For decades we’ve talked about “curing” cancer, yet for nearly a century cancer has continued to elude our efforts. Is it because our research is flawed? Possibly cancer is just too tough to beat? I would argue it is a fault of neither; instead, I believe it has to do with our strategy. Fundamentally we as a society have equated a “cure” with “treatment” and in doing so we have failed those that fight the battle against cancer each and every day. Certainly we’ve improved odds of survival and even reduced unbearable side effects from treatments, but we’ve also reduced our focus to hitting “base hits” when we should be aiming for the “homerun” of a total cure.
To better understand the battle for a cure, you need to look at the history of our efforts. Going back around a century and a half we started to advance surgical efforts against cancer. With it we revolutionized the prognosis of solid tumor cancers – at least to the extent that surgery was possible for each form of cancer. About 25 years later we started working with the new-found technology of radiation, thereby increasing our effectiveness on those tumors that we weren’t able to reach with surgical options. About 30-40 years later we focused on those cancers the surgery and radiation had little effect on and invented chemotherapy. Each time our prognosis improved and thousands, if not millions, of survivors benefited. Still, in the last 80 years we haven’t seen the same advances. Why? The key is to look at our previous successes. In the development of surgery, radiation and chemotherapy we focused on those tumors and cancers that were immune to current treatment methods. We focused on the “lost cause” cancers. And precisely when society begged us to let these patients die peacefully, one brave researcher tried to offer hope. In each situation, these initial discoveries were labeled as “cruel”, “experimental” or “damaging”. Today we call them cures. More recently we also learned that pediatric cancers may also be more difficult to treat and possibly more aggressive, thereby offering a “biggest bully” effect. Unfortunately these same lessons are now lost in history. Instead of taking the next step and focusing on the difficult cancers, we have become complacent to focus on improving the current treatments and lessening the impact of side effects. We focus on those cancers that affect the greatest numbers of patients and not the ones that force us to learn the most scientifically. And in doing so we have become a community focused on treatment more than curing cancer.
Brain cancers and tumors are the next frontier in the cure for cancer. They are exactly what the fourth generation of a true cure strategy would focus on. These cancers are difficult to surgically remove, have only temporary effects from radiation and are immune to most chemotherapy methods due to a blood-brain barrier. They are the one remaining form of cancer that force us to invent entirely new methods rather than tweak current treatments. Through this, they are our “homerun cure” revolution and what we learn from beating brain cancer will change everything we apply to all cancers. Specifically pediatric brain tumors represent a category that also encompasses the purest forms of brain cancer and some of the most aggressive, thereby employing the “biggest bully” strategy.
Already we are seeing the benefits of an increased focus on pediatric brain cancers. We’ve seen improved data collection to determine actual patterns, developed primarily because when the population diagnoses size is small we need to capture every dataset possible and can’t rely upon general percentages to guide our efforts. We’ve identified mutation markers in pediatric brain tumors that we’ve never before seen in other tumors but are just started to detect in other cancers. These mutations change what we know of drug performance markers and may even lead to improved customized trials into the future. We’ve created new innovative ways of reaching tumors that outperform and even sometimes replace current surgical measures. Finally, we’ve focused back on the science of curing cancer, rather than just simply doing what may be convenient. And it is a change long overdue.