In the wake of the sensation
There is no breakthrough in oncology
Vasily Vlasov, "Trinity Variant"
More recently, almost all the news media spread the news: "British Israeli scientists have invented a universal cure for cancer." We asked the Vice-President of the Society of Evidence-Based Medicine Specialists, MD, Professor of the Higher School of Economics to comment on the news Vasily Vlasov.
Humanity is waiting for news. If there are none, then they are invented. Moreover, in order to show that this is not just news, but what kind of news, they use words like "innovation" or, even worse, "disruptive innovation". Or even game-changing innovation. It seems that where progress is most obvious – computer processors and displays obviously delight us year after year – these words play less than in oncology.
Forty years ago, a pessimist noticed that if you read cancer journals, you get the impression that oncology can do a lot now and soon all forms of cancer will be curable. Of course, this is a false impression. The reason for this is several circumstances.
Scientists like to report successes and don't like to write about failures. How, for example, can I report for a grant with a message about the failure of the project? Difficult. Therefore, the results are presented as the achievement of an important result, even if not the one that was declared. Even if doctors want to write that their new treatment plan turned out to be no better than the old one and send the article to the journal, it is likely that the editor will reject it. It's not interesting to readers. So, it harms the reputation of the magazine. Readers want a magazine that publishes "breakthrough innovations", where there is a source for optimism.
Big problems for oncology are created by its next importance. In the XX century, there was an epidemiological transition – people began to die not in childhood and not from infectious diseases, but in old age, from chronic diseases. In the middle of the twentieth century, it looked like an epidemic of coronary heart disease. With a further increase in the life expectancy of people, the proportion of those who survive to malignant neoplasms of older age is growing. An increase in cancer mortality with increasing life expectancy is a sign of progress. A good sign. That is why the tasks set in the plans of the Russian government to reduce the overall mortality and mortality from cancer, on the one hand, are logical, and on the other – contradict each other. The task of reducing cancer mortality is the task of reducing overall mortality, a big reduction.
Mortality from stomach cancer (per 100 thousand population of both sexes), standardized by age, in a number of countries. Source: Global Burden of Disease Project.
A large reduction in cancer mortality could be achieved if effective means of prevention were known. Alas, only some forms of cancer are highly dependent on living conditions, nutrition and infections. Accordingly, with improved living conditions, reduced transmission of infections associated with cramped living, eating habits, mortality decreases. Thus, over the past 25 years, the death rate from stomach cancer has decreased twice in countries with high mortality (Japan, China, Russia, Kazakhstan, Ukraine and a number of others not shown in the figure).
The second important feature of oncology is the special fear that people experience before diseases, generically called "cancer". These are very different diseases in their origin, course, and treatment possibilities. Some of them do not affect not only life expectancy, but even its quality. People live and die with these forms of cancer, but they don't die from them. People are afraid of other oncological diseases – leading to the death of most patients, such as melanoma and lung cancer. Death from them is usually slow, accompanied by painful extinction. Humanity was not ready for this kind of death. It was only at the end of the twentieth century that developed countries began to pay attention to the importance of creating human conditions for the dying. What, for example, in the USA in the 1980s was categorically denied by society - suicide with the help of a doctor or other assistant – is now becoming a legal and approved practice. In some developed countries, the practice of assisted suicide or euthanasia (the difference is that with euthanasia, the procedure is performed by a doctor) has become legal and very common. In other countries, such as Russia, attention is already being paid to the development of palliative care, but discussions about suicide and euthanasia are suppressed and even banned. Russia in this sense corresponds, for example, to the UK of the 1970s.
For these reasons – the high mortality rate from cancer and its subjective importance – attention to the development of cancer prevention and treatment tools is very high. The most expensive surgeries, the most expensive devices (for radiotherapy) and, of course, the most expensive medications. Alas, only some solutions are effective and only in relation to some tumors. Here is an example of an idea that was supposed to radically change the treatment of solid tumors. Drugs that suppress the proliferation of cancer cells (chemotherapy) are used alone or in addition to surgical removal of the tumor. In the 1950s, an idea was expressed: chemotherapy should be carried out even before surgery. Then the size of the tumor will be smaller, its potential for metastasis will be smaller. At the end of the twentieth century, this idea was put into practice on a massive scale. In particular, this option was appreciated by surgeons operating in hard-to-reach places where the tumor is adjacent to vital organs. At the same time, research was actively conducted. If in the early 1990s only a few articles were published per year, then in 2012-2017 - one and a half thousand articles (estimated from the MEDLINE database). Gradually, information about the effectiveness of such treatment was accumulated. It turned out, for example, that in relation to breast cancer, despite the impression of surgeons that the removal of the tumor is more effective, neoadjuvant therapy does not lead to an increase in the life expectancy of patients.
Tremendous success has been achieved in chemotherapy in some areas. The most famous of them is the development of the drug imatinib for the treatment of chronic myeloid leukemia in cases where the patient has a so–called Philadelphia chromosome. This variant was discovered in 1960, and chronic myeloid leukemia became the first cancer for which a genetic substrate was discovered. Decades of research into this phenomenon have led to the development of a drug that, since 2001 (in the USA), gives most patients with chronic myeloid leukemia effective control over the tumor for many years. For some, taking the medicine means complete or almost complete preservation of working capacity and quality of life. With imatinib, a wave of hopes has risen for the development in the near future of a variety of drugs designed to treat individual cancer variants. This wave of optimism has transformed into global hopes for "personalized medicine", when everyone suffering from a chronic disease takes a special medicine that corresponds to the characteristics of the disease and the person. This HYPE is mainly used to give optimism to financing programs and has little basis in the form of the results of effective developments.
That is why – because of the enormous importance of malignant tumors and the very limited possibilities of their treatment - every message about the development of new treatments is met with keen interest. The other day, newspapers around the world told about the MuTaTo technology created by Israeli scientists (the name comes from multi-targettoxi – "multi-purpose toxification", not to be confused with the name of the music service). The authors said that in a year they will be able to present a remedy for a complete cure of cancer. That's right: "a complete cure for cancer". This phrase alone is enough to dismiss the news about mutato as not trustworthy: cancer is a combination of very different diseases, and it's just not serious to talk about one remedy. If we add the promise that the medicine will be effective for everyone, from the first day and with almost no side effects, then the assessment of the news will be more like this: shameless chatter. Yes, of course, the authors say that their technology is a breakthrough (a disruption technology of the highest order). The essence of the technology, the authors explain to journalists, is the use of peptides to detect malignant cells and kill them. And what do they tell the scientific community? Nothing or almost nothing. The authors reported that they presented the results at three conferences and their presentations went unnoticed. Magazines? The authors "can't afford it" for reasons of time and expense. Strange. Scientists have not seen the results and, of course, do not comment on newspaper interviews. Investors who have to make estimates based on any available information and respond with their money use a very unambiguous assessment: unadulterated bullshit (loosely translated – "pure–proof zvezdezh" - VM). I tend to agree with investors.
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