My opinion is yes. Now clinicians are testing things ranging from cancer immunotherapy to vaccines. Cancer cells are being targeted specifically by abs with attached toxins, chemicals etc. and eliminating cancer stem cells, which is the holy grail for cancers elimination, is the current focus of many laboratories. Even though trials have failed, ie the recent melanoma trial by GSK with immunotherapy, for cancer, we now know in many instances know the genetic mutations involved. This in combination with genetic screening and breakthrough techniques to rapidly sequence whole genomes of cancer cells, will allow custom therapies. Also, in terms of standard therapy, I think researchers have finally figured out, that like viruses and viral therapies, because they mutate all the time, that a cocktail of drugs is what is required for treatment. And since now drugs like kinase inhibitors have reached the market, these and other drugs with less side effects can be used as combination therapies. So while there would be no cure, per se, the patient, like those with HIV could be in remission for the rest of their lives. The main hurdle is money and time to do the clinical trials.

I was thinking to some degree at first the same way as Rohan. But first let me say that we have a century to do this. And in terms of the technologies that are coming out, now, things are happening exponentially rather than linearly. Think about stem cell research, tissue regeneration, and what has been done with cancer. But things do progress slowly because drug discovery progresses slowly. That is why we need more research funding. At least for the US, research funding is at a standstill. One part is to catch it early, and stop it, so that one does not have to worry about the cancer mutating. That is why cocktails are so important. The current trials are doing these types of studies. So I think diagnostics go hand in hand with a cure. As our diagnostic systems get better, and they are, a cure will be in sight for the up and coming generation. This is my belief. The cup is half full, so to speak.

For diagnostics, with the miniaturization of technology, now labs are starting to screen thousands of factors all at once in patient samples. And this is at the DNA, RNA, protein, and metabolite level. I believe that the development of these types of tests is critical as to how we can find a cure for the most prevalent types of cancer.

Painstaking efforts of Researchers of last Century has made it possible to achieve 100% remissions for some type of cancers such as Leukemia, HL,NHL etc.

Researchers of current century are carrying on the works of previous century, so it is very possible that in this century we'll be definitely able to won the "War Against Cancer"

Do not believe that the cancer problem will be solved so soon. There is a lot of work waiting us. As David Dent once said “We are only at the foothills of understanding cancer, and the biological mountain still lies in the clouds ahead.”

I guess I am just optimistic. It is hard to watch those individuals that succumb to cancer.

I think that the main goal should be to protect normal cells from the effects of chemotherapy on dividing cells. A solution to this problem is "cell inflation assisted chemotherapy":

http://onlinelibrary.wiley.com/doi/10.1002/cam4.91/pdf

In theory, such a method could be developed in less than 5 years. But this would require a political will.

Rohan, I perfectly agree with you. We have enough data.

What we need is ideas and a political will. If the goal of scientists is just to publish data, then we are going the wrong way. First successes against cancer came from considering that drugs leading to low white cell counts in the blood could be used against cancer cells.

David, have a look at this:

http://onlinelibrary.wiley.com/doi/10.1002/cam4.91/pdf

http://www.youtube.com/watch?v=FBLnL4XA6fc

We should be realistic about cancer figures. Based on WHO, deaths from cancer worldwide are projected to continue rising, with an estimated 13.1 million deaths in 2030, this figure is much higher than 2008 estimate (7.6 million deaths).

Investments on cancer care facilities including diagnostic and therapeutic items have been increased dramatically during last 50 years, but these investments have contributed a little to reduction of cancer burden.

While acknowledging the painstaking work on understanding biology of cancer and heavy infrastructure on pharmaceutical side, we should think more on the prevention side.

Prevention, Prevention, and Prevention!

At least 1/3 of all cancer deaths could be prevented through elimination of well-known environmental and lifestyle risk factors including smoking, obesity, inappropriate diet, high salt, alcohol, lack of physical exercise and infections (HPV, H.pylori, etc).

@ Mohammad

We all know that prevention is important, but it impossible to avoid all cancers. And this thread is about cure. Do you think that sequencing all tumours and finding a drug combination specific for each patient will be the way to get rid of cancer? If not, have a look at this:

http://www.youtube.com/watch?v=FBLnL4XA6fc

@Alexander Julianov "The War Against Cancer has been Half Won and Half Lost". I'm saying dis coz there are medicines which can induce remissions but on the other hand they are so costly dat poor peoples can't afford that. For e.g Paclitaxel a highly effective anti mitotic drug marketed by Pharma major Bristol Meyers Squibb used for treatment of lung, ovarian, breast, head and neck cancer, and advanced forms of Kaposi's sarcoma is $8143 , which is out of reach of middle class families

Dear Prafulla,

In my country all of the antitumor agents are covered by the government. However this does not means that we are remarkably effective.

