Why don't we cure cancer?

Interview on World Cancer Day - Why haven't we defeated cancer yet?

When the federal government proclaimed the “National Decade against Cancer” last week, Health Minister Jens Spahn attracted attention. He said: "Others go to the moon, we want to defeat cancer." He said that he would consider cancer to be defeatable within one to two decades. However, experts consider the target to be unlikely.

In an interview with the RedaktionsNetzwerk Deutschland, Arnold Ganser, Director of the Clinic for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation at the Hannover Medical School (MHH) talks about the progress in research and new therapeutic approaches.

Mr. Ganser, what is easier: To fly to the moon or to defeat cancer?

Both are extremely difficult. When three people want to fly to the moon, thousands of people are working in the background. If we are to conquer cancer, we will face non-stop problems that affect millions of people. If we assume that every cancer is different in every patient, then we have a problem that will never be completely solved.

What Makes Cancer So Complicated?

Cancer always arises at the genetic level. In the case of leukemia, there are usually around ten genes in each patient that are altered in the malignant cells. There are hundreds in breast cancer or kidney cancer. It is then extremely difficult to find the mutation that is primarily responsible for the development of cancer. In addition, one does not know exactly what caused the genetic change. That could have been sheer coincidence. The older you are, the greater the likelihood that several genetic changes will come together. This explains the increase in the risk of cancer in old age.

Prof. Dr. Arnold Ganser. Source: Philipp von Ditfurth

So there will never be an all-encompassing cure - one drug for every type of cancer imaginable?

No, that's utopian. Therapy has to be specific. With a few exceptions, however, we will probably never find a mutation that is primarily responsible, which can always be attacked directly and which then makes the cancer disappear.

What progress has been made in treating cancer in recent years?

For example, new drugs have been used to activate the immune system against cancer cells. In many types of tumors, the patient's immune cells are paralyzed by the cancer cells. This paralysis can be neutralized with medication in the so-called checkpoint inhibitor therapy - and the body's own immune cells become active again. You can already see great successes in lung cancer or black skin cancer.

What development do you currently have the greatest expectations?

Some tumor cells have a genetic change in what is known as the apoptosis apparatus, which means that they no longer die. Then, of course, the tumor tissue gets bigger and bigger. There are now approaches that intervene in this process and ensure that the cells die again - just like normal cells. Medicines that have been around for around two years are very helpful in treating lymph node cancer, for example.

There is also a hype around the world about genetically modified immune cells, or CAR-T cells. The patient's own immune cells are genetically activated against malignant cancer cells. This allows the immune system to be controlled even more specifically and prevents important healthy cells from being hit. This therapy is highly effective. But because each patient gets their own processed cells, it is still incredibly expensive at the moment.

So will cancer be treated more and more personalized in the future?

Yes. However, we must not forget that the detection of tumors can also become even more specific. That you can see even better where in the body what type of tumor cells are hidden. Medicines can then be brought to these locations in a targeted manner.

We are talking about expensive therapies, some of which cost several hundred thousand euros. In contrast, many cancers could be avoided.

If we think about how we can best spend our money, then it is certainly not for increasingly expensive therapies. The most efficient would be prevention, for example through education programs against smoking, through the avoidance of environmental toxins. This would also save patients a lot of suffering: not having a tumor is better than having one, even if one is lucky enough to have been cured.

Also read: Hundreds of thousands of cancer cases would be preventable

By Anna Schughart / RND