Science & Vie: Treating cancers remains a challenge… Why?
Éric Solary: Because it’s an incredibly diverse disease. Let us recall here that a cancer corresponds to a mass of abnormal cells, which have acquired mutations [légères modifications au niveau de certains gènes, ndlr] allowing them to proliferate rapidly and haphazardly. Problem, these molecular anomalies are different, not only according to the patient but also according to the affected organ, the types of cancers at the level of this organ, and even within the same tumor! Moreover, they change over time. In short, a tumor is not a uniform cluster of all identical cells but of several types of cells in constant transformation. Under these conditions, to be effective, a treatment must be able to target not one type of tumor cell but several.
Hence the difficulty in finding therapies effective for all tumors and all patients.
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S&V: That said, people die less of this disease these days…
ES: Yes. While some cancers – such as those of the pancreas and brain – remain difficult to treat, the 5-year survival rate for patients, all types of cancer combined, has risen from 20% before the Second World War to 60% today. . And it keeps on growing.
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MORE THAN 2,000 YEARS OF FIGHT
4th c. av. J.-C.
The Greek physician Hippocrates gives the name “carcinoma” – derived from crabs – to progressively fatal lumps. For the doctor, the disease is caused by the retention of humor and black bile.
With the invention of the microscope and anesthesia, scientists associate cancer with a cluster of cells, which can be extracted from the body. The first treatment against cancer was born: surgery.
Beginning of the 20th century.
The discovery of X-rays and then of radium led French doctors to propose a new type of treatment: radiotherapy. It consists in irradiating the tumor to fragment the DNA of its cells and thus destroy it.
American Cyanamid launches thiotepa, the first chemotherapy. This treatment uses synthetic chemical molecules, cytotoxics, administered intravenously.
Oncology enters the era of precision medicine, with the launch of imatinib. This therapy is designed to target tumor abnormalities, identified by genetic analysis.
The first immunotherapy is authorized in France. This involves injecting monoclonal antibodies (ipilimumab), capable of “awakening” the patient’s immunity inhibited by cancer cells.
A hyper-personalized treatment is approved in Europe to treat certain blood cancers: CAR-T cells.
The patient’s immune cells are genetically modified to specifically attack the tumour.
S&V: What is this due to?
ES: Advances on all fronts of cancer research: in basic research, which has made it possible to better understand how cancer appears and evolves; in therapeutic research, where new treatments are developed; and in research on the early detection and diagnosis of cancers, knowing that the earlier a cancer is detected and treated, the greater the chances of recovery.
S&V: Have the treatments themselves changed a great deal?
ES: Yes, very much. Over the past two decades, thanks to enormous progress in genetics and increased access to rapid DNA sequencing tools, we have entered the era of precision medicine, also known as personalized medicine, which consists to offer the therapy best suited to the biological profile of the patient and the mutations of his tumour. Currently, this medicine is essentially based on two recent classes of treatment, which have significantly improved the management of certain patients: targeted therapies, which aim to specifically block certain processes at the origin of the appearance or dissemination tumors; and immunotherapy based on monoclonal antibodies [un type de protéine, ndlr], which aims to “wake up” the immune system bridled by the tumor, so that it destroys it itself.
S&V: What are the current issues in cancer research?
ES: There are three major ones.
Continue to study the thousands of biological and genetic mechanisms through which cancer appears, evolves and resists, in order to better adapt the treatment to the disease and the patient, and to discover new therapeutic targets on which to act. Better understand also why immunotherapy treatments are not effective in all patients – only 20% to 40% of patients with metastatic melanoma respond to them, for example; this, to identify predictive biomarkers of the response, which makes it possible to better select the patients who can benefit from this type of therapy. Finally, to develop new anticancer therapies that are effective in as many patients as possible. On this point, researchers are following several promising avenues (see following pages) .
S&V: What will tomorrow’s oncology look like?
ES: It should be more and more personalized. On the one hand thanks to the development of new therapies making it possible to adapt the treatment to the patient and his tumour; but also thanks to the constitution of databases listing the genetic, protein and other characteristics of the tumors and the patients treated. The analysis of this data via artificial intelligence should help us to have a global vision of the patient and his cancer and thus to personalize the treatment as much as possible. To hope one day to cure all cancers, going in this direction is crucial.
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Precision medicine promises to cure all cancers one day
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