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New drugs and therapies target and fight tumor cells more precisely and gently.
December 10, 2024
Philip Reichardt
The news is full of optimistic reports about breakthrough drugs. But what is the actual likelihood of truly getting the deadly disease under control once and for all soon?
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The silent hope of reading a year at this point cannot yet be fulfilled. Not least because around 200 different types of cancer are known, which differ greatly in their genetic and biological characteristics. Some tumors respond very well to new therapies and drugs, while other types of tumors, such as pancreatic cancer, are still difficult to treat.
However, we know much more today about how cancer cells form, what favors them, and what accelerates their growth. And thus much that takes away the horror of the cancer diagnosis. In particular, advances in genomics enable cancer to be detected and treated at an earlier stage.
New drugs and therapies make it possible to target and combat tumor cells more precisely and gently, with the result that “the cure rate for many types of cancer will be significantly higher in the future than it is today,” says Ulrich Keilholz, director of the Charité Comprehensive Cancer Center. Moreover, diseases can be “controlled in the long term with a good quality of life.” In addition, data and study results on the connections between lifestyles and cancer risks are increasingly available to more doctors and researchers thanks to better networking of scientific institutions and artificial intelligence, providing new approaches to prevention.
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1.6 million people in Germany are currently living with cancer that was diagnosed in the past five years. That's almost two percent of the population. At first glance, this is an alarmingly high figure, but it also reflects a positive trend: Cancer does not necessarily lead to death, but can be managed thanks to precise and new therapies, meaning:
Despite the illness, it is possible to lead a dignified life. "The precision with which we can diagnose and the treatment options for symptoms like pain and unpleasant side effects have significantly improved. The therapies available today are generally more tolerable," says Prof. Christof von Kalle, head of the Berlin Institute of Health Research.
In fact, the number of deaths due to cancer has significantly decreased in the last ten years. In breast cancer, the chances of survival and recovery - provided it is diagnosed early - are almost 90 percent (1973: 65 percent), and prostate and skin cancers can also be cured in nine out of ten cases.
However, it is concerning: Around 500,000 new cases are registered each year, and the trend is rising. By 2030, 600,000 new cases are expected annually in Germany. Globally, a total of 218 billion dollars will then have to be spent solely on cancer treatments.
The increase in new cases is also a consequence of higher life expectancy. Because old age is considered the greatest risk factor for the development of most cancers. As we age, the likelihood of accumulations of genetic changes in a cell increases. Healthy cells usually go through a five-stage process before they become cancer cells develop.
In the case of colon cancer, the duration of a phase is about 10 to 15 years. The risk of a 70-year-old man developing colon cancer is 1000 times higher than that of a 10-year-old child. The extent to which the genome changes, in turn, depends crucially on lifestyle. "Without a breeding ground of cancer-promoting habits," writes molecular biologist Dr. Hanna Heikenwälder, "very few cancers can develop."
Up to 40 percent of new cases, according to estimates by the German Cancer Research Center, could be avoided by healthier lifestyles. This would mean 200,000 fewer cancer diagnoses - per year.There is ample evidence for this. The more the number of smokers decreases in a society, the lower the number of lung or laryngeal cancer cases. The number of cervical cancer cases decreases as countries launch vaccination campaigns against human papillomaviruses. This opens up enormous opportunities for prevention.
Still greatly underestimated, but number 1 in the ranking of cancer-promoting factors: overweight. The link between the development of cancers and severe overweight is now as well established as that between smoking and cancer. What many people don't realize is: Overweight accelerates the aging process and thus increases the risk of cancer. Raising awareness of this is a worthwhile goal: In Germany, 53 percent of women and 67 percent of men are currently overweight, with around 25 percent of adults even being severely overweight.
The list of harmful habits is followed by lack of exercise and poor diet. Numerous studies confirm that Exercise protects against cancer. Physical activity improves immune function, bone density, circulation, blood pressure, and sleep , lowers the concentration of stress hormones and increases resilience under stress - all factors that reduce the risk of cancer.
Studies attribute the increasing spread of colon cancer among younger people, among other things, to industrially manufactured food that contains little fiber and vitamins, but a number of potentially harmful additives.
A new method to detect cancer cells at an early stage and to analyze already diagnosed tumors is liquid biopsy. Instead of taking tissue samples as before, blood samples are taken in liquid biopsy and examined for tumor cells or tumor DNA. This method is particularly advantageous for types of cancer where tissue sampling is risky, such as in lung or brain tumors.
Since tumor cells are present in the blood only in very small amounts, liquid biopsy requires extremely sensitive methods. Liquid biopsy is therefore currently used primarily as a complementary method, as the accuracy of tissue analysis is currently higher.
For decades, surgery, radiation, and chemotherapy were considered the only promising therapy forms. They are still used today. Advances in genomic research have also enabled the development of numerous new drugs, which rarely lead to a cure because many cancer cells develop resistance to a drug after months or years of treatment. "Nevertheless, this is a great success," says Prof. Keilholz, "because cancer thus becomes a chronic disease from a deadly one."
For a long time, it was common for patients with a specific diagnosis to be prescribed the standard therapy corresponding to the type of cancer. For some patients, it worked better, for others it was less successful. The precise analysis of the tumor allows the development of personalized therapies tailored to the specific mutations of the respective cancer cells. This means that the patient receives therapy that is precisely tailored to their disease.
This could also prevent therapies from having no effect while being associated with severe side effects, as is often the case with conventional methods. To ensure personalized therapies are available to as many patients as possible in the future, the results of such therapies need to be shared across countries and made accessible to as many doctors as possible. This is not yet the case.
Leading the development of cell therapies are the pharmaceutical companies BioNTech and Moderna. The CEOs of both companies also mention years when they expect approval of their drugs and vaccines. Moderna has developed a drug that is to be used in combination with the drug Keytruda to treat skin cancer. In phase 3, the strictly controlled testing on patients, it has already achieved impressive results. Moderna CEO Stéphane Bancel hopes that the drug will be approved in 2026.
At BioNTech, more than 40 products are in the pipeline. The progress of the development can be tracked on their website. Four drugs are also already in phase 3. BioNTech CEO Uğur Şahin recently announced the approval of the first drug for 2026. And "by 2030," says Şahin, "we want to have a large portfolio of cancer therapies on the market."
The greatest hopes are currently pinned on immunotherapies. At its core, they rely on activating the body's own immune system to recognize and combat cancer cells. There are different approaches and mechanisms involved. Some drugs have already been approved, while many are still in testing.
So far, immunotherapies are mainly used in incurable diseases at an advanced stage, with the goal of extending life and improving quality of life. Currently, so-called checkpoint inhibitors and CAR-T cell therapy are used most frequently. Checkpoints in the immune system usually limit the immune response, while the inhibitors ensure that the braking effect of the checkpoints is eliminated, thereby enhancing the immune response.
In CAR-T cell therapy, the body's own immune cells are reprogrammed to recognize and kill cancer cells. Vaccinations with mRNA vaccines train the immune system to recognize and fight cancer cells. Özlem Türeci, Chief Medical Officer of BioNTech, describes the mechanism of mRNA vaccines as follows: "The vaccination leads to an increase in immune cells that recognize and kill cancer cells with high precision, so an 'armada of clone warriors.' It then comes to a man-to-man battle: immune cell against tumor cell."
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A new method to detect cancer cells at an early stage and analyze already diagnosed tumors is liquid biopsy.
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Numerous cancer medications are currently undergoing testing.
