As the American Society of Clinical Oncology conference preps to open this week, AstraZeneca asked cancer experts what they think about mentioning the C-word—in this case, cure—in talking about cancer treatment.
The panel of cancer experts, oncologists, researchers and patient advocate leaders offered many perspectives and personal examples, but not surprisingly, didn’t come to a simple consensus.
Still, the hypothetical exercise shines a light on drug development advances—and the fact that some cancer cures are moving within reach. What will happen when drugs adopt, or at least consider using, the word “cure” in talking about cancer therapies?
“In one week’s time, we’ll have the opportunity to learn about some of the latest and most important advances in the oncology space and within that context, on the eve of the latest practice-changing (advances), it’s perfect that we’re having this conversation,” said David Fredrickson, AstraZeneca executive VP of its oncology business unit.
Cristian Massacesi, senior VP and head of AstraZeneca's late-stage oncology development, related the story of his own uncle, who was diagnosed with late-stage cancer, facing a life expectancy of only a few months. But thanks to advanced therapies, his uncle is not only still alive six years later, but also cancer-free.
“Can we say he is cured? Probably we cannot. The science and the current data don’t tell us that for sure,” Massacesi said, adding that as a researcher at AstraZeneca, his mission now is developing treatments, like those for his uncle, that will “provide meaningful time to patients" but also ones "ultimately that can lead to cure.”
While the not-yet-cure words in use now by drugmakers, physicians and even patients may vary—remission, cancer-free, stable disease or even chronic condition—AstraZeneca’s panelists did agree on other issues. Especially the industry changes necessary to begin using the word cure legitimately.
Screening—earlier, more comprehensive and more of it—topped the list for many. Another important change is the need for ubiquitous and fair access across the full scope of cancer care.
“Do you really cure a disease if you have people who are left behind with it? ... The thing that keeps me up at night is does everyone benefit from the clinical trials we’re doing. Will everybody have access?” said Craig Emmitt Cole, M.D., who heads clinical research in hematology/oncology and multiple myeloma at the Michigan State University Breslin Cancer Center.
Elizabeth Franklin, president of the Cancer Support Community, agreed, adding, “There is actually no such thing as cure without equity. Period. … I don’t want to see a system of haves and have-nots, and I worry that when we see this rapid innovation, it’s going to benefit a certain group in our society. I want to make sure that when we talk about cure we are absolutely talking about cure for all.”
Patient perspectives, shown in a short video of opinions displayed onscreen, varied from those who said the word cure offers “false hope” and has “no place in clinical” discussions to another patient who said yes to the word because it “gives hope.”
Surgeon scientist Jonathan Spicer, M.D., medical director of the McGill Thoracic Oncology program, said that for many of his patients, cure is at the top of their agenda, although as he acknowledges “obviously it’s more complicated than that.”
He talked about a recent lung cancer surgical patient who was in her 30s. He successfully removed her tumor and offered the additional positive news that her tumor had a genetic indication for which there are targeted treatments.
“It was so important for me to tell her that she was cured, and it’s a very difficult conversation to have,” he said. “I don’t know whether she’ll have a recurrence or something down the road … There’s a lot on the line.”
As the panel moderator, Ron Winslow, a medical and science reporter formerly with The Wall Street Journal, chimed in—and perhaps the crux of the dilemma: “There is this sort of ‘you’re cured, but.’ There’s always that ‘but’ hanging in the air."
And that is the reality of the use of the word cure in cancer—at least for now.