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New medications and therapies target and combat tumor cells more precisely and gently.
December 10, 2024
Philip Reichardt
The news is full of optimistic reports about groundbreaking drugs. But what is the real likelihood of getting the deadly disease under control once and for all soon?
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The quiet hope of reading a year at this point is currently still unfulfilled. This is 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, remain difficult to treat.
However, much more is known today about how cancer cells form, what promotes them, and what accelerates their growth. This includes many things that dispel the fear of a cancer diagnosis. In particular, advances in genomic research are helping to detect and treat cancer at an earlier stage.
New drugs and therapies make it possible to target and treat 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.
In addition, diseases are "to be controlled in the long term with a good quality of life." Added to this is the fact that data and study results on the connections between lifestyles and cancer risks are increasingly available to doctors and researchers, thanks to better networking of scientific institutions and artificial intelligence, providing new approaches for prevention.
1.6 million people in Germany are currently living with a cancer diagnosis that was made in the past five years. That's almost two percent of the population. At first glance, this is an alarmingly high value, but a positive trend can also be seen in it: Cancer does not inevitably lead to death, but can be managed thanks to precise and new therapies, which means:
Despite illness, a dignified life can be led. "The precision with which we can diagnose and the treatment options for symptoms such as 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 from cancer has significantly decreased over the last ten years. In breast cancer, the chances of survival and recovery—provided there is an early diagnosis—are almost 90 percent (1973: 65 percent) and prostate and skin cancer can also be cured in nine out of ten cases.
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However, it's 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 sum of 218 billion dollars will then be needed just for cancer treatments.
The increase in new cases is also a consequence of higher life expectancy. A high age is considered the greatest risk factor for the development of most cancers. As age increases, the likelihood of genetic changes accumulating 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 genetic material changes depends significantly 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 with a healthier lifestyle. That would mean 200,000 fewer cancer diagnoses per year.There is ample evidence for this. The more the number of smokers in a society decreases, the lower the number of lung or laryngeal cancer cases. The number of cervical cancer cases decreases as soon as countries start vaccination campaigns against human papillomaviruses. This presents a huge opportunity for prevention.
Still greatly underestimated, but number 1 in the ranking of cancer-promoting factors: overweight. The link between cancer development and severe overweight is now as well proven as that between smoking and cancer. What many people are not aware of: Overweight accelerates the aging process and thus increases the risk of cancer. Raising awareness on 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.
In the list of harmful habits, lack of exercise and poor nutrition follow. Numerous studies confirm that sport protects against cancer. Physical activity improves immune function, bone density, circulation, blood pressure, and sleep , reduces the concentration of stress hormones, and increases resilience under stress - all factors that reduce cancer risk.
Studies attribute the increasing spread of colon cancer among younger people to industrially processed food, which contains little fiber and vitamins, but a number of potentially harmful additives.
A new method to detect cancer cells early and analyze already diagnosed tumors is the liquid biopsy. Instead of taking tissue samples as before, liquid biopsy involves taking blood samples and examining them for tumor cells or tumor DNA. This method is particularly advantageous for cancer types where tissue sampling is risky, such as lung or brain tumors.
Since tumor cells in the blood occur only in tiny amounts, liquid biopsy requires extremely sensitive procedures. Therefore, liquid biopsy is currently primarily used as a supplementary method, as the accuracy of tissue analysis is still higher.
Surgery, radiation, and chemotherapy were considered the only promising forms of therapy for decades. They are still used today. Advances in genome research have additionally 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 turns from a deadly disease into a chronic condition."
For a long time, it was common for patients with a certain diagnosis to be prescribed the standard therapy corresponding to the type of cancer. In one patient, it was more effective; in another, it was less successful. The precise analysis of the tumor allows for the development of personalized therapies tailored to the specific mutations of the respective cancer cells. This means the patient receives a therapy that is precisely tailored to their condition.
This could also prevent, as often happens with conventional methods, therapies from being ineffective and simultaneously associated with severe side effects. To ensure that personalized therapies are available to as many patients as possible in the future, it is necessary for the results of such therapies to be shared across countries and accessible to as many doctors as possible. This is not yet the case.
Leading in the development of cell therapies are the pharmaceutical companies BioNTech and Moderna. The heads of both companies also mention years when they expect approval of their drugs and vaccines. Moderna has developed an agent that is to be used against skin cancer in combination with the drug Keytruda. In Phase 3, the strictly controlled testing on patients, it has already achieved impressive results. Moderna CEO Stéphane Bancel hopes the agent will be approved in 2026.
At BioNTech, more than 40 products are in the pipeline. The progress of development can be tracked on the homepage. 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," Şahin says, "we want to have a large portfolio of cancer therapies on the market."
Currently, the greatest hopes are pinned on immunotherapies. At their core, they rely on activating the body's own immune system to recognize and fight cancer cells. There are different approaches and mechanisms. Some drugs are already approved, many are still being tested.
So far, immunotherapies are mainly used in incurable diseases in advanced stages, with the aim of extending life and improving quality of life. Currently, so-called checkpoint inhibitors and CAR-T cell therapy are most frequently used. Checkpoints in the immune system usually limit the immune system's response; inhibitors ensure that the braking effect of the checkpoints is released and thus enhance the immune response.
CAR T-cell therapy involves reprogramming the body's own immune cells so they can identify and kill cancer cells. Vaccines with mRNA vaccines train the immune system to detect and fight cancer cells. Özlem Türeci, Chief Medical Officer of BioNTech, describes the mode of action of mRNA vaccines as follows: “The vaccination leads to the multiplication of immune cells that can identify and kill cancer cells with high precision, essentially creating an 'armada of clone warriors.' It's a man-to-man battle: immune cell against tumor cell.”
