Go to the Globe and Mail homepage

Jump to main navigationJump to main content

Medicine

Is chemotherapy about to become a thing of the past? Add to ...

When Harvey learned that his melanoma had spread to his lungs in the winter of 2008, he started planning for his death. Despite a down market, he liquidated his stock-market assets to ensure his wife wasn't doubly burdened.

He moved the investment firm in which he is a partner to a smaller space. He didn't take an office - he figured that with his fatal skin cancer he wouldn't live long enough to use it. He hated waste.

"Everybody goes," Harvey (who asked that his surname not be used) said matter-of-factly in the boardroom of his downtown Toronto office.

More than two years later, Harvey, wearing a navy blue suit and tie, is at work on a sunny spring day. Aged 77, he self-consciously pats his thinning scalp. "I used to have a full head of hair," he explains.

Not that he's complaining. In January, Harvey started taking a drug known as PLX4032 in a clinical trial in Philadelphia. If it weren't for those pills - three, vitamin-sized ones in the morning and another three at night - he would be near death.

He points to his chest, where 2.1- and 1.4-centimetre cancers had been found in his lungs. "My tumours," he says now, "are almost imperceptible."

Researchers have made a remarkable breakthrough in the treatment of one of cancer's deadliest forms - about 5,000 Canadians were diagnosed with malignant melanoma last year.

Harvey's new cancer therapy is tailored to a genetic mutation called B-RAF, which affects roughly 60 per cent of patients with melanoma. And it's shrinking tumours, many by more than a third.

It's a significant shift for a disease that had not seen progress for four decades. And it illustrates the power of what is called personalized medicine.

Instead of developing drugs that destroy fast-growing cells - normal as well as cancerous ones, a method that seldom works with later-stage cancer - scientists are now looking to slow or stop the genetic mutations that fuel cancer's growth. And the approach is tailored to patients depending on individual mutations.

It's all about providing the right therapy to the right patient, improving care and even saving money.

CAN A FUTURE CANCER CRISIS BE AVERTED?

At no time has a breakthrough ever been more needed. Unless progress is made in controlling cancer, an estimated 27 million new cases will be diagnosed worldwide by 2050, creating a huge economic and health-care burden.

As a result, research is happening at a dizzying rate: The International Cancer Genome Consortium announced that it is working to catalogue the genetic changes of the 50 most common cancers - 500 genomes from each cancer type.

That makes it the most ambitious biomedical research effort since the Human Genome Project (the international effort to map human genes that was completed in spring, 2003).

For a wretched disease with an equally wretched prognosis (most patients with Stage-4 melanoma die within a year after the cancer has spread), the PLX4032 treatment is a first. Patients at death's door, some unable to get out of bed or hold down food, are now working, shopping and enjoying life - an average of six months more of it.

"We're more than one and a half years out now from the initial studies," said Keith Flaherty, a medical oncologist who led the first trial of the drug PLX4032 while he was at the University of Pennsylvania.

"One and a half years [of survival] in melanoma, is phenomenal. … This is a massive change, to have it under control."

PUTTING THE BRAKES ON CANCER REPRODUCTION

Developing targeted therapies that cause programmed cell death is "our only road forward," according to Dr. Flaherty, who is now director of developmental therapeutics at the Massachusetts General Hospital.

PLX4032 - so new it is not commercially available - is the only targeted therapy for melanoma that works.

But it is not the only targeted cancer medicine. Gleevec turned a potentially killer disease - chronic myeloid leukemia - into a chronic one. Herceptin transformed one of the most aggressive forms of breast cancer into one of the most curable.

Both drugs focus on genetic mutations acquired later in life - ones that are not inborn and are therefore not passed on to children.

These genetic triggers are at the heart of current cancer research. They provide constant signals to cells to reproduce; they are the automotive equivalent to pressing the accelerator in a car. A new drug such as PLX4032 offers the brake.

"We're sequencing a whole genome here. We're going to sequence thousands of cancer-genome tests," said Tom Hudson, president and scientific director of the Ontario Institute for Cancer Research.

"There's going to be a generation of useful tests and drug combinations. In cancer, you don't want to develop a new drug if the target isn't known in advance."

Single page
 

In the know

Most popular videos »

Highlights

More from The Globe and Mail

Most popular