#WorldCancerDay: We aim to create a world without cancer
Targeted therapies and immuno-oncology can help us to end cancer, argues Kees Roks, Novartis OncologyTo mark World Cancer Day, 4 February, Kees Roks assesses the big trends shaping the future of cancer care.
Q: The World Cancer Day campaign calls for ‘a future without cancer’. How can this be achieved?
We believe it is possible to master cancer and provide patients with options for cure or to reach their natural end-of-life in comfort and relative health. Many more cancers are now curable and some type of cancers that were once a death sentence are now manageable chronic diseases. A lot has been achieved and incremental innovations give us reason to believe it is a fight we can win.
However, to win the battle against cancer, we need to know the enemy. Ageing and growing populations will potentially translate into a tsunami of cancer and other diseases – one in three people in Europe will be diagnosed with cancer in their lifetime. That’s a scary number but the industry is bringing real investment to this fight.
Q: What are the most exciting advances?
Targeted therapies, adoptive cellular therapy and advances in immuno-oncology are changing how we treat people with cancer. Targeted therapies are already a reality with targeted therapies for chronic myeloid leukaemia (CML), for example.
We’re also excited by what’s happening in lung cancer where there is no longer a one-size-fits-all approach. Decades of research have led scientists to identify specific mutations in non-small-cell lung cancer. By identifying these mutations, in between 3% and 4% of patients, informed treatment decisions can be made.
Q: What about personalised medicines?
The big advance in this field is adoptive cellular therapy using autologous CAR T-cell treatment. This is truly personalised – patients are treated with their own extracorporeal modified cells. It may not be for every patient but, if you look at certain paediatric lymphomas, it may be possible to cure selected patients with some children already surviving more than 5 years. CAR-T is the first of its kind, but more therapies will join the list of truly personalised cancer treatments. This is just the start.
Gene therapies and gene editing techniques are another major advance: these treatments allow genes to be inserted, or for faulty genes to be cut out and replaced with a healthy copy.
If done in time, young patients can grow up to live normal lives without any residue of disease.
Ultimately, screening, early detection and right diagnostics are extremely important drivers in how we identify and target diseases that are candidates for any personalised therapy, especially cell and gene therapies.
Q: Is there a tension between the rising demand for treatment and the resources needed to deliver personalised cell therapies?
There can be a tension between demand for live-saving treatment and the goal of delivering access to all. Access for highly specialised therapies can be limited by production capacity.
Then there is the issue of cost. At Novartis, we have a strategy in place to enable access worldwide. To be able to provide better and more affordable health care for all, we need to move towards a more value-based and differential pricing approach.
Q: What role will big data play in getting the most from medicines?
First, we must learn as much as possible from all the data we already have from clinical trials. In the past, companies have used trial data for publications and then moved on, but if we consolidate all the information we have, it could tell us a lot about patients’ mutations, for example. The only problem is that we will first need to clean up this data and put it in a single readable database.
We must also use data to help us identify the right patients for clinical trials of targeted medicines. This will allow for earlier inclusion in trials, more successful trials, and a faster drug development system.
Q: Are diagnostics central to all of this?
If you want to treat specific mutations, you need to test for them. Not every country is able to provide this. In melanoma, it’s important to test for the BRAF gene so that you can give the right combination of treatments. Some centres don’t have the capacity to do this; others have diagnostic facilities but do not have enough information on how to use them more effectively. If we get it right, there is huge potential for more successful treatments and better patient outcomes.
Q: Has the approach to cancer care been transformed by these innovations?
Less than 20 year ago most people diagnosed with cancer didn’t have much of a future: they had surgery, chemotherapy or radiation therapy – or a combination of interventions. These therapies came with side effects and had a major impact on quality of life. The tools we have today, have allowed for a more patient-centred approach that looks to their future rather than just survival.
Q: Is this a ‘peak’ in the history of oncology care?
No – in fact, innovation is accelerating. Disruptive therapies like CAR-T therapies are just coming on stream. When you look at the past 20 years, the progress that has been made has been extremely encouraging. We should be optimistic about the future of oncology care.