Just a little more than 100 years since the organization of the American Association for Cancer Research, that is the hope for those at the forefront in the fight.
For Dr. Arthur Frankel of Temple the immediate goal is to speed the development of cancer treatments. He is director of the Cancer Research Institute and of the Division of Hematology /Oncology at Scott & White Memorial Hospital.
Normally, a drug company will spend 15 years and $900 million to get a drug to market. Frankel wants to reduce the time by a third and lower the cost to less than $100 million.
For Dr. Roy W. Smythe of Temple the immediate goal is to reduce the trauma of surgery itself when treating cancer. He is chairman of the Department of Surgery at Scott & White.
Both Frankel and Smythe say immense progress has been made in finding ways to treat patients with cancer.
In the last 20 years, better imaging and better selection of candidates for surgery, advances in limiting the scope of surgical procedures and improvements in pain management and intensive care have helped patients, Smythe said.
“The technology continues to advance in regards to what we can get away with - smaller incisions and less trauma to the patients,” Smythe said.
For example, today it’s possible to use robotics for some prostate cancer surgery. And, video-assisted small-incision surgeries are used for kidney cancers, colorectal cancers and lung cancers.
One only has to look at how breast cancer is treated to realize how far medicine has come, said Dr. Lute A Oas, radiation oncologist the Scott & White Center for Cancer Prevention and Care in Killeen.
For years, the treatment of choice for breast cancer was a radical mastectomy with lymph nodes removed. Today, breast-conserving surgery (a lumpectomy) followed by radiation therapy has replaced mastectomy for women with early stage breast cancer, Oas said.
Radiation treatment for many cancers has made great strides, Oas said, and physicians can now specifically target tissue with cancer, sparing healthy cells.
“It’s a young technology, but very promising,” Oas said.
Future treatments
While advances continue to make surgeries less traumatic, Smythe said he hopes the day will come when surgery is unnecessary.
Researchers are working toward tailored treatments based on a patient’s biological makeup.
“Most of us who do cancer surgery and cancer research would love to see the day when we don’t have to put a knife on anybody’s skin; we’d just give them something and they would get better,” Smythe said. “That’s unlikely to happen anytime soon, but that’s what we all hope for.”
Smythe said his lab is working on a kind of lung cancer, colon cancer and esophageal cancer and is looking at genes that let tumors resist effective treatment.
In the process, it is expected that treatments will be developed that don’t require conventional chemotherapy, but will use agents that make the cells want to die.
“This is an exciting time to be a surgical oncologist because of all of these advances,” Smythe said. “Thirty years ago surgical oncology was a messy business. When people came to the surgeon their inclination was it was a death sentence, but now we at least have a fighting chance with the majority of patients that we see, if not to cure them, then to at least significantly extend their lives.”
Smythe believes the biggest impact for cancer patients will come from the development of drugs that can be given by mouth or put directly into the bloodstream to reach cancer cells anywhere in the body.
“There are many people whom we don’t operate on now because the disease has spread to other parts of the body,” Smythe said.
And 70 percent of patients who have lung cancer are not candidates for surgery, he said.
However, he believes during this generation chemotherapy will be used to kill tumors in areas where the cancer has metastasized and the initial tumor, too large to be destroyed by chemo, will be removed with surgery.
More research needed
Survival rates continue to improve for patients with many types of cancer, federal data show.
“Cancer is a different disease than what it was 30 or 40 years ago,” Frankel said. “It’s possible now to start to talk about many patients of cancer as having a chronic disease.”
As with rheumatoid arthritis or diabetes, there are people who can have cancer, but have it under control.
“That’s a real blessing,” Frankel said, “but it’s also a responsibility, because there are more people with a voice who can say, ‘you know I’m living with this, but I would love it even more if you could eliminate the disease I’m living with.’”
The Cancer Research Institute was created because cancer patients today still have limited options, Frankel said, and there are still cancers that end the lives of thousands each year.
Frankel wants the institute to be the vehicle that takes ideas from the lab to the patient in record time and for less money. “We want to see new ideas,” he said.
Frankel wants Temple to be the place for “researchers from around the world to bring their innovative ideas for cancer treatments.
“We’re hoping to keep this type of research environment going so advances can continue.”
Also, if the institute can continue to grow as other centers become more limited, it might serve as a magnet for researchers and patients who need specialized care.
In addition to other research, the physicians here also keeping up with the technological advances that play a role in beating cancer.
Smythe said Scott & White partners with certain manufacturers and is kept informed of what is under development.
“We’ll occasionally trial some of their newer equipment if slight changes have been made, and we’re on their list if significant changes are made,” he said.
In vascular surgery, for example, Scott & White participates with 10 national clinical trials using new technologies. A local surgeon is the primary investigator in two or three of the studies.
“We’re helping to decide what everyone is going to adopt,” Smythe said.
