The healthcare burden of cancer is increasing worldwide. There were an estimated 18 million new cancer cases in 2018,1 a 28% annual increase from 2012. Alarmingly, by 2030, annual diagnoses are expected to increase another 31% to 23.6 million new cases per year.
The Cancer Burden
Contemplating both the ominous increase in cancer rates and its biological drivers, reviewing the oncology landscape becomes akin to studying the military strategies of Attila the Hun. The story is one of deception, traitorous conversion, brute force and surrender. Cancer cells’ number-one priority is to survive, thrive and expand their territory.
Until recently, the medical community’s primary strategy to battle cancer was to reduce or eliminate cancer cells or cancerous masses by surgery, radiation, cell-killing chemotherapy or a combination of the three. Because of an incredible array of scientific, biological, medical and therapeutic advancements, there is now a diverse set of treatment approaches — many still in various stages of development.
An Expanding Arsenal
The expanding set of treatment options include more efficacious and less toxic chemotherapies, targeted therapies, hormone therapies, stem cell transplants, increasingly sophisticated biomarkers, immunotherapies, therapeutics utilizing cancer’s metabolic behaviors and a growing understanding of ways to deliver on the promise of precision medicine.
Immunotherapy, currently the darling of the oncology world, is an approach that uses or retrains the patient’s own immune system to fight cancer. The age of immunotherapies was ushered in by the approval of ipilimumab, a melanoma treatment, in 2011. As of March 2019, 13 new cancer immunotherapies have been approved and are becoming the standard course of care for a growing number of cancers. In fact, according to a Nature survey published in November 2018, from September 2017 to September 2018, there was a 67% increase in the number of active agents in the global immuno-oncology pipeline (2,031 agents in 2017 versus 3,394 in 2018).2
Until recently, the FDA has approved therapeutics in alignment with the area of the body where the cancer in question originated (e.g., lung cancer or ovarian cancer). However, this is changing, presenting some fascinating opportunities for a possible new paradigm in the development of cancer drugs that are tissue agnostic. The agency has now approved two treatments based on a common biomarker across different types of tumors rather than body location.3
Maybe putting cancer cells to “sleep” while avoiding the potentially dangerous side effects of most oncology treatments will work. Associate Professors Tim Thomas and Anne Voss from the Walter and Eliza Hall Institute, Professor Jonathan Baell from the Monash Institute of Pharmaceutical Sciences and Dr. Brendon Monahan from Cancers Therapeutics CRC are leading research to determine whether inhibiting KAT6A and KAT6B could be an effective and less risky approach to treating cancers. Rather than focusing on damaging cancer cell DNA (which also damages the DNA of healthy cells) as chemotherapy and radiation strive to do, this approach targets KAT6A and KAT6B proteins, both of which are known to play important roles in fueling cancer growth. With these genes in a state of permanent sleep, several cancers should simply stop progressing.4
Yet another approach takes advantage of the unique metabolic characteristics of cancer cells. Several emerging methods strive to change or suppress cancer’s metabolism to stop it in its tracks. However, the development team at Vybyl Biopharma is taking advantage of cancer’s metabolic behaviors to target drug delivery. The Vybyl team knew that RAS-driven cancers are “hungry” for the fatty acids contained within human serum albumin (HSA). They are developing a small molecule drug conjugate that hitchhikes by uniquely mimicking fatty acids on key HSA and lipid nutrient acquisition pathways central to tumor growth to deliver highly toxic yet highly effective solid-tumor chemotherapies like paclitaxel in a targeted manner. This avoids many of the consequences of untargeted chemotherapy administration.
A Revised Outlook
It was not long ago that surgical removal, radiation and untargeted chemotherapies were the only weapons within the medical community’s cancer-fighting arsenal. Today, the rapid development of novel oncology solutions shows no signs of slowing down, and the battle to fight cancer will continue with increasingly effective weapons.
- “Worldwide Cancer Data.” World Cancer Research Fund. 2019. Web.
- Tang, Jun, Laura Pearce, Jill O’Donnell-Tormey, and Vanessa M. Hubbard-Lucey. “Trends in the Global Immuno-oncology Landscape,” Nature. 17: 783–784 (2018).
- Blank, Christine. “FDA Clears Novel Cancer Treatments.” Formulary Watch. 4 Dec. 2018. Web.
- Hall, Walter and Eliza Hall. “New Anti-cancer Drugs Put Cancers to Sleep — Permanently.” Medical Xpress. 2 August 2018. Web.