chase Cancer Center, has explained, "It turns out cancer is a general term. There are lots of different kinds of cancer in different tissues that act in different ways. They're not all caused by the same mutations and they're not all going to respond to the same type of treatment."
Genetic variations in all of us make each cancer its own unique experience. Some treatments work well for some people, and other people not at all. I didn't have the right BRAF mutation for vemurafenib, a treatment that was approved by the FDA mere days before I was diagnosed at Stage 4. Is vemurafenib an effective treatment for a specific type of cancer? Yes. Would anybody call it "the cure" for cancer? Of course not.
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Along with the truly thrilling prospect of more people being able to say they had, past tense, cancer, and even more never getting it in the first place, there needs to be space for thinking beyond all-or-nothing. Cures are great; I should know. And advancements in one form of cancer can often signal hope for treatments for others. Immunotherapy, for example, used be the dark horse of oncology. Today it's an approved protocol for dozens of cancers, with clinical trials for even more — just like that promising rectal cancer trial out of MSKCC — chugging along right now. There have been incredible recent breakthroughs even in deadly cancers like pancreatic.
But those breakthroughs will continue to be, for the foreseeable future, very tailored propositions. As a researcher once helpfully explained to me, you're not going to get a sweeping cure-all like penicillin for something as complex and variable as cancer. Frankly, the idea of lots of effective possibilities and treatments, instead of one magic bullet for the second leading cause of death in the US, is pretty amazing.
As we continue to make advancements in eradicating cancer, we can also make space for living with it. For certain patients, cancer is no longer a death sentence but merely a condition they can abide with. Some people's tumors simply cannot be eradicated entirely. For them, the phrase "halting the progression" can be just as beautiful, and offer just as long and bright a future, as "cured." Given the often invasive and arduous nature of treatment and the toll it can take on the human body and psyche, the goal of a spotless scan may be far less meaningful than a healthy overall quality of life anyway.
"Future cancer therapeutics will not win through a simple cancer-killing strategy," the authors of a 2020 paper in the journal Cancers wrote. Instead, "We would likely benefit more patients overall by transforming cancer into a manageable chronic disease, rather than solely focusing on finding a complete cure 'Holy Grail.'"
This is a line of thinking worth adopting, even for those of us outside of the research world. It would mean that a diagnosis wouldn't come with a presumptive assumption we're "battling" cancer. It would mean that one small word wouldn't get to be the umbrella term for such a complex experience. It would mean, at this breathtaking time in science, shifting the narrative from a war on a single enemy to a story of incredible hope, for millions more living, breathing human beings.
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