🤔 Will We Ever Truly Cure Cancer?

I want you to imagine a perfect world.
A Utopia.

We’ve done it all.
Solved world hunger. 
Poverty has been eradicated. 
We prevented a Terminator-style AI uprising. Banning it and declaring it forbidden knowledge like some kind of dark magic from a whimsical land. 

And in that world, towering above almost every other human achievement, stands one goal.

The Holy Grail.
The One Piece of Medicine.
The final frontier.

Curing cancer.

For decades, this single idea has captured the imagination of doctors, researchers, engineers, and scientists across the planet.
Hundreds of thousands of brilliant minds.
Tens of billions of dollars.
And trillions of unsolicited banner ads, claiming the cure for cancer is a herbal remedy from Kuala Lumpur that you can buy for $9.99 on Amazon.

Some have dared to look for the silver bullet
Like this man below.

This is Marino Barbacid. A famous Spanish molecular biologist, who came to fame by isolating the first human oncogene(a cell that turns into a tumour) in 1982.

Over the last fortnight, he’s made headlines again for eliminating KRAS-mutated pancreatic tumours in mice.

Amazing breakthrough, no doubt. But X, Insta and sensationalist papers have credited him for “curing” pancreatic cancer. 

And it wouldn’t be the first time…
It would seem every couple of months, a new “cancer” cure emerges
It’s not your imagination – the media does love a dramatic cancer story.

One analysis of newspaper reports in the 1990s found that over 40% of touted “cancer breakthroughs” were never actually borne out by further research, and only about 27% of those discoveries made it into practice a decade later. 

Let’s look behind the hype. 
Today’s Deep Dive question is: Can we, and will we ever actually cure cancer?

Let’s begin.

After an eternity in medical school,
Living on pesto and despair,
And spending more time with Passmed than your own family...

Doctors around the world get rewarded with sweet gifts for their steadfast determination:

And in the UK?

A "congratulations" email from HR with your surname spelt wrong.
Computer access denied (login not set up).
Plus a lanyard. If you were to be oh, so, very lucky.

No heirloom. No keepsakes.
And no damn sword😪.

Don't be too butthurt. There was one gift you forgot to claim…

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I’m not here to repeat your pre-clin oncology lecture series.
But it's worth rehashing the fundamentals so we’re all on the same page. 

Clinically speaking, the word “cure” isn’t something used liberally in oncology.
Everyday conversation, tabloids and Imjustbait will imply cure means cure - disease is gone forever. 

But cancer isn’t so simple in reality. To suggest surgery, chemo or radiotherapy will permanently cure cancer is an insult to it’s crafiness. 

That’s why oncologists are often allergic to the C-word. That’s why, instead, remission is the key term used.
Remission - no evidence of disease in investigations. 

When a patient is clinically disease-free, they’ll be declared to be in “complete remission” or “No Evidence of Disease(NED).”

But between cancers, complete remission varies. 

In some cancers, like testicular cancer, five years of disease-free survival might be taken as a “cure”.

In others, like melanomas, relapse can occur a decade or more later,

Definitively, “Cure” in cancer usually means the patient will likely die of something else before the cancer returns.
It’s less a guarantee and more a statistical milestone. 

Clear?
Sweet. Let’s move on.

So if you happened to be an oncological scientist who went into a coma in the year 1990 and woke up today, you’d be pretty shocked by how far we’ve come.

Back then, it was the good ol’ slash(surgery), burn(radiotherapy) and poison(chemotherapy). If that didn’t work… gg’s.

Luckily, there has been a technological revolution, resulting in a diverse oncological arsenal aimed at outsmarting cancer on multiple fronts. 

For Example…

Targetted Therapy

These are drugs cleverly designed to attack cancer cells’ specific genetic mutations or molecular party tricks. The og poster child is Imatinib for Chronic Myeloid Leukaemia. Making a previously fatal leukemia to something of a chronic illness(10 yr survival 20% => 80%). 

