Cancer: a public health imperative 04/02/2022 | Article
Scientific and technological advances now mean that curing some types of cancer is no longer a pipe dream. In addition to better disease control, interdisciplinarity will be one of the main components of this transformation. As with other areas of medicine, funding will be a key driver for change.
The official data are irrevocable1. Cancer caused ten million deaths in 2020, making it the second leading cause of death worldwide. According to IARC [International Agency for Research on Cancer], a third of these deaths were directly linked to five major risk factors: namely, obesity, diet, physical condition, alcohol and tobacco. Tobacco is the primary cause of the deadliest of all cancers, i.e. lung cancer, which accounts for 18% of deaths. Another key feature is the sharp rise in the number of cancer cases, with nineteen million new cases detected. Breast, lung, colon, prostate and skin cancer are the most represented in terms of incidence. To put it more starkly, the key criticality indicators show how far we have to go to reduce the social, human and financial impacts of cancer, whose annual cost is estimated at $1,160 billion2. In addition to wider access to increasingly sophisticated treatments, prevention and early detection have been identified as two key parameters. In imperative terms, the further scaling of existing services would also be profitable, potentially yielding $12.43 for each dollar invested3.
Driven by dynamic research, we have witnessed several major advances over the past decade. “Advances have been made as a result of a better understanding of the disease, its risk factors and the circumstances of its occurrence,” says Professor Fabrice Barlesi, Managing Director of Gustave Roussy. More preventative, especially thanks to advances in the area of screening, cancer medicine is now undeniably more accurate. Scientific knowledge is no stranger to this phenomenon. “The (almost completed) molecular genotyping of cancers has boosted the development of highly targeted therapeutic strategies that have significantly improved the care of many patients.” A radical development which has also encouraged the advent of immunotherapy. “This new approach, which restores the activity of the immune system, has produced very interesting results in diseases with a very poor prognosis, such as melanoma or lung cancer”, observes Fabrice Barlesi. In his opinion, this has very significantly extended the life expectancy in 15-20% of patients treated with immunotherapy. In another major trend, the arrival of CAR-T cells has undeniably opened up new prospects in the treatment of haematological cancers, validated by initial successes. This promising technology could now be applied in the field of solid tumours.
To take the next step, scientists will have to overcome many challenges. “We need to find a way to circumvent the primary resistances that make immunotherapies ineffective in some patients, either by combining them together, or by associating them with other treatments”, explains Professor Barlesi. Other issues include the problems involved in better controlling the disease. Like CAR-T cells, the development of new cell therapies and targeted therapies should help in this area. However, anticipation will be one of the watchwords of the transformation. “We must be able to create avatars of a tumour to allow us to test and identify the most suitable therapeutic solutions for each patient. We need to act upstream of the treatment to optimise its chances of success.” Long neglected, post-cancer management will also be a major avenue for progress, particularly in children. The objective is clear: to minimise the impact of treatments and disease to enable patients to live as long as possible, and in the best possible conditions. To achieve this ideal, we will need to overcome several obstacles. “Interdisciplinarity will be the primary driver of any breakthrough innovation. And this combination of experience and expertise will be our strength”, assures Fabrice Barlesi.
Major financial challenges
As with other areas of medicine, investment will be a key driver for change. “The impetus could be driven by States or major academic institutions, but it will absolutely need to be supported by private funding and philanthropy”, comments Professor Barlesi. Increasingly sophisticated, cancer treatments will require increased financial resources to stimulate research. Due to the wide variety of diseases, the focus will be more on subgroups of patients, not without increasing the cost of the programmes initiated. Although essential, public-private partnerships will no longer be sufficient. “Investment funds should contribute to facilitate the discovery and support the distribution of new medicinal products.” One of the examples mentioned is the Boston cluster, which is an embodiment of “the way forward”. This emulation is a guarantee of speed and efficiency, but it is subject to conditions: “More open to opportunities in the health sector, financial operators will have to accept the risk inherent in any scientific research. To alleviate the burden of this uncertainty, they will need to rely on specialist advice. And confidence will be a determining parameter in the investment decision.” One thing is certain: academic, industrial and financial worlds will have to cooperate more closely for the common good. The fairly optimistic Professor Barlesi firmly believes in the theory of de-compartmentalisation for the benefit of patients.
The path to a cure
Long considered an incurable disease, cancer could become “merely” a chronic disease. With the announced advances in treatment, could its eradication be envisaged in the medium term? “A cure, in the strict sense of the term, seems totally illusory. The disease could nevertheless become a bump in the road that in most cases people manage to overcome. We are currently curing almost half of all cancers. And this percentage could reach two-thirds by the middle of the century,” announces Professor Barlesi. Beyond drug treatments alone, prevention and education will play a key role in the process. “To achieve this goal, the fight against smoking, alcohol consumption and malnutrition will need to be supported by more proactive public policies. The systematic roll-out of the vaccination against cancer of the cervix should follow this same approach.” Early screening is also a critical component. “The sooner we manage to detect the disease, the better we will be able to treat it! At the very least, it guarantees that cancer patients return faster to society and enjoy a longer life expectancy.” In this area, artificial intelligence could both contribute to scientific knowledge and refine the diagnostic accuracy. “Simplicity, accessibility and fairness will be three determining variables in encouraging patient support”, concludes Fabrice Barlesi.
Partner of the PRISM project, the national precision medicine centre launched by Gustave Roussy, Paris-Saclay University, CentraleSupélec and Inserm, which were later joined by Unicancer and ARC, Candriam will contribute to the fight against cancer. Through its network of experts, it will target developments, projects and solutions that are the most beneficial to the community.
World Cancer Day: the challenge of (re)cognition
To achieve fairer care! This year World Cancer Day will focus on understanding and recognising inequities in cancer care. This event will be an opportunity to challenge the status quo which results in the loss of too many human lives. Treatment, prevention, screening… Particular emphasis will be placed on access to essential health services, which ostensibly varies according to income, level of education and geographical location. In addition to reducing discrimination linked to ethnic origin, gender, sexual orientation, disabilities and lifestyles, the international community will also have to take up the challenge of knowledge. “Informing, raising awareness and educating populations, especially the youngest, will be key in the fight against cancer”, restates Professor Fabrice Barlesi, the managing director of Gustave Roussy.
Blood test: a very encouraging discovery
This is a major breakthrough. Researchers at Oxford University* have managed to develop a blood test able to detect early cancer in people with unexplained symptoms, such as weight loss or fatigue. Unable to identify the type of tumour, this tool would nevertheless be able to identify the possible presence of metastases with an efficiency of 94%. Based on nuclear magnetic resonance-based metabolomic analysis, which has been successful in screening for multiple sclerosis, it has been tested on blood samples from 300 patients. It now needs to be tested on a larger scale to confirm the promising initial findings.
(*) “Metabolomic biomarkers in blood samples identify cancers in a mixed population of patients with nonspecific symptoms”, Clinical Cancer Research (January 2022).
1“Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”, International agency for research on cancer (December 2020).
2“Assessing national capacity for the prevention and control of noncommunicable diseases: Report of the 2019 global survey”, World Health Organization (March 2020).
3“Global costs, health benefits, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis”, The Lancet Oncology (March 2021).