Fueled by a new therapeutic arsenal and a better understanding of the disease, oncology has made spectacular strides in recent years, and the research area still seems vast.
Cancer is a lifelong scourge caused by the transformation of cells that become abnormal and multiply excessively.
But advances in research have made it possible to better understand this disease, which causes almost 10 million deaths worldwide every year: we now know that there are not “one” but “several” types of cancer for the same organ. And that there can be different tumors for the same type of cancer.
“Talking about colon cancer or breast cancer means nothing; The challenge today is to define what a cancer looks like on a biological level,” explains doctor Fabrice André, research director at the Anti-Cancer Center Gustave-Roussy, to AFP.
For example, there are three main types of breast cancer that are not susceptible to the same treatments.
In recent years, “the development of molecular technologies has made it possible to better identify which abnormal proteins need to be blocked” for each tumor type, Prof André continues.
This better understanding of the disease led to the advent of targeted therapies in the 2000s, targeting a specific genetic mutation.
In the past, chemotherapy was often the only treatment offered, but since it aimed to eliminate cancer cells regardless of their location in the human body, it could cause side effects.
For various types of cancer, such as certain forms of leukemia, “targeted therapies have been a revolution,” says Professor Bruno Quesnel, Director of Research and Innovation at the National Cancer Institute (Inca).
In the last decade, immunotherapy has emerged as the most important advance in oncology.
The principle: the patient becomes his own medicine. Unlike chemotherapy, we no longer attack the cancer cells themselves, but the immune cells that surround them to activate them. Recharged, it is the latter that destroy the tumor cells.
This discovery earned James Allison of the University of Texas and Tasuku Honjo of Kyoto University the 2018 Nobel Prize in Physiology and Medicine.
For some types of cancer, this discovery was of great importance. For example, before 2010, the survival rate for patients with metastatic melanoma (the most serious skin cancer) was very low. Thanks to immunotherapy, life expectancy has increased by up to ten years compared to a few months before.
But not all tumors respond to this treatment, which can also have side effects.
“We are only at the beginning of immunotherapy,” assures Professor Bruno Quesnel. The variations of this new therapeutic weapon are already numerous: bispecific antibodies, cell and gene therapies (CAR-T cell)…
“Now we have to be able to combine treatments as intelligently as possible,” says Pierre Saintigny, oncologist at the Léon Bérard Center in Lyon. “With immunotherapy, we’ve taken a step forward in cancer treatment, but there are still steps to climb for any patient who doesn’t benefit.”
Researchers can rely on biotechnology’s ability to develop new drugs that are increasingly specific and less toxic.
Another pillar to rely on: the development of artificial intelligence (AI), which already allows a better definition of cancer prognosis. Thanks to her, “we will be able to find out which patients can benefit from a short treatment”, assures Fabrice André. Advantage: therapeutic de-escalation for patients and lower costs for the community.
Breast cancer pioneered the use of AI, which should now benefit other types of cancer.
Another hope lies in the ability to detect a tumor very early in the body. “We already do this in the United States by examining the DNA thanks to a simple blood test, but there are still many false positives,” notes Fabrice André.
Prior to the generalization of such a technique, to date, prevention is the best way to avoid a majority of cancers.