In some cases, patients like Ms. MacKenzie with cancer that has spread inside their bodies — called metastatic disease — are able to stay alive much longer than previously predicted. Some are cured altogether by new drugs, a reversal of fortune that patients and doctors dared not contemplate just a few years ago. In a growing number of cases, patients with metastatic cancer are not cured but have access to so many treatment options that they are able to leap from one to the next, changing course whenever their cancer becomes resistant to a drug, always staying ahead of their disease.
This is a new paradigm. Until recently, the prevailing wisdom in oncology was that many early-stage cancer patients could be cured, but metastatic disease was almost always incurable. This thinking drove cancer research, treatment and care for decades. Oncologists often threw the kitchen sink at early-stage cancer patients, performing invasive surgeries and administering heavy doses of chemotherapy — which can make patients sick to their stomachs, prone to infection and bald, but can also have long-term side effects including infertility, heart damage, numbness in hands and feet, brain fog and fatigue. The belief was that the only chance to save the lives of such patients was to eliminate the possibility of their cancer’s spreading. Since metastatic disease was usually considered incurable, research focused on early-stage disease. For unfortunate patients who developed advanced cancer, care typically consisted of additional rounds of chemotherapy and palliative approaches. Now there is new hope for many of these patients.
It would be foolish to argue that we have the entire category of cancer in our cross hairs. Cures or long-term survival for certain types of the disease — like pancreatic cancer and glioblastoma, the form of brain cancer that killed Senator John McCain — are still stubbornly out of reach. For people with these and some other forms of cancer, the mortality rate has barely budged in the past 30 years. Researchers are working to change this through more laboratory work and research. More than 800 pancreatic cancer clinical trials are now recruiting patients across the country. And diseases like breast cancer — for which there are many new treatments and more every year — are still lethal for tens of thousands of people per year.
Outpacing cancer is currently within reach only for certain cancers and patients, but the lessons learned on these fronts are gradually being applied elsewhere. This is raising the possibility that at some point in the not too distant future, diagnoses of any kind of Stage IV cancer will dictate patients’ treatment, but not their fate. Or at least that’s the promise for those with access to the most cutting-edge science.
Right now, two relatively new classes of cancer drugs are displacing traditional chemotherapy for many types of cancer and giving metastatic patients, in particular, more time. Many of these advances employ a person’s own immune system to eliminate cancer cells, rather than using chemotherapy or radiation to do the extinguishing. These are modern immunotherapy drugs and antibody-drug conjugates, or ADCs.