We just do not still sufficiently understand this group of cells which we named “cancer”, and how exactly they kill our patients. We need new ideas, an effective new concept. For example: I am surgeon, and that what we do in surgical oncology is related with archaic concept – we are removing tissue mechanically. That’s all. Irrespective of that how we do it and which “star wars” technology we use in modern surgery, we are just removing some tissue. Do not look like a progress over the last century. And the situation in medical oncology is not very different as everything depends on our basic knowledge of the biology of cancers, which is far from deep understanding for vast majority of the cases.

Dear Daniel

Your “cell inflation assisted chemotherapy” idea is impressive. Hope to see results of clinical trials using your method soon.

My emphasis on the prevention is based on common believe on cost-harm balance applicable to populations in long term, not just for specific cancer in a limited time.

Many therapeutic and early detection modalities are struggling to downgrade burden of cancer. The typical example is Barrett’s surveillance for oesophageal adenocarcinoma, which extensively being practised in many countries including USA and UK. According to recent report by Corley et al (Gastroenterology 2013; 145:312) endoscopic surveillance of patients with Barrett’s oesophagus was not associated with a substantially decreased risk of death from oesophageal adenocarcinoma.

Dear Mohammad,

I completely agree with you on the cost-effectiveness of prevention. I just wanted to mention that the question was about a universal cancer cure. I am not optimistic about "personalized" medicine, one of the main difficulties being randomized clinical trials for personalized therapies. Concerning Cell Inflation Assisted Chemotherapy, it has not been possible to get funding for a trial in the primate in France, for "political" reasons, and therefore there will be no clinical trials, but if people are interested in this idea, they can try to convince their own authorities.

Thank you all to scientist for nice and informative sharing!!

Dear Daniel & Mohammad

I completely agree with you on the cost-effectiveness of prevention.But I just wanted to mention that all country must focus on the present issue and contribute to solve it then we have some good out put or conclusion. Because we all try to solve it and waste our energy and resources but out put not always clear so International cancer research society Must make a protocol for that. (i had plane out my idea for that i will also upload that document here within short time) it covers following points

1) all countries fund available with one authority (build by election and scientific beck ground)

2) then divide work allotment according to geometry /resources and environment culture.

3) make a protocol for like concept of (Reverse pharmacology) so it give fast result.

i am not 100%sure but if we align this thing then we get some conclusion. i also request all member to please email me to design a one protocol for this thing and contribute for society.

Regards

Dr vipul

I agree with Alexander that we still don't know the exact causes of angiogensis.

I am currently working on visualization and quantification of biological processes taking place at the molecular and cellular level by using nanoparticles. The primary focus is towards the real time assessment of tumour response to treatment, toxicity measurement to adjacent normal tissues and quantification of macromolecular drug gets into a tumour. The use of nanoscaled carriers in drug delivery is expected to increase drug specificity, thus reducing side effects. However, these sort of studies are still in very early phase and to be honest we should not expect a dramatic change /decline in cancer patients even in near future. Technology comes at the cost of money and nanotechnology is the future of cancer cure which is very expensive right now. Although it looks idealistic but I appreciate vipul's concept. You may find it informative

http://blogs.plos.org/speakingofmedicine/2012/11/20/first-international-collaborative-analysis-of-cancer-research-funding-by-icrp/

Regards,

Aamir

Though my answer can be totally hypothetical but i wish to share that- Nowadays we are living in the environment with full of chemicals( in diet, drugs,polishes, creams, paints, clothes and almost everywhere) and Radiation ( may be ionizing or not, electromagnetic etc) which are proved carcinogenics. Cell behavior is as difficult to understand as of human beings.So......................?? But, we must be hopeful and keep trying to conquer such a distressing problem. May GOD help us!

@ Sumayia

The complexity of cancer pathways is depressing, but this does not mean there is no simple answer. Look at my proposal for instance:

http://onlinelibrary.wiley.com/doi/10.1002/cam4.91/pdf

Look at the citations below. Our expectations remain the same for more than century.

