Vim & Vigor - Fall 2020 - GMC - 26

ancer treatment is better today-and often
designed just for you-because research keeps
unmasking the disease's secrets. In the 1940s,
no one really understood what caused cancer,
and the only treatments were to cut it out or
burn it out (via radiation), explains Richard L. Schilsky, MD,
executive vice president and chief medical officer of the
American Society of Clinical Oncology. "So many cancers
for which we had either no therapy or no effective therapy,
we now have treatments that have converted these cancers
into almost chronic illnesses that people can live with over
long periods," Schilsky says. He tells us about the impact of
discoveries over the decades in how cancer grows and hides.

How vast has the improvement in treatment been from
the 1940s when chemotherapy
began to today-the span of
one lifetime?

FALL 2020 VIM & VIGOR

What was treatment like
before chemotherapy?

Schilsky: The general belief in the early

Richard L. Schilsky, MD,
executive vice
president and chief
medical officer of the
American Society of
Clinical Oncology

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years of cancer treatment was the more surgery, the better. It led in many cases to very
extensive, disfiguring surgeries [in hopes of
catching any cancer cells around a tumor] that
we now have learned are largely unnecessary,
because many cancers already will have spread
throughout the body very early in the course
of the disease. So there was a paradigm shift
that led to the development of what we now
call adjuvant chemotherapy [medicine after
initial treatment to keep cancer away], which
has been highly effective [because it targets
the cancer throughout the body rather than
just at the original site].
The 1980s were kind of the doldrums in
terms of developing new treatments. What
was happening then was the discovery of what
makes cancer tick. And from that point on, the
whole field of what we now call precision medicine really took off. We now know that cancers
have many ways of hiding from the immune
system or inactivating the immune system. We
have a whole new generation of drugs that are
able to activate the immune system, unleash
it, help it find the cancer. They are producing
long-lasting remissions for many patients.

ILLUSTRATION BY MONICA HELLSTRÖM

Schilsky: There are cancer types that when
I was in my training in the late 1970s we considered to be almost hopeless, like metastatic
malignant melanoma, a skin cancer that once
it spread in the body, there was essentially
no effective treatment for it. Today, there are
multiple effective treatments. People with
metastatic melanoma can live for years, and
some of them might even be cured by some of
the modern immunotherapies.
Kidney cancer is another example of a
cancer where there were never any effective
drugs. Now there are something like 10 or
12 effective FDA-approved therapies. Breast
cancer was transformed by the development
of drugs like Herceptin, which for those
women who have HER2-positive breast cancer,
as it's known, became a life-prolonging and in
some cases a curative therapy.
It's important to point out that all of these
advances, by and large, have been the result
of basic research that has enabled a much
deeper understanding of what causes cancer than we ever had back in the 1970s and
before. In the early years of cancer treatment,
we basically looked for drugs that killed
cancer in a test tube or killed cancer in an
animal model. It was kind of one-size-fitsall. All patients with a given kind of cancer

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typically got the same kind of chemotherapy
regimens and so on.
If you flash-forward 40 years, it's very different. We have a much deeper understanding
of the basic biological mechanisms that cause
cancer. Because of that understanding, we're
able to develop much more targeted, highly
specific, less toxic and more effective treatments that work better, work for longer periods of time and have fewer side effects.
We recognize that cancer is not one disease;
it's not even dozens of diseases. It's hundreds of
diseases or maybe even thousands of diseases,
as you begin to break it down. Personalized
treatment doesn't work perfectly; it doesn't
work for every cancer type or for every patient.
But when you consider that there are very few
cancer patients now who do not have multiple
therapy options available to them-some of
which can produce remissions that last for
years-it's a very different and much more
hopeful landscape.

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Vim & Vigor - Fall 2020 - GMC

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