Cancer treatments

Like many people, I have seen loved ones and friends suffer from cancer. I am sure that for  most of us,  the most dreadful words we can hear from our doctor say is: “I am sorry but you have cancer.” 

I was, therefore, very interested in the latest edition of the Economist magazine when they featured a special section on “Treating Cancer.”It says that cancer is the world’s second leading cause of death after heart disease – 8.8 million in 2015. Around 75 percent of cancer deaths are in low and middle income countries like the Philippines and the number of cases has increased by 33 percent because of ageing and population growth. However, I was also surprised to read that in America, 67 percent of cancer patients will survive for at least five years.

The article answered two questions I have always wanted to ask. The first is about chemotherapy; and the second is about the new branch of therapy – immunotherapy – that seems to have gained popularity in the medical world.

On chemotherapy

“Though few cancers can be cured with chemotherapy on its own, many can be set back a long way and controlled for quite some time. Chemotherapies, like radiation therapies, are often used to mop up the cancer left over when primary tumors have been excised.

One problem with chemotherapy is that cancers can become resistant to it. Most cancers are genetically heterogeneous, because the cells accumulate new mutations as they grow. Some of these mutations can make the cells less susceptible to the chemotherapy. As treatment continues, such cells become more numerous, and as they divide they go on to accumulate mutations that make them even more resistant – the cancer evolves resistance to chemotherapy as an infection can evolve resistance to antibiotics. That is why chemotherapies are now often used in combination. It is harder to evolve resistance to two or three drugs at the same time.” 

Chemotherapy also sometimes causes side effects like fatigue, hair loss, mood changes and nausea. Some have long term effects like damaging the heart, the nerves and fertility. The severity of the side effects can  vary from person to person. Some side effects, like nausea, can also be treated with secondary drugs under certain circumstances.

Immunotherapies

There is a promising new class of treatment known as immunotherapy – the “treatment of diseases by inducing or enhancing or suppressing an immune response.” Although immunotherapy is observed to work in many cancers, research across all types of cancers tried so far, only about 20 percent respond to this new approach. It seems to be still in the early stages of being a real cure. 

According to the Economist article: “Though immunotherapy is still new, it has already radically shifted the treatment and research landscape. A wide range of combinations is being tested in the hope of improving patients’ responses. A trial combining Opdivo and Yervoy in malignant melanoma has shown tumors to shrink in 60 percent to 70 percent of patients ( although it causes serious side effects). Dr. Wolchok says it is not yet possible to calculate the median survival time in the trial population – because more than half of the patients are still alive...This enthusiasm may lead to wasted efforts, and even delay progress. But there is no doubt that immunotherapy will from here on be a key part of treatment for a growing number of cancers. Perhaps the most telling measure of its success is that some oncologists have started to complain, quietly, of a shortage of specialist doctors. Patients keep coming back instead of dying.”

Costs of cancer treatments

Cancer treatments today are very expensive. It is hoped that as more advances in medical research are made, treatments will become cheaper. Here is the cost evaluation of cancer treatment by the Economist: “Novartis’s new therapy costs $475,000. Genome editing treatments seem likely to be the most expensive cancer treatments the world has ever seen.“

There are several reasons for the present high cost. The most obvious is that research and development costs are very high. The new treatments, for example, require a pharmaceutical company to make the appropriate “antibodies.” These are more expensive to make than the smaller molecules used in older therapies. Hopefully, generic versions will someday be discovered that will be cheaper.

However, the Economist also said : “But the overwhelming factor [ for the very high prices] is that in America, the world’s largest market for drugs, prices are set by what the market will bear. When life-saving drugs are available from only one or two providers, high prices are given. That is why pharma companies have piled into oncology over the past decade. They see a market which, by 2025, is forecast to be worth $45 billion to $100 billion a year.”

But, there is also a warning regarding these new cancer treatments. “The immune system’s complexity means that it will not always react as doctors hope. Some treatments will prove less effective than at first they seemed. This is a particular problem for cancer drugs, which tend to be approved after comparatively small trials. A recent study of 36 drugs approved between 2008 and 2012 found that it did not help patients live longer. The price of these drugs ranged from $20,000 to almost $170,000 per patient.”

Hopefully, the world can unite and declare a War on Cancer. 

Creative writing classes for kids/teens and adults

Young Writers’ Hangout for Kids & Teens on Oct. 7 and Oct. 21 (1:30-3pm/independent sessions). Turning Ideas Into Books  for Adults with Karina Bolasco on Nov. 11, 2017 (1:30pm-4:30pm).All sessions are at Fully Booked Bonifacio High Street.  For registration and fee details text 0917-6240196 or email [email protected].

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