“It would be a great thing to be alive in 1947 by which time the cancer menace will have been overcome” (W. W. Keen in his Presidential address before the American Medical Association, 1897)

“I noted with interest that your object is research, both into the cure and causes of cancer. No doubt in the last resort the discovery of the cause is the only certain and absolute means of cure. But I am glad that you have not ignored the practical side of the problem. Remembering the thousands of sufferers from cancer, I feel that if your discussions lead to advance in diagnosis, treatment, or even palliation of the disease, this Conference will have justified and earned the gratitude of mankind” (The late King George V of England, at the opening of the First International Cancer Conference, held in London in August, 1928)

“We live in a roseate atmosphere of breathless expectancy hoping that momentarily the long awaited and comforting announcement will be heard that the cause or cure of cancer has been discovered” (O. H. Wangensteen, 1957)

@ Alexander

The causes of cancer are known for more than three decades, so we cannot say that we are expecting to discover its cause in order to cure it. In addition, the pace of therapeutic progress has been quite independent of identifying causes. What we need the most is good ideas.

@ Rohan

Do we really need to know what causes somatic mutations to treat cancer? Suppose, for instance, that we finally learn that polymerases make errors, and that, statistically, there will be cells harbouring enough mutations as to become cancerous. Does this mean that we have to change the polymerases in our bodies? And the same can apply for the genome: once you have the full genome of your specific cancer sequenced, how much does it help?

Once again, I suggest you to have a look to my paper:

http://onlinelibrary.wiley.com/doi/10.1002/cam4.91/pdf

Cancer will never be fully "cured" as a heterogenous disease the multiple contributions to the presence of cancers will never be completely stopped before they occur. I personally think the focus needs to be on cooperation of the numerous groups and areas of research (cancer-specific as well as general) to work together to collate information and determine where the preventable changes are, as well as regions to target for treatment. Researchers and scientists within cancer research become so involved with one or a couple of specific areas that it is sometimes difficult to consider the interaction of numerous or be humble in that perfecting treatment/prevention towards one mutation or epigenetic change will not "cure" cancer.

Completely agree with you Kristina. Most of the successes in the treatment of various types of cancer are related to clinical observations or chance, not to understanding the biology of disease. The “language” of cells is still not sufficiently learned. To share hot example: after decades of basic and clinical investigation of colorectal cancer (one of the “biggest killers”) it was considered proven that EGFR blocking is helpful for patients with wild-type KRAS exon 2. The paper published in NEJM past week surprisingly suggests that current treatment is probably harmful for the subgroup of patients having mutations in exons 3 and 4! No comment.

@Rohan

The problem with the mouse model is that they have very few granulocytes in their blood. Therefore, trying to create a "cell inflation" in granulocytes would mean to reach non physiological levels of granulocytes in the blood. Moreover, setting the conditions for cell inflation in the mouse would be as difficult as in the primate, with the additional problem that these settings might not be useful for patient treatment. In man, there is enough evidence for negative feedback in the granulocyte lineage, and the main issue is technical: is it possible to keep human granulocytes ex vivo long enough as to observe restauration of the granulocyte pool before reinjection? It's a little bit like gene therapy: the concept is strong, and you should not need to seek a proof of concept in the mouse, the real problem is to find good vectors for human cells. In the case of Cell Inflation Assisted Chemotherapy, a study in the mouse would additionnally generate distinct problems and would unnecessary delay the setting of the method in man.

My proposal for a trial in the monkey in France has not been funded, on the ground that I had no preliminary data (which is circular), but I see no reason why it would not been funded in other countries.

@Daniel

Interesting concept. I guess you a working generally on hematologic malignancy models where it has the potential to succeed. Unfortunately in most of the solid tumors there are several limitations to apply it. There is little, if any problem with tissue regeneration/remodeling in patients with hematologic malignancy, as the complete response to the anticancer treatment usually is not related with severe specific complications from the target organ (bone marrow, lymph nodes) if we exclude severe peripheral blood cytopenias. However if you have complete response in T3-4 tumor of a hollow organ like esophagus, stomach, colorectum it is usually complicated with perforation or bleeding. Other locations as brain and lungs also had similar specific life-threatening complications related to rapid death of a substantial part of the tumor. So the tissue regeneration/remodeling become important part of the treatment strategy in most of the solid malignancies. And the key remains the “cell language” and we are not fluent in it.

„Le monde de la réalité a ses limites; le monde de l'imagination est sans frontières”, Rousseau

@ The "cell inflation assisted chemotherapy" concept is aimed at protecting normal cells, and therefore increasing the therapeutic index of drugs which work by inducing mitotic death. It is obviously not aimed at replacing surgery. But chemotherapy is useful in many solid tumors.

