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Pursuing cancer elimination one cancer type at a time

By Jo Willey, journalist and former Daily Express Health Editor whose work also appears in the Daily Mail, The Mail on Sunday, and The Sun
Published 25 January 2021

For so long, curing or eliminating any cancer has seemed like nothing more than a pipe dream. But that is starting to change. Advances in our understanding of tumour biology and how they’re triggered, diagnostics and a new era of targeted cancer immunotherapy treatments mean that dream is now starting to become a reality.

When Roger Bannister broke the four-minute mile barrier in 1954, he achieved what runners had been striving to do since 1886. Just 46 days later his record was beaten and, since then, more than a thousand others have done what for so long had seemed an unconquerable feat.

But that’s the thing about breakthroughs. It takes just one momentous push for the barrier to be breached, for the impossible to become possible and the possibilities to expand and accelerate.

Scientific breakthroughs come from constantly learning and building on what others have done and we are now at a stage in history where our understanding of diseases and how to diagnose, treat and even prevent them has never been greater.

This century has seen a revolution across science, technology, digital, data and genomics which is propelling scientists ever-closer to what has long been a Holy Grail of scientific and medical endeavour - curing cancer. This ever-expanding knowledge has led to a raft of remarkable innovations, tools and treatments which have brought the complete elimination of one form of the disease - cervical cancer - within reach.

“The successful elimination of cervical cancer needs a global approach, and we need to be able to address the entire spectrum of the disease from prevention to detection to treatment.”
Dr Yvonne Lin-Liu

“Women are often a key pillar of many families and key contributors to society and cervical cancer often affects them in the prime of their life which is why eliminating this disease is so crucial,” says Dr. Yvonne Lin-Liu, Senior Medical Director, Roche, who is also a practicing board-certified academic gynecologic oncologist in San Francisco.

 

The patient perspective

Cancer can cause a great deal of suffering for those affected and their loved ones. We all need to join forces to prevent this suffering.

This devastating disease claims the lives of about 340,0001 women globally every year, a death toll made even more shocking because cervical cancer is almost 100% preventable and treatable when detected early. But the fight is on. In November 2020, 194 countries committed to the WHO’s goal of eliminating cervical cancer by implementing a vaccination, screening and targeted treatment strategy which could cut new cases of the disease by 40% and five million related deaths by 2050.2

It is an ambition being supported by World Cancer Day 2021 under this year’s theme of “Together, all our actions matter” which is shining a spotlight on defeating cervical cancer.

The testing toolbox driving diagnosis
 

Unlike the majority of cancers, the main cause of cervical cancer is well known with almost all cases (99%)3 caused by the human papillomavirus (HPV) which infects most men and women at some point in their lives. The majority of infections clear on their own but for some women they persist and over time can progress into cervical pre-cancer or cancer.

Over 100 countries4 have licensed one or more HPV vaccines, with 74 having it on their national immunization programme for girls, and 11 countries also for boys.5 But vaccination alone isn’t enough. Elimination will only come from a comprehensive, triple-intervention strategy of vaccination, advanced screening and diagnostics, and the early treatment of cancerous lesions.

“We want to start with prevention, before we even get to diagnosis. We are seeing a shift from simply treating a disease to trying to detect it early and prevent it from becoming established in the first place.”
Dr Eslie Dennis

However, nearly 90%6 of annual cervical cancer deaths occur in low and middle-income countries with poor healthcare systems which women often struggle to access. This is why Roche has added HPV screening to its Global Access Program implementing cutting-edge diagnostic tests and lab systems in regions of greatest need.

Portrait shot of Dr Eslie Dennis, VP, Medical Affairs Roche Tissue Diagnostics
Dr Eslie Dennis

“A woman dies from cervical cancer every two minutes. That is unacceptable,” says Dr Eslie Dennis, VP, Medical Affairs Roche Tissue Diagnostics. “This is the first cancer that we are so close to being able to eliminate and we have the right tools to make this a reality.”

The Pap test, introduced in the 1940s, revolutionised cervical cancer screening, slashing rates in countries using it by at least 65%. But its limitations mean many cases might be missed. Now, a new era of innovative technologies is transforming cervical cancer diagnostics and early intervention, accelerating the move towards personalised healthcare.

This sophisticated next-generation molecular, cellular, biomarker and tissue-based testing toolbox provides powerful information to healthcare professionals. It is transforming patients’ lives across their entire journey by identifying those with high-risk HPV infection, triaging those with positive HPV tests by identifying cell changes which indicate a higher risk of cervical disease and testing to give an accurate diagnosis of cervical pre-cancer.

“We now know a lot more about how cancer develops, what spark triggers the whole tumour development cascade and what is driving the disease at a molecular level,” says Dr Lin-Liu. “We are also moving away from ‘trial and error’ care and one-size-fits-all medicines to treatments tailored to an individual patient.”

Targeted treatments and the holistic integration of care
 

The elimination of cervical cancer can be achieved because of the powerful integration of diagnostics, pharmaceuticals, data and the evolution of personalised healthcare. Having all areas of expertise under one roof, Roche is uniquely positioned to follow this holistic approach to support the WHO goal of putting all countries on the path to cervical cancer elimination by 2030.7

But elimination will not be possible if the cancer continues to be diagnosed late or advances, which is why new treatments that can improve outcomes while ensuring an acceptable quality of life for women receiving them must be developed.

