I agree that we all have our biases.  My bias is that we need to move away from unilateral causality (genotype to phenotype) and targeted therapies to understanding cancer as a systemic disease.  Yes, certain genotypes can increase risk for certain types of cancer but one of the precursors of cancer is genome-wide epigenetic changes, indicating that multiple systems are involved.  The microenvironment changes gene expression on an ongoing basis.  The p53 tumor supressor gene has more than 10 different functions depending on the microenvironment.  That is why diet, carcinogens, etc., are so important.  With trillions of cells in the body and continuous turnover, we get mutations on a regular basis.  These are usually caught by DNA repair mechanism that repair strand breaks, base-pair mismatches and insertion / deletion mistakes; or by apoptosis, which id programmed cell death that happens when a cell starts to malfunction; as well as anoikis and immune cells that target and kill cancer cells. There is also a system of bioelectric currents stemming from ion channels in cell membranes and  microtubules within cells that are important in cancer initiation and progression. Cancer is not a disease of single cells, it is a disease of that results when the informational organization within and between cells and tissues breaks down.  As burden on the defense systems increases, the system's ability to respond appropriately to new onslaught weakens.  It's as if the body reaches a point of bifurcation where a tumor forms and co-opts the very mechanisms that previously defended against it (e.g., macrophages).  Targeting a single pathway when so many are involved (e.g. Akt signaling, Notch signaling, Hedgehog signaling, RAS signaling, Wnt signalling, etc., etc.), simply does not make sense. The current paradigm focuses on killing cells and is based on the same type of thinking that we use with antiobiotics to kill invading bacteria.  However, tumor cells are part of our own bodies, not foreighn invaders.  Killing them makes us sick - which is why chemotherapy is so devastating.

So what is the best treatment?  Currently that depends on the type of cancer.  But in general, I think we need a new paradigm that re-programs the body's own defense mechanism so that it can cure itself.

Your question is a very difficult one, because each researcher in this field thinks that his or her line of work and investigation is the more promissing one. And usually they believe this until the day they die. When you have invested all your lifetime in a certain line of research is because you do believe it is the more promissing one.

So if I have to answer your question, considering that I am strongly biased for what I said above, I think that the pH paradigm in cancer may be highly promissing.

Best regards.

Tomas 

Hi, 

Yes, every researcher is biased to his or her field, However, I think the cancer research is moving toward personalized medicine and combination of different antitherapeutic  approaches.  

I wish there was a simple answer, but unfortunately there is not.  I do believe the trend towards personalized or precision medicine is our best bet.  Each cancer, while it may share characteristics with other cancers, is completely distinct, so there is no one size fits all treatment.  With that said, great advances are being made in immuno-based therapies and precision medicine.

With the exception of hematological cancers there was no real progress in cancer therapy in the last 50 years or so. A new approach has been suggested by Thomas Seyfried ("Cancer as a metabolic diesease") based on the Warburg effect. The basic assumption is that cancer is a metabolic disease, the metabolic problem beeing damaged mitochondria. Since cancer cells are not able to metabolize fat it is mandatory to keep glucose levels as low as possible, Glucose shouls only come from gluconeogenesis. This ketogenic diet is a non toxic approach which in my opinion is very promising. First clinical studies have been performed with astonishing succes.

I am sorry to disagree. A lot of progress in cancer have been made in the last 50 years. I also disagree with the keyogenic diet. There are no sound proofs that favour it.Now if you mean a calorie restrcted diet instead of a ketogenic one, in this case I may agree.

I agree that we all have our biases.  My bias is that we need to move away from unilateral causality (genotype to phenotype) and targeted therapies to understanding cancer as a systemic disease.  Yes, certain genotypes can increase risk for certain types of cancer but one of the precursors of cancer is genome-wide epigenetic changes, indicating that multiple systems are involved.  The microenvironment changes gene expression on an ongoing basis.  The p53 tumor supressor gene has more than 10 different functions depending on the microenvironment.  That is why diet, carcinogens, etc., are so important.  With trillions of cells in the body and continuous turnover, we get mutations on a regular basis.  These are usually caught by DNA repair mechanism that repair strand breaks, base-pair mismatches and insertion / deletion mistakes; or by apoptosis, which id programmed cell death that happens when a cell starts to malfunction; as well as anoikis and immune cells that target and kill cancer cells. There is also a system of bioelectric currents stemming from ion channels in cell membranes and  microtubules within cells that are important in cancer initiation and progression. Cancer is not a disease of single cells, it is a disease of that results when the informational organization within and between cells and tissues breaks down.  As burden on the defense systems increases, the system's ability to respond appropriately to new onslaught weakens.  It's as if the body reaches a point of bifurcation where a tumor forms and co-opts the very mechanisms that previously defended against it (e.g., macrophages).  Targeting a single pathway when so many are involved (e.g. Akt signaling, Notch signaling, Hedgehog signaling, RAS signaling, Wnt signalling, etc., etc.), simply does not make sense. The current paradigm focuses on killing cells and is based on the same type of thinking that we use with antiobiotics to kill invading bacteria.  However, tumor cells are part of our own bodies, not foreighn invaders.  Killing them makes us sick - which is why chemotherapy is so devastating.

