Oncology’s Darwinian Dilemma

” “No cancer patient should die without trying immunotherapy” is a refrain in oncology clinics across the country right now. A treatment consisting of antibodies that awaken the immune system to attack cancer, immunotherapy carries far more promise than chemotherapy, and it has considerably fewer side effects. Since the FDA’s first approval a decade ago, it has revolutionized cancer care. Consider Stage IV non-small cell lung cancer. Twenty years ago, when the only option was chemotherapy, oncologists could tell their patient, with almost 100 percent certainty, that they would not be alive in two years. Today, miraculously, many patients with Stage IV lung cancer are alive five years after diagnosis — and some are even cured.

But the rub is that this immunotherapy revolution applies only to a narrow set of patients. Some benefit, but the majority do not. And patients who are cured constitute an even smaller minority. Why is this? How can immunotherapy cure a 65-year-old, newly retired man of Stage IV lung cancer, restoring the promise of his golden years with his family, but do nothing for the 55-year-old woman whose cancer robs her of decades of life? We do not know. A flurry of research is aimed at trying to answer this question. And what it is uncovering is the sheer variety of lung cancer and lung cancer patients. No two patients with lung cancer are the same. Their tumors have different genetic mutations. Their immune systems behave differently. We are even learning that their metabolisms can affect responses to treatment. And, astonishingly, emerging evidence suggests that the billions of bacteria that colonize their skin, lungs, and colons play a role in how they respond to cancer treatment….’

via LA Review of Books.

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