The past decade has unlocked the power of immunotherapy, transforming treatment and patient care across multiple cancer types. A growing understanding of tumour biology and learnings about the cancer immunity cycle has revealed more than one way to harness the immune system.

Portrait shot of Dr. Yvonne Lin-Liu, Senior Medical Director, Roche Pharma
Dr Yvonne Lin-Liu

By identifying where the immune system fails in each patient’s tumour, the right treatment combinations which can provide long-term, transformative benefits to patients can be pinpointed.

We are now at an exciting turning point in history where the potential benefits of combining immunotherapy with chemotherapy, radiotherapy, targeted medicines or other immunotherapies to help restore a person’s damaged immune system to attack their own cancer, are becoming a reality. These combinations are being explored to see how they can help improve outcomes for people with cervical cancer.

Experts from Roche are also collaborating on the imCORE Network, one of the largest networks of industry-academia collaboration focused on accelerating cancer immunotherapy research to find a cure for cancer and transform patient lives.

“The difference in side effects between contemporary cancer immunotherapies and traditional chemotherapies is like night and day,” says Dr Lin-Liu. “With the global impact of cervical cancer, we want our drugs to deliver transformative anti-cancer benefit with a tolerability that allows a woman to maintain some semblance of normality.”

The data revolution driving a new era of patient care
 

Transformative advances in science and technology have created increasing amounts of information and data being captured, stored and analysed across many different cancer types. More is now being learned than ever before about how cancers manifest, how they affect patients and how those people will respond to treatments.

“To pursue a smarter, more efficient mission against cancer, we are turning cutting-edge science into new, innovative diagnostics and medicines to prevent the preventables, cure the curables and focus our precious healthcare resources on increasing our scientific understanding to develop evermore effective treatments for those cancers we cannot prevent or cure.”
Dr Eslie Dennis

Roche has partnered with Flatiron Health on one of the largest, most-representative, anonymised clinical data sets now being used by cancer researchers worldwide to accelerate the pace of drug discovery and approval.

This information explosion has also resulted in daunting levels of complexity in healthcare, with the growing levels of medical information complicating timely treatment decision making and disease management. But digital decision support tools are harnessing this powerful data to collate patient information, simplify processes and standardise treatment decisions by oncology care teams.

According to Dr Dennis: “Cancer care is complicated – it requires large, highly trained, multidisciplinary teams to optimally deliver. It is essential to have robust and accurate diagnostics and treatment decision tools to give oncologists confidence in their treatment decisions to get the best possible patient outcomes.”

One united step forward taking us closer to defeating cancer
 

Eliminating cervical cancer is a medical and societal ambition which cannot be solved in isolation and will need strong collaborations across a wide range of partners to achieve it.

“Cervical cancer is the only cancer we have the tools in place to eliminate in my lifetime. But it will take a paradigm shift by governments and every stakeholder to achieve it,” says Dr Dennis.

But, just like a world of possibility was opened up by Bannister breaking the four-minute mile, there is hope that eliminating cervical cancer will be the breakthrough which triggers a new era of pursuing elimination of cancer one type at a time.

“Maybe we will not cure all cancers. Some may become a chronic disease that we can contain. But others we are working to eliminate, starting with cervical cancer,” says Dr Dennis. “The integration of diagnostics, pharmaceuticals, data and private and public efforts is absolutely essential in this quest, saving lives and bringing hope to patients and society.”

End-Illustration

References

  1. World Health Organization. Factsheet: Cervix uteri [Internet; cited 2021 Jan 21]. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf
  2. World Health Organization. News: A cervical cancer-free future: First-ever global commitment to eliminate a cancer [Internet; cited 2021 Jan 21]. Available from: https://www.who.int/news/item/17-11-2020-a-cervical-cancer-free-future-first-ever-global-commitment-to-eliminate-a-cancer
  3. World Health Organization. Health topics: Cervical cancer [Internet; cited 2021 Jan 21]. Available from: https://www.who.int/health-topics/cervical-cancer#tab=tab_1
  4. World Health Organization. News: Major milestone reached as 100 countries have introduced HPV vaccine into national schedule [Internet; cited 2021 Jan 21]. Available from: https://www.who.int/news/item/31-10-2019-major-milestone-reached-as-100-countries-have-introduced-hpv-vaccine-into-national-schedule
  5. World Health Organization. Immunization, Vaccines and Biologicals database, as of 9 August 2017 [Powerpoint; cited 2021 Jan 21]. Available from: http://www.who.int/entity/immunization/monitoring_surveillance/VaccineIntroStatus.pptx
  6. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. [Internet; cited 2021 Jan 21]. Available from: https://gco.iarc.fr/today
  7. World Health Organization. News: A cervical cancer-free future: First-ever global commitment to eliminate a cancer [Internet; cited 2021 Jan 21]. Available from: https://www.who.int/news/item/17-11-2020-a-cervical-cancer-free-future-first-ever-global-commitment-to-eliminate-a-cancer

Tags: Science, Innovation, Patients, , Cervical cancer, Personalised Healthcare, Diagnostics