Breaking down “the cure”

Misleading metaphors can create an imaginary battlefield for the so-called “war on cancer,” and can also feed into conspiracy theories about the existence of a cure, but one that is much less profitable than the massive amount of money being spent in the search for a cure. When Nixon declared “the war on cancer” 50 years ago, the metaphor was used as tool for imparting patriotism to those who donated money to cancer research. More recently, those donating money are becoming concerned about transparency behind the lab bench, wondering how much longer the war will go on. After all the time and money invested into cancer, some have started to question researchers’ motivations and to suggest that money is going towards a self-perpetuating cause that is discovering more types of cancer than it is curing. Here, I breakdown some of the current advancements in cancer research and explain why war-related metaphors may be leading us down an endless road. Cancer begins as the differentiation of our own bodily cells past the point of regulation but still within the scope of self-recognition. Without regulation, these cells can proliferate while the body unknowingly supplies the fuel. And with self-recognition, cancerous cells remain undetected by the immune system. These rogue cells aggregate in the form of tumours, usually confined by some structural tissue, in which case they are benign, otherwise they’re malignant and are free to traverse the body via the circulatory system before settling in a new tissue.

There are nearly an infinite number of potential cellular targets for cancerous deregulation. Moreover, the cell-to-cell communication systems within humans are immensely complex and can allow molecules — including cancerous ones — to pass to both neighbouring and distant cells. This means that cancer is a very heterogeneous entity, often with many distinct genetic makeups. No longer can we regard all cancers as targets for a single, universal cure. Rather, they need to be classified as biochemically distinct diseases with similar phenotypes.

The war analogy for cancer research can be useful when it comes to knowing your enemy. Indeed, much of the current research is aimed at identifying how each case of cancer manifests itself in a body ruled by order. But this type of work is quickly being replaced by up-and-coming forms of cancer therapy, particularly targeted therapies, which can overcome the heterogeneous make up of the disease. Targeted therapies, unlike traditional methods, such as chemotherapy, radiotherapy, and surgical extraction, are specifically designed to avoid damaging non-cancerous cells. Chemotherapeutic agents, on the other hand, target rapidly dividing cells, including those that naturally occur in the body, such as intestinal gut villi, meaning that they are bound to damage non-cancerous as well cancerous cells. Similarly, radiotherapy rarely achieves the precision needed to only kill cancerous cells.

In the past decade, the US Food and Drug Administration has started to approve targeted anticancer pharmacological agents as opposed to chemotherapeutic ones. There are two main routes for targeted therapies. One involves engineering monoclonal antibodies so they bind and neutralize cancerous cells. A key challenge of this approach is identifying which surface receptor of a cancerous cell to target and not to provoke an autoimmune disease in the process. The second route uses small molecule inhibitors that interfere with and inhibit specific cellular signalling cascades involved with cancer. Imatinib (marketed as Gleevac) was one of the first small molecule inhibitors to be used as an effective cancer treatment, specifically treatment of chronic myeloid leukemia. But the small target audience for drugs like imatinib mean that pharmaceutical companies are sometimes reluctant to invest in their production and need to sell them at very high prices to make a profit.

Cancer can be a remarkably complex disease, leading some to believe that it will remain incurable, despite all of the recent progresses. We can expect cancer to continue appearing in redundant but diverse forms. However, new advancements can always improve the mortality of the disease. The bigger issue right now is the limited availability of cancer drugs and treatments to those who need them most. With investments in cancer research growing larger each year, soon the medical community will have to find ways to overcome the obstacle that is profitability and begin investing in the distribution and access of these drugs to developing countries. Arguably, at no point down the road will we be sitting across the finish line with a singular cure to end all cancer; instead, our incremental advancements in cancer research will help to manage a chronic condition.