Cancer is no longer a death sentence these days. In the future, the chances of those affected could improve significantly – due to advances in existing therapy and new methods that are being used more and more frequently.
A diagnosis of cancer still comes as a shock to those affected. Around 500,000 people in Germany are confronted with it every year. However, the prognosis for cancer has improved significantly in recent years and will continue to do so in the future. Already today, two-thirds of people who are diagnosed with cancer have a realistic chance of surviving the disease.
New developments in cancer therapy are also responsible for the positive trend. Doctor Susanne Weg-Remers explains what they are and how they work in the FOCUS online interview. She heads the cancer information service of the German Cancer Research Center (DKFZ).
FOCUS Online: What are the reasons for the better prognosis for cancer?
Susanne Weg-Remers: There are several, early cancer detection and diagnostics have improved, but above all there are a number of new therapeutic approaches. There have been particularly great advances in recent years in targeted therapies and immunotherapies. Before we talk about them, however, it makes sense to place them within an overview of cancer therapies—they’re not the only thing used to treat cancer.
Do you mean the already established cancer therapies?
Weg-Remers: If you have received a cancer diagnosis, the following questions are initially decisive for the choice of therapy:
Therefore, in addition to the histological examination of a tissue sample, cancer diagnostics always also includes spread diagnostics. It is therefore examined whether the tumor is limited to the organ in which it was discovered or whether it has already metastasized to the neighboring lymph nodes or even to organs that are further away.
Therapy is planned accordingly. Is the base always the operation?
Weg-Remers: In the case of local tumors, surgery is the central therapy option. Removing the tumor can prevent the disease from spreading further.
In addition, there are a number of therapeutic approaches to prevent a recurrence, i.e. a recurrence, after the tumor has been removed. This includes
The goal of therapy is healing.
What about advanced cancer?
Weg-Remers: Sometimes tumors have already metastasized when they are first diagnosed. Or there is a relapse after successful initial treatment: either a recurrence develops in the already affected organ or distant metastases occur. Only in rare cases can the goal of therapy still be healing. It is now a matter of stopping the disease as far as possible, gaining years of life and maintaining the quality of life.
The five therapy pillars are also used here – surgery, radiation, chemotherapy, targeted therapies and immunotherapies.
Susanne Weg-Remers is a doctor and head of the cancer information service at the German Cancer Research Center. Those affected and those interested can find answers to all questions relating to cancer there. The medical staff of the publicly financed service impart knowledge, help with orientation and support with difficult decisions. They answer around 30,000 individual inquiries by telephone and e-mail every year – up-to-date, scientifically sound and independent. The medical team at the Cancer Information Service will answer individual questions on the free number 0800 / 4203040.
So the same therapy planning as for a localized carcinoma?
Weg-Remers: However, with a different focus, systemic therapies play the main role here, i.e. therapies that affect the entire body, such as chemotherapy, targeted medication or immunotherapies. Radiation and surgery are of secondary importance here.
In my opinion, this overview is important in order to be able to better classify the individual therapies and their further development.
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One of these developments is targeted therapy, how does it work?
Weg-Remers: It developed out of an ever better understanding of tumor biology. Today we know much more precisely than before what goes wrong so that a healthy cell becomes a cancer cell. There are usually a whole series of biological changes that have to happen for this to happen:
At these four points do the new drugs start?
Weg-Remers: These new properties of the cell control the targeted therapies very precisely. However, these mechanisms are not the same in every tumor. The individual tumors differ significantly from one another, even if the result – uncontrolled, destructive growth – is always the same. Targeted drugs are therefore only effective if they can control specific target structures that must also be present in the respective tumor.
So precise diagnostics determine the success of targeted therapy?
Weg-Remers: Before this therapy, a precise molecular diagnosis of the tumor is necessary in order to find out which target structures are present. Then you know whether you have another option available with the targeted therapy and which drugs you can use.
There are currently a number of different targeted drug groups and new drugs are approved every year in order to be able to target even more different target structures.
Also interesting:
There are also advancements in immunotherapies such as cancer vaccination. What can we expect from this in the future?
