The Past, Present, and Future of Cancer Therapy

Everyone knows someone who has been affected by cancer—a parent, sibling, partner, teacher. Maybe you are a cancer survivor yourself. Because cancer inevitably touches all our lives, directly or indirectly, it may come as no surprise that cancer was the second-leading cause of death in the United States in 2021 and 2022.¹ Fortunately, the outlook for patients affected by cancer is improving as the therapeutic landscape evolves. A recent study demonstrated that the rates of new cancer cases remained stable in both men and women over the past 25 years, while the number of deaths due to cancer trended downwards.² This decline in mortality may be attributed to strides in cancer prevention, early detection, and the availability of treatment options with ever-improving efficacy.²

Cancer is often described as a “modern disease,” but the history of oncology predates the modern era. The first record of a human tumor is a description of a breast cancer case dated all the way back to 3000 B.C.E. Historically, cancer was treated with radical, often unsuccessful surgical techniques.³ Surgery remains an important tenet of cancer treatment today and is one of the main pillars of cancer therapy outlined by the American Association for Cancer Research. The accompanying pillars are radiotherapy, chemotherapy, molecular targeted therapy, and immunotherapy.⁴ The past century has witnessed several breakthroughs in cancer treatment, and the number of available therapies continues to increase exponentially.

In 1898, a cancer case was cured by radiation therapy for the first time, thanks to the pioneering work of Marie Curie and the discovery of X-rays.⁵ Chemotherapy came on the scene in the 1940s.³ Many early chemotherapy agents are still used today, such as 5-fluorouracil, which is used in the treatment of colorectal, stomach, breast, and pancreatic cancer.⁶ The last two pillars of cancer therapy have emerged in the past 40 years alone.⁴ The 1980s signaled the beginning of a new era of drug development in which medications are designed to act on specific molecular targets involved in cancer growth. These targeted therapies include drugs called kinase inhibitors and monoclonal antibodies.³ Antibodies are a natural defense mechanism against disease, but they can be engineered to recognize specific molecules, such as proteins expressed only on cancer cells. Rituximab was the first monoclonal antibody drug to be approved for cancer treatment, specifically for non-Hodgkin lymphoma.⁵

The fifth and final pillar of cancer therapy is immunotherapy, a treatment strategy that can better equip the patient’s own immune system to kill cancer cells.^4,5 Immunotherapy includes immune checkpoint inhibitors, a type of monoclonal antibody drug.³ Ipilimumab was the first immune checkpoint inhibitor to be approved by the Food and Drug Administration (FDA) in just 2011.^3,7 Pembrolizumab received FDA approval shortly after in 2014 and, in 2017, became the first cancer drug that can be used to treat any tumor with specific genetic changes present that has spread and cannot be treated with surgery, regardless of the cancer type.⁷

Antibody-drug conjugates (ADCs) are a relatively new and rapidly growing drug class. An ADC consists of both a monoclonal antibody and a chemotherapy agent: two pillars of cancer therapy combined into one. An ADC is designed to deliver a cell-killing compound precisely to cancer cells by targeting proteins that are expressed more in cancerous cells than healthy ones.⁸ The first ADC was approved in 2000, and research efforts have grown rapidly since then.⁸ In 2023, there were over 100 new ADCs in clinical trials. This category growth was driven largely by successful ADC trials just over the last five years, especially in cancers that otherwise do not respond to further treatment.⁹

The number of approved cancer medications continues to grow. In the first three months of 2024, the FDA issued 14 approvals with cancer indications.¹⁰ Eighty tyrosine kinase inhibitors and 11 immune checkpoint inhibitors have been approved by the FDA as of January 2024.^11,12 If you do not find these numbers impressive, consider that the average new drug spends approximately nine years in clinical development, and these drug classes have existed for mere decades.¹³ Despite the lengthy, resource-intensive process required to bring a new drug to market, huge strides have been made to improve outcomes for patients living with cancer. The five-year overall survival rate for young women with breast cancer increased by nearly 15% between 1975 and 2015, likely due to therapeutic advances.¹⁴ As the 21st century progresses, healthcare providers are becoming better equipped than ever to offer patients cutting-edge care. I am grateful to live in a time during which my loved ones affected by cancer have the privilege of receiving novel treatments that can be life-changing, and I am hopeful that the outlook will further improve for patients in the next decade and beyond.

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References

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10. Staff CRC. FDA Approvals in Oncology: January-March 2024. American Association for Cancer Research (AACR). April 3, 2024. Accessed November 18, 2024. https://www.aacr.org/blog/2024/04/03/fda-approvals-in-oncology-january-march-2024/
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