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Science & Vie: Cancer treatment remains a challenge… Why?
Eric Solari: Because it’s an incredibly diverse disease. Recall that cancer corresponds to the mass of abnormal cells that have received mutations [légères modifications au niveau de certains gènes, ndlr] allowing them to multiply quickly and promiscuously. The problem is that these molecular abnormalities vary not only from patient to patient, but also from organ to organ, types of cancer at the level of that organ, and even within the same tumor! In addition, they change over time. In short, a tumor is not a single cluster of all identical cells, but several types of cells that are constantly transforming. Under these conditions, to be effective, the treatment must be able to affect not one type of tumor cells, but several.
Hence the difficulty in finding effective therapy for all tumors and all patients.
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S&V: Still, fewer people die from this disease today…
ES: Yes. While some cancers, such as pancreatic and brain cancers, remain difficult to treat, the 5-year survival rate for patients combined has increased from 20% before World War II to 60% today. And it continues to grow.
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MORE THAN 2000 YEARS OF STRUGGLE
4 Art. pr. Zh.-K.
The Greek physician Hippocrates gave the name “carcinoma” (derived from crabs) to progressively fatal tumors. According to the doctor, the disease is caused by the retention of moisture and black bile.
With the invention of the microscope and anesthesia, scientists associate cancer with a cluster of cells that can be removed from the body. The first cancer treatment was born: surgery.
The beginning of the 20th century
The discovery of X-rays and later radium prompted French doctors to propose a new type of treatment: radiation therapy. It consists in irradiating the tumor to fragment the DNA of its cells and thus destroy it.
The beginning of the 1950s
American Cyanamid launches thiotepa, first chemotherapy. This treatment uses synthetic chemical molecules, cytotoxic substances administered intravenously.
With the advent of imatinib, oncology is entering the era of precision medicine. This therapy is designed to treat tumor abnormalities identified by genetic analysis.
The first immunotherapy is allowed in France. This involves the introduction of monoclonal antibodies (ipilimumab) capable of “awakening” the patient’s immunity inhibited by cancer cells.
Hyper-personalized therapy approved in Europe for the treatment of some blood cancers: CAR-T cells.
The patient’s immune cells are genetically modified to specifically attack the tumor.
S&V: What does that have to do with it?
ES: progress on all fronts of cancer research: in basic research that has led to a better understanding of how cancer arises and develops; in therapeutic research, where new methods of treatment are being developed; and in research on early detection and diagnosis of cancer, knowing that the earlier cancer is detected and treated, the better the chance of recovery.
S&V: Have the treatments themselves changed much?
ES: Yes, very much. Over the past two decades, thanks to tremendous advances in genetics and increased access to rapid DNA sequencing tools, we have entered the era of precision medicine, also known as personalized medicine, which consists of offering therapies that best match a person’s biological profile. patient and his tumor mutations. At the moment, this medicine is essentially based on two recent classes of treatment that have significantly improved the treatment of certain patients: targeted therapies, which aim to specifically block certain processes in the appearance or dissemination of tumors; and immunotherapy based on monoclonal antibodies [un type de protéine, ndlr], which aims to “wake up” the immune system tamed by the tumor to destroy it itself.
S&V: What are the current challenges in cancer research?
ES: There are three main ones.
Continue to study the thousands of biological and genetic mechanisms by which cancer originates, develops, and resists, to better tailor treatment to the disease and patient, and to discover new actionable therapeutic targets. It is also better understood why immunotherapy treatment is not effective for all patients – for example, only 20-40% of patients with metastatic melanoma respond to it; this is to identify predictive biomarkers of response that allow better selection of patients who may benefit from this type of therapy. Finally, to develop new anticancer treatments that are effective in as many patients as possible. In this regard, researchers identify several promising directions (see following pages) .
S&V: What will oncology look like tomorrow?
ES: It has to be more and more personalized. On the one hand, thanks to the development of new treatment methods that allow to adapt the treatment to the patient and his tumor; but also through the creation of databases listing the genetic, protein and other characteristics of tumors and patients being treated. Analyzing this data with the help of artificial intelligence should help us have a global view of the patient and his cancer and thus personalize treatment as much as possible. If we hope to one day cure all cancers, moving in this direction is critical.