One of the big questions that in 2023 science is still trying to answer is when cancer can stop being that word that, when pronounced, leads to think about death. Part of that challenge has begun to retrace. Somehow, the 43,<> doctors gathered these days at the McCormick Place convention center in Chicago, try to contribute their grain of sand to test that response.
Clarín arrived at the Congress of the American Society of Oncology (ASCO), which takes place until next Tuesday, after a three-day stopover in Oxford, Massachusetts, where today it aims to create something where there was nothing before, through molecular and genetic developments with more chances of targeting the tumor.
What has been temporarily left behind in the circuit through the United States is largely the future but, timidly, begins to outline the present. Not without a load of uncertainty: how to know if these revolutionary therapies will be compatible with people's pockets. That is, the possibilities of access to innovations when the difference between life and death is played between yes and no.
Meanwhile, the first major therapeutic option continues to be chemotherapy, amortized and cheaper, but paradoxically adds its share of drama to the scenario: the shortage of some of these medications in the United States and other countries in the region – such as Peru and Colombia – due to supply problems.
The picture is not simple: on the one hand, expensive drugs that really require financial creativity in order to bridge the chasm that often separates futuristic laboratories from the millions of patients who need access. On the other hand, "cheap" drugs whose patents expire and consequently the laboratories that manufactured them tend to run out of business because they cease to be economically profitable.
Advanced lung cancer seen through X-rays.
There is a red light on at ASCO in that sense, which underlies the 2,900 scientific works – a record – that show these days the new therapeutic trends for different types of cancer. The alert was evident from the beginning of the congress: authorities issued new clinical guidance to better treat patients with gastrointestinal cancer amid shortages of cisplatin and carboplatin.
These are two chemotherapeutic agents, today extremely scarce and at the same time essential to treat a variety of gastrointestinal cancers, including that of the esophagus, pancreas and colon. The guide provides five general principles that describe reasonable medication substitutes and how to prioritize patient needs.
ASCO officials also warned that they will soon issue supplemental guidance for the treatment of breast, genitourinary, and lung cancers, and another endorsed by the Society of Gynecologic Oncology for the treatment of cervical and ovarian cancers.
In our country the issue is not alien, since the Argentine Association of Clinical Oncology had warned about this issue last year, when a shortage was also noted. "It happened with cisplatin and carboplatin, but it was never clear to us what had been the cause of that shortage," Claudio Martín, secretary of the Association, which is currently attending the Chicago congress, told Clarín.
Today's scenario is not a scenario that affects therapies in Argentina (almost all chemotherapy administered in the country is produced in national territory), although it is difficult to know if in the future a similar situation may generate anxiety again. In the United States, in addition, the issue of expired patents has been added to a production problem at a plant in India.
Medical checkups and annual lung cancer screenings. Photo: Shutterstock.
This is how this dual challenge of cancer has become evident at ASCO, perhaps more than ever: to ensure that the latest advances permeate to the less advantaged sectors of societies, while at the same time finding ways to keep the production of generic medicines attractive even after patents expire, to ensure an adequate supply.
Within the first part of the question, that is, the area of novelties, good news appears such as the confirmation of the benefit of immunotherapy for survival in advanced ovarian cancer; or the fact that radical hysterectomy (surgery to remove the uterus, cervix, part of the vagina, and a large area of ligaments, tissues around these organs, and sometimes the ovaries, too) may not be necessary for low-risk, early-stage cervical cancer.
To this are added other good results against breast cancer, from adapting the therapy according to the response obtained, which allows to avoid chemotherapy in treatments that now resort to it by default; and the announcement of better results against prostate cancer, with darolutamide as the protagonist of one of the presentations at ASCO: already approved and marketed the drug, the positive impact it is having in real life was analyzed.
The study was conducted on 875 patients in the United States and the proportion of those who progressed to metastatic castration-resistant disease was lower with darolutamide (17.7%) compared to enzalutamide (28.3%) and apalutamide (27.8%). In addition, the adverse effects that forced to abandon the treatment were also lower: 30.4 percent, against 28.3 and 28 respectively.
Clarín discussed some of the most urgent challenges currently posed by cancer with one of the "godmothers" of darolutamide. In the conversation with Christine Roth, head of the Strategic Oncology Business Unit at Bayer, the question resurfaced: how close or far we are from achieving sustainable solutions against cancer.
Christine Roth, Head of the Strategic Oncology Business Unit at Bayer.
"It depends on the type of cancer. There are some cancers that are already considered chronic diseases today: some of the blood cancers and some solid tumors, but one of the ambitions for the future is to find the right combinations and sequences of treatments that allow patients to live longer than they can consider or say that cancer is a chronic disease." Roth said.
From that side of the counter, the reality seems more optimistic: "Today, with the advent of cell therapies, where we are manipulating and engineering cells to be injected into the body to fight cancer, we have stories of very successful patients, who have not only managed to turn cancer into a chronic disease, but the disease has been eradicated. That's the promise of cell therapy, but today that promise is real for a small group of cancers."
What a pharmaceutical company like Bayer focuses on in this complex scenario in order to reach a satisfactory response. Roth: "The types of tumors we prioritize are those that have a large number of patients, but not enough treatments, or that are not ideal. That's where we start. Then we look for what it is that we are uniquely qualified to do. Take lung and prostate cancer. We can make molecules that other companies wouldn't even dream of."
Lung and prostate cancer are types of tumors that can often use small molecules by mouth instead of chemotherapy or immunotherapy. "There's a lot of research and development about what's going to happen tomorrow. At the end of the day we have to see what will be the issue of greatest impact, to achieve the best for patients, "closed Roth, not if before drawing a horizon of enthusiasm: "The patients of the future will have safer and more effective medicines, they will be treated earlier and earlier and will use more direct drugs to attack those tumors, Because these patients will be healthier and will need to be treated for much longer."
Chicago. Special Envoy