Most recently, KRAS has been all the rage. 

In 2021, the first KRAS inhibitor (sotorasib) was approved for KRAS-mutant lung cancer, marking a landmark.
And it is! Scientifically, we cracked a very tough molecular nut. 

Clinically, though, the story is sobering.

In trials, sotorasib did improve progression-free survival over chemo in KRAS-mutant lung cancer, but the difference was on the order of one extra month (median PFS ~5.6 vs 4.5 months). And the overall survival benefit was essentially none; median OS was about 10.6 months on the drug vs 11.3 months on chemo.

Definitely a work in progress

Cellular Therapy

CAR-T therapy. It involves reprogramming patients' own T-cells to hunt down cancer.

Works an absolute charm in certain leukaemias and lymphomas, but its practical utility is confined to just that.

In leukaemias, they all have one dominant antigen(e.g. CD19 on ALL cells, for example). Solid tumours have proven much more difficult for CAR-T to dismantle. 

Cancer Vaccines

The success of mRNA vaccines for COVID-19 lit a creative spark in cancer research.

A personalised cancer vaccine

We sequence the tumour, find neoantigens(mutant peptides unique to you), and then inject an mRNA vaccine that encodes them into you. Teaching your immune system to hunt your cancer specifically. It doesn’t get more personalised than that. Besides Spotify Wrapped, maybe.

In 2024, we got some of the first evidence that this might be legit with the KEYNOTE-942 trial. 

This RCT tested how a vaccine performed compared to standard care for high-risk Stage III/IV melanoma. The 5-year data dropped just a couple of days ago and showed a sustained 5-year reduction in deaths or recurrence by 49%!

The issue with personalised vaccines is that they’re personalised. Making manufacturing a custom vaccine for each patient is resource-intensive and incredibly expensive.

This, therefore, makes it a lil unlikely to be provided on the NHS.
A therapy potentially reserved only for the ultra-rich. 

All the same, we’re still a way from it being FDA/NICE approved, so time will tell…

So with all these fancy sci-fi therapies in the pipeline, none are quite that “cure” the world desires. It has not all been in vain, though.
There have been many geniune improvement.

Survival gains

Over the last few decades, the overall 5-year survival rate for all cancers combined in developed countries has climbed significantly – for example, from about 50% in the 1970s to ~70% by the 2010s.

For metastatic (Stage IV) cancers, which are harder to “cure,” we’ve still seen meaningful extensions of life. 

These are real people getting extra Christmases, seeing kids graduate, etc., because of incremental improvements.

Rethinking what it means to “cure”

So we’re clear on what “cure” means.

Some cancers we actually do “cure” – from early-stage cancers to many advanced lymphomas and leukaemia.

But for common solid tumours, like lung, colon and breast? Yeah… cure isn’t likely here.

Instead, we may think of a chronic disease model we mentioned earlier: One will likely die of something else before the cancer. 

Now, if this is the goal, we’re making bounds towards it. 

The goal becomes to extend life and preserve quality of life, even if cancer is still present, akin to how we manage HIV or diabetes.

To that end, I’d say we’re doing a pretty good job 👍

So, are the weekly cancer breakthroughs moving us closer to a cure?
They are… just not in the Hollywood, single-miracle sense.

The war on cancer isn’t likely to end with a bang; no single “cure” will drop the curtain. Instead, it’s a war of attrition, won bit by bit.

Breakthroughs are meaningful: that new drug that adds 6 months of life might not sound sexy, but to the patient who gets to see a newborn grandchild because of it, it means the world.

Perhaps the best way to think of it is like building a cathedral.
Each breakthrough is another stone laid.

No one stone completes the cathedral, but without each, the structure wouldn’t stand. Someday, hopefully, we’ll step back and see that we’ve built something that resembles a cure…a world where cancer can be effectively managed or cured in most cases. 

So we are getting there, one breakthrough at a time.

Handover Over 🫡

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