Science has helped us reduce cancer deaths, lengthen lifespans, and improve our quality of life

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ADVANCES IN CANCER TREATMENT
Our Past, Present, and Future
How science has helped us reduce cancer deaths, lengthen lifespans, and improve our quality of life.
PAST
PRESENT
FUTURE
Cancer is known as “the emperor of all maladies.” It's an ancient disease that, in some ways, is just as mysterious as it was when it first appeared in written records thousands of years ago, during the time of the ancient Egyptians. Cancer refers to abnormal cell growth, which can metastasize (or spread) throughout the body and threaten the function of healthy organs and tissue. Although some facets of cancer still remain a mystery, science has helped us understand that cancer can affect over 100 different bodily systems and has various causes, from our genetics to our environment.

Thanks to science, we've not only made incredible headway in understanding the disease, but also in detecting and treating cancer over the past several millennia. Here's a look back to see how far we've come – and what's on the horizon. 

PAST
Some of the earliest human knowledge of cancer comes from ancient Egypt. Recovered manuscripts from that era describe patients with advanced-stage cancers and the accompanying treatment – sometimes crude surgery, but more often, no treatment at all. Fortunately, much has changed since then. 

3000 BCE

The Edwin Smith Papyrus and the Ebers Papyrus, authored around this time, describes an early cancer treatment from ancient Egypt.

These two documents are considered to be some of the oldest and most well-preserved medical texts in existence. Both texts describe case studies where tumors are removed by surgeries, though the Edwin Smith Papyrus notes that there is no treatment for the underlying disease.

As it becomes more culturally acceptable for doctors to dissect human cadavers, medical knowledge around cancer continues to grow.

Medical pioneers start to hypothesize that cancer was actually caused by a chemical process in the body gone awry – and doctors start to use the scientific method to research cancer, basing their findings on observation rather than cultural or religious precepts. Surgery, rather than blood-letting, becomes the principal method of treating cancer. Researchers also start to suspect that cancer can be caused by environmental factors, such as occupation and social class.

1400-1800 AD

Wolfram C. Fuchs becomes the first person to identify a brain tumor via x-ray imaging – opening up a new world of cancer detection.

Around the same time, other researchers started to realize that radiation can detect tumors and shrink them as well, leading to the birth of radiotherapy to treat cancers like malignant epithelioma. Not long after that, however, the earliest pioneers of x-ray imaging start to lose limbs, develop skin cancers, and die due to metastatic carcinomas caused by radiation exposure. It's not for another several decades that a causal relationship between radiation and cancer is definitively established.

1899

1920s-30s

Dr. George Papanicolaou, a Greek immigrant and physician, created the Papanicolaou test – otherwise known as the “pap smear.”

Papanicolaou was the first to identify cancerous cells in the vaginal secretions of his patients, under the microscope. Using this knowledge, Papanicolaou created what we know today as the “pap smear,” to identify and classify cancers of the uterus, vagina, and cervix.

His protege, Dr. May Edward Chinn, helped popularize the test particularly among low-income and underserved patients in 20^th century Harlem, giving birth to the concept of community-based cancer screening. In just a few short years, these advancements in screening and early detection led to a rapid decrease in cervical cancer deaths

During World War II, the United States Army accidentally discovers that soldiers exposed to mustard gas develop reduced white blood cell counts.

This leads scientists to theorize that similar chemical compounds might affect cell growth. Two Yale pharmacologists named Alfred Gilman and Louis Goodman put this theory to the test by treating lymphomas in mice with a compound called nitrogen mustard. This compound significantly reduces the size of tumors in mice and also in humans – though the subjects need to keep coming back for additional treatments in order for the tumors to continue to shrink. This discovery marks the beginning of chemotherapy as we know it today.

1940s

1941

Scientists discover that some cancer cells – specifically breast and prostate – depend on hormones to survive and thrive.

Dr. Charles Huggins, a urologist at the University of Chicago, was one of the scientists who pioneered this discovery, revealing through his research that metastatic prostate cancer improved in some patients after the removal of their testicles. Huggins' discovery would open the floodgates for hormone therapies designed to treat breast and prostate cancers.

1956

The world's first bone marrow transplant is a success.

Dr. E Donnall Thomas, who pioneered the treatment and would later go on to win the Nobel Prize in Medicine, transfers bone marrow from a healthy baby girl to her identical twin sister with leukemia, effectively curing her. Bone marrow transplants (also known as stem cell transplants) become the standard of care in treating certain types of cancers, such as leukemia, multiple myeloma, and lymphomas.

1990
Bacille Calmette-Guérin, or BCG, becomes the first-ever FDA-approved cancer immunotherapy,
a treatment that harnesses the power of the body's immune system to help kill cancer cells. Originally developed as a vaccine for tuberculosis, bacterium Mycobacterium bovis (BCG), is a standard of care in early-stage, non-muscle invasive bladder cancer when injected into the bladder. Once injected, the bacterium can infect some cancer cells and stimulate the immune system to help find and destroy other cancer cells in the bladder. This revolutionary treatment has laid the foundation for the evolution of immunotherapy for cancer treatment. 

PRESENT

The revolutionary cancer treatments of the 19th and 20th centuries turned cancer from a disease that was nearly always fatal to something that can be tested for and treated. Cancer patients today live longer and more satisfying lives than ever before, thanks to the hard work of researchers and oncologists. And not only are scientists developing new technologies to treat cancer patients, they’re also learning more about how our biology shapes cancer — and how we can use our own bodies to fight cancer (with a little help from science).

