GUY RAZ, HOST:
Are you also optimistic about where we're headed?
DAVID AGUS: Yeah, you know, we're on the edge of the cliff. We're willing to take risks. Our patients are willing to take risks.
RAZ: This is David Agus; he's also a cancer doctor and a professor at USC Medical School.
AGUS: So it's really an exciting time where all of a sudden, the change of progress versus time is happening, and hopefully we're starting to make differences.
RAZ: But still, right now, this is David Agus's reality.
AGUS: Two to three times a week, I look someone in the eye and say I have no more drugs to treat your cancer. There are remarkable pills that can stop leukemia - certain kinds of it in its track - certain kinds of lung cancer, certain kinds of kidney cancer with immunotherapy - small little wins. But the big picture is not a dramatic benefit. And so we need to reassess where we are.
RAZ: And what David Agus has been arguing is that the way we approach the fight against cancer is all wrong; that cancer isn't just lung cancer or breast cancer or prostate cancer, but it's more about the environment where the cancer lives - the entire body.
AGUS: And so there are millions of contexts in the body. And I look at it like you're driving to LA to San Francisco. And if I take a car and take it apart and look at every piece of the car, it doesn't tell me how long it takes to get from LA to San Francisco. I forgot the weather, the traffic, how much caffeine the driver drank, the bladder size of the driver 'cause they all matter. And in the cancer world, as with many other diseases, all we're doing is we're studying the car. We're studying the cancer cell, and we forget to study everything else. And so I think the future of cancer research is not just studying that cell, but it's studying the environment, studying the whole system - who the host is, who the patient is.
RAZ: And David says one of the things that's holding us back from approaching cancer as a whole system is the way we talk about it. David picks up this idea from the TED stage.
(SOUNDBITE OF TED TALK)
AGUS: So one of the fundamental problems we have in cancer is that right now, we describe it by a number of adjectives - symptoms. I'm tired, I'm bloated, I have pain, et cetera. You then have some anatomic descriptions. You get that CAT scan. There's a three centimeter mass in the liver. You then have some body part descriptions. It's in the liver, in the breast, in the prostate. And that's about it. So our dictionary for describing cancer is very, very poor. It's basically symptoms. It's manifestations of a disease. What's exciting is the government has spent 400 million dollars, and they've allocated another billion dollars to what we call The Cancer Genome Atlas project. So it is the idea of sequencing all of the genes in the cancer and giving us a new lexicon, a new dictionary to describe it. So obviously, the technology is here today, and over the next several years, that will change. You will no longer go to a breast cancer clinic. You will go to a HER2 amplified clinic or an EGFR activated clinic. And they will go to some of the pathogenic lesions that were involved in causing this individual cancer.
RAZ: OK, so right now, if you're diagnosed with, say, breast cancer, right, you go to a breast-cancer specialist, and the doctor prescribes a standard treatment - usually a combination of surgery, chemotherapy, maybe radiation. But here's the thing...
AGUS: There are probably dozens of kinds of breast cancer, dozens of kinds of prostate and lung cancer. And so going forward, we're going to start to define the parameters. I'm going to look at it and say this cancer can only live in the breast so just surgery is all we need. Or this one grows like a tree so we need to do surgery with radiation. Or this one can live elsewhere in the body so we need to give chemotherapy. So I think that's going to be the fundamental change here is that we're going to start to treat that whole individual, that complex system rather than just the cell.
RAZ: David's idea here is that while we should treat cancer in the context of the body as just one part of a larger, complex system, we can do that without necessarily understanding how it all works.
(SOUNDBITE OF TED TALK)
AGUS: The goal of me as a cancer doctor is not to understand cancer. And I think that's been the fundamental problem over the last five decades is that we have strived to understand cancer. The goal is to control cancer. And so the problem is, is that it's not just one system; it's multiple systems on multiple scales. It's a system of systems. What we're talking about in the body and cancer is starting to model it like a complex system. Well, the bad news is, is that these robust, and robust is a keyword, emergent systems are very hard to understand in detail. The good news is you can manipulate them. You can try to control them without that fundamental understanding of every component.
RAZ: So you're saying we don't really need to understand cancer? I mean, there's just going to be things that we're never going to understand - we just have to accept and that's OK?
AGUS: No question about it. We are never going to understand the complex things that are going on with these 20,000, 30,000 genes in the cell and then each of the cells that are contributing to all the environmental things and how they're connecting to it. Do you think anybody truly understands the economy?
AGUS: No, but at the same time, we can control it. We can raise interest rates, we can change money supply and other things we know can affect the economy in certain ways. That's how cancer's going to go. You know, a critical trial was done about 15 years ago where they took women with premenopausal breast cancer. And after treatment, when we normally wait until the reoccur and treat again, they divided the group into two. One got a drug that builds bone, a drug for osteoporosis, and one got placebo. And in that trial, they reduced recurrence of the breast cancer by over 40 percent. Why? Because breast cancer metastasizes to bone.
AGUS: So one of the most dramatic benefits across any cancer trial, and it was a drug that didn't even touch the cancer; it changed the system.
RAZ: So I mean, if we eventually start to treat cancer more like part of a system - I mean, how far could this go? Like, what would a visit to a doctor's office be like?
AGUS: Well, I think the doctor's visit of the future will be you go in, and we prick your finger and take a drop of blood. And that blood gives you a profile of everything going on at a moment in time. So it tells you what's going on; it's the state of the system, whether you're in a health state or a cancer state. So in the future when I treat the cancer, I may also change your body so the cancer doesn't want to go elsewhere and grow and make it inhospitable if you will. At the same time, I'm going to look and say why did he or she get cancer? Well, they had significant inflammation, and their body was receptive because this kind of tissue allows other cells to grow rather than just normal cells. And I'm going to change that or attempt to change that. So defining the system is going to be key.
RAZ: I mean, if you think about, like, HIV-AIDs, right? I mean, 20 years ago this was a death sentence, and now, people live full lives with it. We've just figured out a way to control it. So I mean, sounds like what you're saying is that the goal isn't to cure cancer, but to kind of make sure that people can live with it.
AGUS: Exactly, it's to stop it from growing. You know, listen, a tie is just as good as a win in a sense, right. If I stop a cancer from growing, and you live with cancer and die with cancer, it's just as good as me going these crazy, heroic, toxic ways to try to get rid of it. So, you know, people, as you alluded to, live a whole, normal life now with HIV by taking a medicine that suppresses it. I want to go that same direction in cancer. I want to change you so the cancer stops growing, and you can live a very fruitful and productive life and play with your children and your grandchildren and live till a ripe old age, which is what we all dream of.
RAZ: David Agus - he teaches at the USC Med School where he heads up the Center for Applied Molecular Medicine. You can find his full talk at ted.com. More ideas about fighting cancer in a moment. I'm Guy Raz, and you're listening to the TED Radio Hour from NPR.
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