Are We Losing the Final Fight against Cancer?

Abstract

Despite our increasing understanding of the biology and evolution of the cancer process, it is indisputable that the natural process of cancer creation has become increasingly difficult to cure, as more mutations are found with age. It is significantly more difficult to challenge the curative method when there is heterogeneity within the tumor, as it hampers clinical and genetic categorization. With advances in diagnostic technologies and screening leading to progressive tumor shrinkage, it becomes more difficult over time to evaluate the effects of treatment on overall survival. New treatments are often authorized based on early evidence, such as tumor response; disease-free, progression-free, meta-static-free, and event-free survival; and, less frequently, based on clinical endpoints, such as overall survival or quality of life, when standard guidelines are not available to approve pharmaceuticals. These clearances usually happen quite rapidly. Although approval takes longer, relative survival demonstrates the genuine worth of a novel medication. Pressure is being applied by pharmaceutical companies and patient groups to approve “new” treatments based on one of the above-listed measures, with results that are frequently insignificantly beneficial and frequently have no impact on quality of life.

Prognostic Significance of the Royal Marsden Hospital (RMH) Score in Patients with Cancer: A Systematic Review and Meta-Analysis

“…Cancer is the second most common cause of mortality worldwide, with almost 20 million new patients and over 10 million deaths per year [1]. Despite advances in the diagnostic and therapeutic fields, over 50% of patients with cancer eventually die of the disease [2]. Additionally, the survivors deal with a wide array of morbidities caused by the disease itself, as well as treatment-related toxicities [3].…”

“…The RMH prognostic score, which includes albumin level, lactate dehydrogenase (LDH) level, and number of metastases, was initially introduced by Arkenau et al as a prognostic score to optimize patient selection for phase I clinical trials, often involving highly selected patient groups [7]. They found that patients with a low RMH score (0-1) had a significantly longer median overall survival (OS) of 33 weeks compared to 15.7 weeks for patients with a high RMH score (2)(3). After that, the prognostic value of the RMH score for predicting outcomes was explored for various cancers on phase 1 trial cohorts, as well as a few cohorts from real-world settings [8,9].…”