Can cancer be figured out?

Steven Reiner, immunologist at the Abramson Family Cancer Research Institute at Penn. In cancer research, genetic findings have opened a Pandora's box of complex pathways.
Steven Reiner, immunologist at the Abramson Family Cancer Research Institute at Penn. In cancer research, genetic findings have opened a Pandora's box of complex pathways. (Archive photo)

While uncovering ever more new steps, science comes closer to a cure.

Posted: July 26, 2012

As both a science writer and a melanoma survivor, I eagerly attend the annual scientific retreat of the Melanoma Research Alliance, which funds cutting-edge research on the skin cancer.

Last year, the first drug targeting a genetic defect that causes melanoma, vemurafenib, came on the market with much fanfare. But at this year's meeting, researchers reported that the drug would not cure most melanoma patients because they eventually develop drug resistance. Much of the research reported at this conference delved into what caused vemurafenib to fail in so many patients, and what new drugs it could be combined with to be more effective.

Sigh.

The meeting echoed what I had been hearing for quite some time in my many years of reporting on cancer.

"We'll have cancer all figured out in five years," Robert Weinberg, a big-name cancer researcher at the Massachusetts Institute of Technology, told me back when I was writing for a magazine published by the National Institutes of Health. Weinberg was excited about the recent findings that certain key genes played a major role in fostering human cancers.

That was 25 years ago.

Was he delusional?

No. Finding those genes did seem like finding the keys that would open up the black box of cancer that had been locked and looming over humanity for millennia. But it was a Pandora's box that opened, as one genetic finding led to another, each spinning out threads that interwove to form a complex web of biochemical pathways needed to make a malignancy.

When at first the research revealed just a few genetic targets, the media trumpeted the promise of nontoxic cancer therapies directed at those targets. Although some patients had remarkable responses, with major shrinkage or disappearance of their metastatic tumors, most either did not respond, or didn't have long-lasting responses.

So the scientists went back to the lab. They discovered that, like a Whac-a-Mole game, as soon as you blocked one cancer pathway, bypass routes eventually develop that would keep feeding those voracious cancer cells, which continued to divide and spread, causing an ultimately fatal swath of destruction. The war on cancer started by the Nixon administration had morphed into something like a war on terrorism - as soon as one terrorist was killed, another came out of hiding to take his place.

Researchers are finding that nailing all the genes involved in cancer is not enough. You also have to scrutinize the regulators of those genes - the compounds that can turn them on and off, thereby determining the amount of cancer-causing or suppressing proteins they produce.

Figuring out cancer by figuring out its genetic coding is not as simple as it once appeared.

Should this realization dampen our enthusiasm that cures are around the corner?

No. Although researchers continue to uncover more steps on the pathway to cancer, each step brings us closer to a cure.

Yes, it's complex, but we've overcome complexity before. When the first chemotherapy was tested on children with leukemia, these treatments failed miserably and led nurses and parents to practically accuse the clinical researchers who tested them of child abuse. Researchers soon discovered that combining several different chemotherapy drugs produced stunning results. Most forms of leukemia in children are curable today, thanks to the perseverance of those researchers.

Lending optimism to the effort is the recent blossoming of crowd-sourced science, whose resources and results are instantly shared on the Web. These Wikipedia-like efforts are spurring clinically relevant discoveries at a faster pace.

One major government undertaking in this regard is the Cancer Genome Atlas. Multiple labs throughout the country work together to genetically analyze thousands of patient tumor samples in fine detail. Their findings are put into the public domain, where even more researchers make use of them.

The speed of such crowd-sourcing-science efforts can be astonishing. One global Internet-based network of researchers provided a detailed genetic picture of the bacterium that causes tuberculosis in the record-breaking time of only four months.

So is the war on cancer endless? No. It may be a slow slog, but it has recently picked up its pace, and we continue to make progress, as evidenced by the millions of people who have had cancer and are still alive today to tell their tale, including myself.

But will we have it all figured out in the next five years? I'll give the most definitive answer to that question that I can, as a science writer who has reported on the field of cancer research for more than 25 years:

Maybe.


Margie Patlak can be reached

at margiepatlak@gmail.com.

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