The National Cancer Institute alone will spend nearly $5 billion this year exploring treatments for cancer. Pharmaceutical companies are heavily invested, as are philanthropies. Allen Lichter, executive vice president and CEO of the American Society for Clinical Oncology, explains how these treatments affect the rate of deaths due to cancer.
How big a role do therapies play in the decrease in cancer deaths?
Over the past 30 years, the number of new drugs that are effective against cancer has skyrocketed. Not only do we have new therapies, but we recognize that they should be applied much earlier. So in the past, cancer chemotherapy was given to advanced disease patients, but now we realize these drugs are even more effective as part of the initial treatment. We also have better surgical techniques and better radiation techniques. All these help produce these changes.
Where do you see the most progress?
There has been slow and steady but critically important progress in breast cancer. We see improvements in prostate and colon cancer therapy. [We] are applying what we learn year after year to chip away at this.
Are there other forms of cancer where progress has not been made?
The one that comes to mind is pancreatic cancer, which is the fourth-leading cause of cancer death in the country. Most cases are discovered when they are far along, and we have not yet discovered important breakthroughs.
Some cancer drugs cost tens of thousands of dollars and may only add a few weeks to life. Are these drugs worth the cost?
Without question, these drugs will eventually be worth the cost. One could argue about [spending] tens of thousands of dollars for a few weeks, but the trials that show the effectiveness of these drugs are in advanced cancer patients, where a few weeks is sometimes quite a remarkable achievement. I think eventually many of these drugs will be used early on with very life-prolonging effects. The high cost will be more than justified.
In these treatments is there sometimes a trade-off between living longer and living better?
That's an important question. In the past, the side effects of therapies that were much more nonspecific [in treating cancer], combined with the paucity of drugs that we had to manage side effects, made some of these therapies less than completely worthwhile. Today we are much better with therapies that are more specific, and also with supportive care and pain management that makes the course of cancer therapy, although not easy, much more tolerable.
What do you think about cancer vaccines? We've been hearing a lot of talk lately about a vaccine for cervical cancer.
The cervical cancer vaccine is a phenomenal breakthrough, one that has the potential of eliminating this disease almost completely. Not that many cancers are caused specifically by viruses. But eventually, preventive strategies have to be part of the total approach to cancer. The easiest cancer to cure is the cancer we don't get because we prevented it.
When you look forward, do you see hope for a treatment that seems to show great promise?
I think one of the most tantalizing areas is the ability to detect cancer early with a blood test, a blood signature, if you will. There is tantalizing evidence that most cancers produce, or are capable of producing, that signal. The signal is very small and hard to detect, but sophisticated detection techniques are making progress. I think someday we will be able to detect cancers at their very earliest stage, which will make them enormously curable.