So what is the best treatment?  Currently that depends on the type of cancer.  But in general, I think we need a new paradigm that re-programs the body's own defense mechanism so that it can cure itself.

We can cure the early stage cancers (breast, colorectal, gastric) with surgery +/- CT/RT.

So what is the best treatment? Early diagnosis

Within the medical profession there at least two groups; one to support prevention , the other to look for diagnosis and treatment. As  public health minded people, we must emphasize:

1. Avoidance of exposure to risk factors and health promotion. This point has been mentioned by Sarah above

2. The need for effective early discovery of cancer

3. On time treatment. Surgery is one of the best choices for many solid cancer.

I agree with Sarah assumption. What we can do presently is to carefully monitoring the disease evolution by liquid biopsy components (CTC, cfDNA, exosomes, stromal products, etc) and adjust the treatment continuously both during the acute phase of treatment and remission, after closing the primary therapy. That means probably a maintainable therapeutic support according  to disease evolution

Added on 4 October 2017

Yes, I am.   I surely have presented the best strategy so far to cure cancer.   I have published three anticancer papers about the Japanese Edible Fucoidan derived from the brown alga Mozuku grown at the seashore around the Noto peninsula, Ishikawa, Japan (please see files; Anticancer Res (from Greece), HepG2 Fucoidan (from Greece), and Rat DEN Np-Fucoi (from India)).   Fucoidan is actively transported without any digestion (please see file; JCB Fucoidan active transport (from The Netherlands)). 

Further, fucoidan is also expected to cure prion diseases (please see file; "Feed by Measure" published from India). 

Metastasis or metastatic cancer seems to be important.   We have found that HCC is induced by HIV-1 and HCV, and Neuraminidase of FluA or NDV is important to die early.   It seems that the metastasis seems to be occurred by infecting other organs by cancer cells containing virus or by direct infection of viruses. 

I have found that pancreatic juices of pancreatic cancer patients' have c.a. 100,000-fold increased lipoamidase/BSSL activity.   This increased gene expression of pancreatic lipoamidase seems to be induced by HIV and HCV.

Fetal hepatocyte Hc has Lipase member I/Membrane-associated phosphatidic acid-selective phospholipase A1-beta at 3.7 μg/mg of cell protein, and has Env polyprotein/Envelope glycoprotein gp160 (HIV-2) at 2.9 μg/mg of cell protein and Genome polyprotein (HCV) at 2.2 μg/mg of cell protein, respectively (total viral protein is 5.1 μg/mg of cell protein).

Hepatoma HepG2 (grown without fucoidan) has Lipoamidase/CEL/BSSL at 15.0 μg/mg of cell protein, and has Envelope glycoprotein gp160 (HIV-1) at 15.8 and Genome polyprotein (HCV) at 7.8 μg/mg of cell protein, respectively (total viral protein is 23.6 μg/mg of cell protein).

Healed HepG2 (grown with fucoidan) has Lipoamidase/CEL/BSSL at 7.4 μg/mg of cell protein, and has Protein Nef (HIV-1) at 0.8 and Genome polyprotein (HCV) at 1.9  μg/mg of cell protein, respectively (total viral protein is 2.7 μg/mg of cell protein).

Therefore, pancreatic cancer may also be induced by HIV and HCV by estimation from our PDMD data. 

Possibly surgery or chemotherapy or radiotherapy or combination of these is effective.

Obituary for she, the great mathematician has appeared in the current issue of the Current Science a journal published in India from last 100 years. For details there is article by Prof. SAMEEN AHMED KHAN; see the link

http://www.currentscience.ac.in/Volumes/113/05/0982.pdf

There is no easy answer. Classical  therapy methods have limited help. This fact  is probably related several factor. Carcinogenesis is very complex and uses several different pathways. In the future,  target oriented therapies which hit  significant pathway focus will be used more effective.