Many triumphs predicted in war on cancer

January 3, 2000
Web posted at: 5:28 p.m. EST (2228 GMT)

In this story: Incredible advances Genetic markers could map way to cure A chronic condition, not a death sentence 'Smart bombs' and other biotherapeutics Kinder, gentler surgery Girl born today may have no lifetime cancer risk RELATED STORIES, SITES

(CNN) -- Diagnosed with breast cancer 10 years ago, Peggy Orlando didn't think she'd be alive to celebrate her daughter's recent 28th birthday. But alive and well, Orlando may represent the accelerating success in the war on cancer.

Cancer researchers predict bio-engineered drugs, vaccines, and more mean a girl born today may not have to worry about breast cancer in her lifetime.

That rosy prediction emerges after a long and pitched battle against the big "C." The first documented cases of cancer go back to the ancient Egyptians. And cancer doctors still have their work cut out for them.

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Cancer treatment and research

Nearly five million lives have been lost to cancer since 1990. This past year, more than 500,000 people died -- more than 1,500 people each day. Cancer continues to be the second leading cause of death in the United States after heart disease.

To be diagnosed with cancer has, for most of human history, been a death sentence. But in 1971, President Richard Nixon declared a war on cancer. He pushed scientists and researchers to put an end to the suffering.

Incredible advances

Since Nixon's initiative, there have been incredible advances. Between 1990 and 1995, overall cancer deaths decreased at a rate of 0.5 percent per year.

"We're seeing death rates drop in major diseases now... We're seeing extraordinary scientific advances that are laying the foundation for truly revolutionary changes in the way cancer is managed," said Dr. Larry Norton, of Memorial Sloan-Kettering Cancer Center.

Initially scientists had only a crude understanding of how cancer worked. In simple terms, it's a cell that's dividing out of control -- growing, replicating, devouring and invading everything in its path. Early treatments were as primitive as our understanding.

"We were doing major radical surgery as standard treatment -- very primitive radiation therapy that carried a lot of toxicity to normal tissue," said Dr. Harmon Eyre of the American Cancer Society.

Doctors still don't know exactly how cancer is triggered -- whether people are genetically predisposed to "get" cancer, or if it's in the air, water and food people eat. Currently, researchers say it's both.

That genetic link has breast cancer survivor Orlando concerned for her daughter, Kimberly, who is scheduled for a biopsy of a suspicious lump.

"I know that the probability is that it's nothing, because I know the statistics," Orlando said. "But she has a lot of my body build, so I think there's a possibility, and there's a tendency there, so it's a worry."

Genetic markers could map way to cure

Genetic susceptibility to cancer may soon lead scientists to a cure. The company Human Genome Sciences is using the understanding of genes to develop new treatments for many types of disease, including cancer. CEO Dr. William Haseltine summarized the most promising research.

"We have two new things to add to the cancer repertoire: new classes of drugs that specifically attack cancer cells and powerful new ways to shield the body while killing the cancer," said CEO Dr. William Haseltine.

"We'll see a major advance in curative cancer therapy for the major cancers such as colon cancer, lung cancer, liver cancer, head and neck cancer."

Doctors have already made progress against prostate cancer, breast cancer and most childhood cancers.

A chronic condition, not a death sentence

While a cure has not yet been found, scientists are confident they'll soon be able to manage cancer as a chronic condition. "Cancers will be controlled in a chronic state, in a very early stage and people will be able to live normal life spans and not have to worry about them," Eyre said.

"I thing we're on the brink of a major breakthrough in cancer therapy," Haseltine said. "First is the concept that we can make human antibodies, target cancer cells, and kill cancer cells, but not affect normal cells. We have the first effective drugs on the market for that purpose. The specific drug I'm thinking of is Herceptin for breast cancer. But that's the tip of the iceberg."

"The second advance is to improve the ability to protect the healthy body from the devastating effects of cancer therapy," Haseltine said.

'Smart bombs' and other biotherapeutics

These new treatments are called biotherapeutics -- compounds made from proteins and genetic material. Some biotherapeutic treatments include gene therapy to replace or repair damaged genes or boost the immune system.

Angiogenesis inhibitors such as angiostatin and endostatin cut off the blood supply to tumors, depriving them of the nourishment they need to grow. And antisense therapy blocks the formation of important proteins that keep cancer cells from growing and spreading.

Monoclonal antibodies are biological smart bombs that target select portions of cancer cells -- leaving healthy tissue alone. There are also powerful new vaccines.

"We are there now," said Dr. Norton. "We have developed that technology so its a real possibility that vaccines are going to make a real difference in therapy tied to early diagnosis and early prevention."

Experts say these biotherapeutic treatments have led to an explosion of new therapies in the drug pipeline—350 drugs currently in clinical trials for breast cancer alone.

Kinder, gentler surgery

Surgical and radiation treatments have also changed dramatically.

"We're doing breast conserving surgery, we're doing colorectal cancer surgery and very few people have colostomies that are permanent and we're doing limb preserving surgery for sarcomas so that the surgery is still equally effective, but it is much less deforming," said Dr. Eyre.

Even with major advances in treatment, experts believe the biggest hope is in early detection and prevention.

"My prediction is that in 10 years cancer doctors will be doing much more prevention than treatment," Norton said. "We already have available to us a medicine that can cut the risk of breast cancer in half for example, and that's the drug tamoxifen."

"Over the next 5 to 10 years we will have a broad range of new early detection markers," Haseltine said. "You'll now give a drop of blood, or more than a drop of blood when you visit your doctor for your yearly health care check -- that blood will be checked for five, 10, as many as 15 different types of cancers."

But with all these advances, there are still a number of cancers that science is struggling with including brain cancer, non-Hodgkin's lymphoma, esophageal cancer and pancreatic cancer. Still scientists are optimistic.

"I think people need not be afraid of cancer. I think there's a tendency to think about the big "C" and to think that this is something to ignore, to hide from," said Dr. Robert Mayer of the Dana- Farber Cancer Institute.

Girl born today may have no lifetime cancer risk

"I think its very unlikely that a little girl born today is going to have to worry about breast cancer in her lifetime by the time she's in a risk category 30 to 35 years from now," Norton said.

Haseltine is even more optimistic in painting near-term victory over cancer. "In the short range, we'll be able to treat cancers better, give people longer healthier lives. In the long term, as we address the problem of aging, we can eventually address and eliminate most cancers," he said.

Peggy Orlando hopes they're right. "I worry about it every day, every ache and pain. You know, 'is it in the bone,' when my hip hurts. I had a headache which is probably a sinus headache (and thought), 'Oh my god, is it a brain tumor?'"

"If you could know that (any cancer) could be treatable, and you wouldn't have to (worry)...that would be wonderful," Orlando said.

Perhaps in the next 20 years, if today's research proves successful, cancer survivors like Peggy Orlando won't have any reason to worry.

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