First, let me thank all of you who viewed this question, especially those who contributed answers and discussion points, as well as those, who voted up this question. When I had started medical school 30 years ago, I had a very strong background in biology, physics, chemistry, i.e. I was considered as the best in the last 3 decades in my school (no teacher could overlook honestly a longer period). I decided to go for Medical School, but wanted to become a scientist - not easy in Germany at that time. I thought it would be interesting to find a big challenge, combining scientific interest and "human biology", i.e. medicine and look into cancer research. There was a big hype of monoclonal antibodies, oncogenes and many other things at that time, but medium aged scientists at the German cancer research center where realistic enough to tell me that even decades ago, many of such centers tried to convince the public and the patients that cancer research made such big progress that new cures would be coming soon, but may never come as expected. Now, 30 years later, I see there really is continuing progress, but also many wrong expectations with too many hypes.

Since S. Paget in 1889 published a "seed and soil" concept in metastasis, the world of science really changed. Not only the physics, which at that time was declared almost at the end, since all major problems seemed to be solved, made dramatic developments - unforeseeable at that time.

With the current state of cancer research, I think we are getting really close to much better functioning therapies, even for late stages of cancer. My view is that much of the genetic approaches was waste of money (most may see it different), but with maybe another 10 years of research we can attack many more tumors with a combination of immune therapies and well choosen synergistic compounds. The most striking developments could be made by attacking metastases in the brain of patients. It seems that astrocytes, which usually protect neurons, unfortunately also protect the tumor cells, but there are now ways tested to block the protection and attack dividing tumor cells - with hopefully no harm to the non-dividing neurons. But this is just one aspect of many more making me optimistic for cancer research.

PS: The term "stem cells" and "tumor stem cells" are often used, but not in a good way, but I am convinced that the new therapies will have to focus on the eradication of those cells. So, if the concept of cancer stem cells, tumor-initiating cells and so on really leads to a whole set of new therapies, would this be worth a Nobel prize for the originators of the cancer stem cell theory?

After attending a recent meeting on new cancer targets, I have to admit, I am much more convincet, that "we" (as all cancer-related scientists) will see the future of more successful cancer treatment in probably much less than 100 years. It is so fascinating to see so many approaches, some more than promising results - and still a lot of lack of using the proven and optimized therapies, but just ignored since 40 years.

A major thought is: cancer cells differ not only in the few genetic mutations, but in so many ways from normal cells, for example in proteins and often wrong location of proteins (for example nuclear proteins in the cytoplasm or even secreted), that is will only need a few smart immunologists to cure cancer sooner as we all can think. I guess, this will be a very successful approach to also solve the "antibiotics-resistance" problem, since we only need to teach the immune system new or old tricks, to either stimulate some cells or to stop some immune tolerance, or both. With the proteomics and similar approaches, I am fully convinced it is just a matter of years to cure the first individual patients, which were analazed for their tumors (not genetically, but from their proteins), so within weeks the right, individual therapy compounds will be created for each patient. Unfortunately, I guess, these experimental approaches will take another few years to be provided to the general public. At the end this may be cheaper and more curative than current therapies - but all this is just my personal speculation. Cancer research remains extremely expensive - with no immediate financial reward for scientists.

Hi Robert,

I am a cancer researcher and an immunologist (which does not mean I am an oncoimmunologist), and I am not as optimistic as you are concerning the immunotherapy of cancer. Anti-CTLA-4 and anti PD-1 antibodies are very efficient against certain cancers, but their effect is quite difficult to predict, empirical rather than based on theory. We know that there is a natural immune response to cancers, which we can try to stimulate, but we also know that cancers are genetically instable and that this instability generates mutants that can escape the immune response. How we can make the immune system more aggressive against cancer cells without affecting normal immunity is not clear for me.

For « personalized » cancer medicine, I think that it’s even worse, because combination of drugs will have to be used, in order to avoid selection of mutants, and in this case there will be a problem of unpredictable side effects and almost impossible randomized clinical trials.

I think that we should go back and consider that the unique universal feature of cancer cells is their ability to divide when they should not, and that this feature could be used for therapy, using conventional drugs which induce mitotic death. This is the basis for my proposal of Cell Inflation Assisted Chemotherapy, but I think there could also be other things to do in the same line, exploiting new technologies.

"Cancer research remains extremely expensive - with no immediate financial reward for scientists." There is a financial reward actually, since we are paid for our research. The thing is that we are paid for producing scientific articles using sophisticated technologies, not to cure cancer. As Watson said: "DNA revealed the causes, it may never reveal a cure". Instead, we should envision cancer research as a fight, not as a way to promote our academic career. And getting more and more information on each individual cancer may be as useful as sequencing the genome of Al-Qaeda members to combat terrorism.

