Exploiting Cancer’s Tactics to Make Cancer a Manageable Chronic Disease

Abstract

The history of modern oncology started around eighty years ago with the introduction of cytotoxic agents such as nitrogen mustard into the clinic, followed by multi-agent chemotherapy protocols. Early success in radiation therapy in Hodgkin lymphoma gave birth to the introduction of radiation therapy into different cancer treatment protocols. Along with better understanding of cancer biology, we developed drugs targeting cancer-related cellular and genetic aberrancies. Discovery of the crucial role of vasculature in maintenance, survival, and growth of a tumor opened the way to the development of anti-angiogenic agents. A better understanding of T-cell regulatory pathways advanced immunotherapy. Awareness of stem-like cancer cells and their role in cancer metastasis and local recurrence led to the development of drugs targeting them. At the same time, sequential and rapidly accelerating advances in imaging and surgical technology have markedly increased our ability to safely remove ≥90% of tumor cells. While we have advanced our ability to kill cells from multiple directions, we have still failed to stop most types of cancer from recurring. Here we analyze the tactics employed in cancer evolution; namely, chromosomal instability (CIN), intra-tumoral heterogeneity (ITH), and cancer-specific metabolism. These tactics govern the resistance to current cancer therapeutics. It is time to focus on maximally delaying the time to recurrence, with drugs that target these fundamental tactics of cancer evolution. Understanding the control of CIN and the optimal state of ITH as the most important tactics in cancer evolution could facilitate the development of improved cancer therapeutic strategies designed to transform cancer into a manageable chronic disease.

A Seven-Gene Signature to Predict Prognosis of Patients With Hepatocellular Carcinoma

“…It has been consensual that cancer may never completely go away. However, with the appropriate approaches, we can turn cancer into a chronic disease that can be closely managed ( Beck and Ng, 2014 ; Afrasiabi et al, 2020 ). In this scenario, an evaluation of OS is considered meaningful for the long-term treatment of the cancer patient.…”

Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review

“…Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness [ 1 - 3 ]. Some cancers, such as chronic leukemia and ovarian cancer can be managed, sometimes described as “controlled,” in a state where the cancer does not grow but is also not cured for months or years.…”

Of magic bullets, multiple targets, and artificial intelligence. Are we all set to defeat cancer?

“…So, the patient does not die with cancer, but lives with cancer. 7 The quality of life has been greatly improved in terms of nutritional, psychological, and physical performance, but we must humbly admit we are at present still unable to cure cancer, with few exceptions. 8…”