Weg-Remers: There is a whole range of different approaches to immunotherapy that are currently being tested in studies. A group of active ingredients that has already been approved and arrived in the clinic includes the so-called checkpoint inhibitors.
These are drugs designed to override the brakes on the immune system. Cancer cells can camouflage themselves from the immune system or inactivate immune cells. These mechanisms drive checkpoint inhibitors.
A completely different approach via the immune system is CAR T cell therapy. Here, the patient’s own immune cells are removed and modified in the test tube so that they can better recognize the tumor cells. They are then returned to the person concerned. It is a completely new therapy that has to be prepared individually for each patient, with great effort. In studies, this treatment has proven itself for a small number of selected patients with certain blood or lymph gland tumors. It is only offered in certain cancer centers.
Will this change in the future, for example if it turns out that some tumor cell characteristics occur in many patients and the immune system can therefore focus on them without the need for time-consuming removal and return?
Weg-Remers: The decisive factor in CAR T cell therapy is that the patient’s own T cells are removed and modified in such a way that they only attack the cancer cells and not the healthy cells. It doesn’t work with T cells from another cancer patient or a blood donor. That remains laborious.
In principle, this is a cancer vaccination? What else can we expect from the mRNA cancer vaccine in this context?
Weg-Remers: The term “cancer vaccination” summarizes various approaches with which the body’s own immune system is activated in order to take action against the tumour. CAR-T cell therapy and mRNA technology are both included.
The mRNA technology originally comes from cancer research and was used during the pandemic to quickly produce the corona vaccines. In cancer research, however, we are not yet advanced enough to be able to use this technology to combat carcinomas in clinical routine on a broad basis.
Developing a vaccine against cancer is a far more complex task than vaccinating against the coronavirus. We need to find out what immune system targets, called antigens, a given patient’s cancer cells have that an mRNA vaccine could potentially be effective against.
Studies are currently underway, for example on skin and colon cancer.
Weg-Remers: There are various approaches that are now being tested in studies. For example, preparations are made that contain several different mRNAs that produce antigens that are particularly common in tumor cells in melanoma or colon cancer.
What about classic cancer therapies? Are there also further developments there, for example in radiation therapy?
Weg-Remers: Yes, the devices are getting better and better in order to work in a more targeted and gentler way. An example: There are now devices that are motion-controlled. When a tumor is irradiated, for example in the chest cavity, the movement caused by breathing and heartbeat can result in healthy tissue in the lungs and heart being exposed to the radiation. Newer devices focus the radiation depending on movement. In this way, the tumor tissue can be irradiated in a targeted manner and healthy tissue that would otherwise get into the beam path through a heartbeat or breathing can be spared.
In addition, nuclear medicine agents have been developed in recent years that can be used, for example, in advanced prostate cancer. These drugs transport radioactive substances in a very targeted manner directly to tumor cells, which are then destroyed. It is therefore a combination of targeted therapy and radiation.
And what about chemotherapy in the future? It does severe damage to cancer cells, but often leads to sensitive side effects because healthy cells can also be attacked?
Weg-Remers: Chemotherapy is an established pillar of cancer treatment, but there are also new developments here. For example, the preparation of the drugs is modified in such a way that the active ingredients are brought to the tumor tissue in a targeted manner. There are other new approaches in the local application of cytostatics, for example in the treatment of liver or peritoneal metastases.
Surgery forms the basis of cancer therapy. They are also changing, sometimes using artificial intelligence, always with the aim of taking radical action against cancer without touching healthy tissue?
Weg-Remers: The new surgical techniques are becoming ever more gentle on the patient. Many interventions can already be carried out minimally invasively, for example in the case of colon or prostate cancer. For the operation of brain tumors, for example, robots have been developed whose technology allows the surgeon to control the surgical instruments particularly finely and precisely.
What importance do you give to the individual treatment options for future cancer therapy?
Weg-Remers: The five pillars remain. However, the cancer therapy of the future will become more and more individualized. We believe that molecular diagnostics will continue to improve and become more detailed, and that more and more patients will benefit from targeted, individualized therapies.
