So Many Drugs, So Little Gain: What Path Forward?

Cancer is still one of the greatest challenges to modern medicine. Despite decades of scientific research, hundreds of billions in investment, and waves of therapeutic advancements, cancer is still the second leading cause of death in the US. The American Cancer Society estimates, nearly two million new cancer cases will be diagnosed in the US in 2025, with greater than 600,000 deaths. Suffering from cancer is a daily reality for more than ten million people each year, as cancer accounts for almost ten million deaths world-wide, and the number continues to rise.

In 1971, President Richard Nixon signed the National Cancer Act, launching the War on Cancer. The National Cancer Act provided record resources for cancer research, new cancer centers were developed, and the National Cancer Institute was strengthened. The ambition was very high, matching the spirit of the space race, however at that point in time, there was still very little understanding of cancer. While the National Cancer Act failed to find a cure for cancer, it did initiate a scientific revolution that over the next fifty years developed a deep understanding of cancer, and provided the foundation for many of today’s efforts in prevention and treatment.

The discoveries in cancer biology led to targeted therapy and immunotherapy and precision medicine. Now, drugs were able to target specific mutations in cancer cells. Imatinib, known as Gleevec, treats chronic myeloid leukemia by blocking the BCR-ABL fusion protein. EGFR and ALK inhibitors reshaped lung cancer treatment for patients with these genetic changes.  HER2 targeted therapy such as trastuzumab, changed the treatment for HER2 positive breast cancer. Collectively, these advances mark major advances in cancer treatment with precision medicine. However, we are still far from the goal of finding a cure.

More Than 100 Drugs for Lung Cancer: Major Advances

Few fields of medicine have seen as many new drugs as oncology. We now have more than 100 FDA-approved drugs for lung cancer alone. These include chemotherapy, targeted therapies, immunotherapies, antibody-drug conjugates, combination regimens, and the like. The development of these compounds has emerged from decades of intensive research on tumor biology and the immune system. Each approval is labeled a breakthrough, and with each newly approved drug, we are widening the arsenal of therapies made available to patients who, not many years ago, had few options.

Limited Gains for Metastatic Lung Cancer

This paradox is perhaps most evident in lung cancer, the number one leading cause of death due to cancer. There has been progress—the last fifty years of more than 100 new drugs approved for treatment are not without merit. However, despite the development of many new treatments, five-year survival rates for patients with metastatic lung cancer is about 8% now, according to the National Cancer Institute's SEER Program and the American Cancer Society. While this number represents an improvement from about 3% in the 1980s prior to the era of targeted therapy and immunotherapy, it is still very low. Most patients with metastatic lung cancer, regardless of all the treatments we have available to them, will die within two years after their diagnosis.

Limited Gains for Other Metastatic Cancers

This dismal outcome is not unique to lung cancer. The pattern is strikingly similar with other  cancers. The five-year survival for representative metastatic pancreatic cancer, liver cancer, and stomach cancer remain below 15%, all while advances in treatment continue.

Overall, we have made progress in drug development which is substantial, but rather incremental. Median survival gains for many cancer drugs approved over the last several decades often amount to only a few months. 

Hope: Early-Stage Cancers Are Often Curable

When a patient is diagnosed with cancer, the prognosis is largely based upon the stage in which it was diagnosed. If the cancer is detected early and is limited to its origin site, surgery alone is often curative. By contrast, once the same disease has spread throughout the body, chances of long-term survival drop dramatically.

The statistics are staggering. If you are diagnosed with localized breast cancer, for example, it has a five-year survival of 99 percent. Similarly, localized colon cancer has a 91 percent survival when "captured" early. Localized prostate cancer has a five-year survival of greater than 98 percent. Even lung cancer has a survival of about 60 percent when "captured" early, but under 10 percent once it spreads. Five-year survival of pancreatic cancer is about 3 percent when it takes hold once it has spread, and about 40 percent when localized. In breast cancer, the ten year survival changes from 99 percent for localized disease to about 30 percent once metastatic. Similarly, colorectal drops from about a 91 percent five year survival rate when localized to about 15 percent. Prostate cancer is typically very treatable in an early stage; once metastatic it declines to about 32 percent.

The differences are so dramatic! An incurable disease once metastatic can be easily curable, when caught early. 

While new therapies will continue to improve outcomes, the greatest opportunity to reduce cancer deaths lies in early detection and prevention. By finding cancers before they spread, we turn a deadly diagnosis into a curable disease from despair to hope.

The New Path Forward:

Leveraging Recent Breakthroughs in Early Detection and Prevention

• Emerging AI-Powered systemic early detection capable of catching most cancers early with a single test.

• Leveraging anti-aging breakthroughs to revitalizing the immune system and reducing chronic inflammation for more effective cancer prevention.

Living a Life Free of Cancer

Regulatory approval and adoption of new systemic early detection and prevention approaches will take long time. Many individuals cannot offer to wait years or decades. Those individuals who are high risk whether through family history, age, or personal health concern can already access to multi-cancer early detection (MCED) blood tests and preventive whole-body MRI. This will provide a new opportunity to catch most cancers at early, curable stages.

Moreover, new primary prevention strategies utilizing anti-aging breakthroughs can enhance the immune system and calm inflammation to reduce the risk of cancer more effectively.

The new path forward is a combination of individual-driven systemic early detection with better prevention with anti-aging. These new approaches offer a realistic vision of what once seemed impossible: living a life free of cancer.