2003
For the first time, scientists establish that the different factors in our environment, such as diet or pollution, can influence our genetic expression.
Sometimes resulting in diseases such as diabetes or cancer. This area of research is known as epigenetics.

2006
The world's first cancer-preventable vaccine is approved by the FDA.
While pap smears, introduced in the 1940s, could detect precancerous cells or early-stage cervical cancers, the early 2000s saw the invention of a vaccine that prevented cervical cancer – and other cancers – from forming altogether. The vaccine blocks transmission of human papillomavirus (HPV).

Early 2015
The FDA approves the first-ever biosimilar medication, which helps the body stimulate the growth of white blood cells  in patients undergoing certain cancer treatments.
Biosimilars are much like another type of medication called biologics. Biosimilars act like a generic version of a biologic drug — highly similar except for minor differences in clinically inactive components. Biosimilars have the same effect as biologics but potentially provide more affordable options for treatment.

Late 2015
Targeted therapies quickly change the game for cancer treatments.
Targeted therapies can be used alone or in conjunction with hormone therapies or other treatments. When used in combination, targeted therapies often can help other therapies work more effectively. Targeted therapies provide an improved approach that has helped doctors better treat metastatic breast cancer, leukemia, and kidney cancers to just name a few. In 2015, Pfizer’s CDK 4/6 inhibitor for certain patients with a type of metastatic breast cancer became the first targeted therapy of its kind to be approved in the U.S. 

2016
The FDA begins to use real-world data (RWD) and real-world evidence (RWE)
to approve cancer treatments, rather than just approving them based on data from randomized clinical trials. Though clinical studies are the gold standard in scientific research, they aren’t perfect: In many cases, patients can be excluded from clinical studies and later approved treatments. (Men, for example, make up less than one percent of breast cancer patients, and as such are largely underrepresented in clinical studies for breast cancer drugs.) Using RWD and RWE, such as data mined from electronic health records, gives the FDA more information on whether cancer treatments will work well for underrepresented patients. In 2019, FDA expanded the approval for a metastatic breast cancer treatment to include men in part using RWD. 

2018
Scientists at Johns Hopkins Kimmel Cancer Center debut a unique, noninvasive blood test used to detect multiple different kinds of cancers at once, before patients show even a single abnormal symptom. 
The test, called CancerSEEK, screens for eight common cancers that account for more than sixty percent of cancer deaths, including cancers of the ovary, lungs, liver, stomach, pancreas, esophagus, colorectum, and breast.

2020
The FDA approves the first-ever “liquid biopsy,”
A way to get all of the pertinent information about a person's cancer simply by drawing the patient's blood and locating genomic alterations from pieces of tumor DNA circulating in the patient's bloodstream.

FUTURE

In less than a century, the landscape of cancer treatment has advanced beyond early scientists' wildest dreams. Cancer can now in many cases be treated quickly, effectively, non-invasively, and in some cases before symptoms even begin. Looking into the future, we can see how past and present cancer therapies and research have laid the groundwork for astonishing potential treatments to come. Here's what we can possibly look forward to.

Advanced Cancer Testing
More advanced testing for different types of cancers
Using just a few drops of a patient's urine, researchers at the Korean Institute of Science and Technology (KIST) are currently piloting a breakthrough test that can detect prostate cancer with nearly 100 percent accuracy, and in as little as 20 minutes.

Meanwhile, in the United Kingdom, the National Health Service plans to roll out a blood test later this year that has been shown in pilot programs to successfully detect over 50 types of cancer in a single blood draw. Although not yet widely available, technologies like these will potentially increase early-stage cancer diagnoses and reduce medical costs and medical staff fatigue as well. 

More Cancer Vaccines
Vaccines that target specific kinds of lethal brain tumors
Diffuse gliomas are usually incurable and difficult to treat. But early clinical trials have shown promise in treating these tumors with a mutation-specific vaccine. The vaccine targets a common genetic defect shared by some diffuse glioma patients – and early human trials are showing that this vaccine produces an immune response in a majority (93 percent) of patients. At the three-year follow-up point, the survival rate for trial participants was an astonishing 84 percent — and of the patients who displayed a strong immune response to the vaccine, 82 percent displayed zero tumor growth after two years. Phase 2 trials are currently in the works.

Brain Treatments
Treatments that prevent cancer from reaching the brain 
Some cancers originate in the brain, while others start elsewhere in the body and metastasize to the brain later. Once cancer passes the membrane known as the “brain-blood barrier,” which happens in about 10 to 30 percent of patients with melanoma, lung or breast cancer, the cancer is usually more difficult to treat and thus more deadly. Thankfully, scientists are currently hard at work developing new medications to cross the blood-brain barrier and specifically treat cancers that have metastasized to the brain.

Cancer Resistance
Treating cancer resistance
In some cases, cancers can develop a resistance to drugs that have previously worked well in the past. Kinase inhibitors, for example, are a targeted medication which block key enzymes that allow cancer cells to multiply — but even with that defense in place, cancers can still mutate and activate a different kinase to start growing again. Scientists are hard at work trying to fight against different “loopholes” that cancer cells use to evade current CDK inhibitor therapies and keep growing. Early clinical trials for a new kind of CDK inhibitor are currently underway to combat the problem of resistance. 

Immunotherapies
Harnessing the body’s own immune system against cancerous cells has proven to be a tremendous success for many cancer patients. Several new immunotherapies are on the horizon and poised to become conventional treatments, including cancer vaccines, cell therapies, gene editing (CRISPR) and microbiome treatments, which may make cancer-fighting medications, such as checkpoint inhibitors, more effective. 

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