Hi Daniel, thanks for your active contributions here! I really share most of your points, although I can not predict how much the theory of tumor stem cells may be critical for your proposed therapeutical approach. I am currently so optimistic since we do not need too much of genetics approaches, we really know that each tumor has some mutations, some of them may even predict the future outcome of a certain therapy approach; I recently learned that --- I somehow left genetics long time ago due to my feelings that this is just for really pragmatic (and not genuine intelligent) people --- genetics really isn't everything in a tumor: many of the protein effects can never be seen on sequencing the whole tumor and patient and compare that. There are often 10,000 different proteins expressed in a tumor cell (compared to maybe 4,000 in a normal cell), and many of such tumor proteins are totally wrong processed, end up in a wrong compartment of the cell or are secreted, i.e. the tumor cell is totally messed up, much more than we could expect from just one or two detected mutations. But this should be used for "easily" attacking all differing tumor cells. This should be more an intelligent than just a stupid pragmatic approach. At the end it won't matter who cures the cancer, the pragmatic or the thinker.

@Jolanta your question sounds like homeopathy... sorry, to say that, please don't waste my topic with such things. You may ask your question as your own question on researchgate, but please not here. You may also ask a homeopathy specialist. I really would appreciate it very much not to have any such "off topic" question here. Thank you.

Jolanta, there is a blog for you:

http://scienceblogs.com/insolence/

Robert, the existence of stem cells does not change the issue, whether they are "true" stem cells (self renewing) or not. It has always been considered that a cancer has a pool of quiescent cells that can be pushed to divide after tumor reduction. This is the reason why chemotherapies must be repeated, and also why it is generally not useful to make intensive chemotherapy if you are bound to use only one cycle, as when you do stem cell transplant.

This question and the answers so far point to the complexity of the problem, the huge growth of data from ongoing studies, and the lack of general solutions to cancer considered as a single disease. By analogy to the previous “golden age of physics” where knowledge provided first primarily more detailed data and complexity then a simplified, unified understanding, I suggest that this is the age of cell biology. If so, then the explosion of cancer biology data and complexity we are seeing now may provide the basis for developing unified and integrated understanding of the various cancers that are currently major causes of death and huge drains on our economy. Biology is more predictable at the molecular level, so I would argue that a quantitative, mechanistic understanding of cancer cells to complement successful systems level complexity will not simply add to the data explosion, but furthermore provide a basis to integrate the information and simplify the complexity in ways directly relevant to improved therapies. In this view by allowing us to increasingly see and define what is going on in cancer etiology and therapeutic responses, cancer research is a key investment that will pay off enormously in terms of reduced deaths, more effective therapies, and fewer hospitalizations.

If I might restate the question as “will we solve the cancer problem” then the answer may be yes or no depending on the level of solution that is considered satisfactory. Given the current cost of development cancer therapies, the cost of cancer in human suffering and lost productivity, and the costs of treatment, I do not think we can afford not to invest heavily in developing the knowledge to do better. Considering that the National Institutes of Health (NIH) calculated the annual cost of cancer in 2008 dollars as $201.5 billion, I suggest that the investment we are making in developing foundational knowledge (although substantial) is still too small and will be cheaper even in the near term than if we stopped research and just used current therapies.

John, if you read what I wrote in this thread, you would see that it is possible to propose general solutions to the cancer problem. And in a more general way, one might consider that even "personalized" medicine is a general solution: identify all the growth pathways in an individual tumor, identify the drugs that can interfere with these pathways, select those that will not act on normal cells, test their action in association, end so on. My opinion is that we should think as fighters, not as academic bureaucrats. So, there are several questions to be adressed:

1) Do we know everythyng we have to know about the enemy, i.e. have we read all the significant papers on cancer? If not, why would we need more information? If we have not read all the good papers on cancer and still we are asking for new information, this may reflect the fact that we are paid for producing information, not to cure cancer.

2) Do we need to know everything before acting? Must the chess player know in what wood is the bishop before moving it?

3) Are the animal models used for fundamental research the best for pre-clinical trials?

There has been a lot of money spent on gene therapy in mice, whereas it was obvious that the problem for use in man was to design vectors adapted to human cells. But experiments in mice lead to publication. Pre-clinical studies in cancer would much better benefit from collaboration with veterinarians treating big animals, but this would require to change the way researchers are evaluated.

Is everything healthy in cancer research?

Nearly 50 years since war on cancer was declared, declarations of victory remain a distant prospect. Here, six cancer researchers assess the lie of the land...

https://www.timeshighereducation.com/features/everything-healthy-cancer-research