“No self-respecting cancer is just going to be able to be targeted with one drug,” Venook says. “It’s like a whack-a-mole. You block one process in the cancer and something else will take over.”
That’s why Ashworth talks unabashedly, about a cure.
“I think we should be aspiring to cure and saying ‘cure’ much more than we do in what we want to ultimately achieve,” he says. “I think it’s defeatist to think otherwise. People talk about making cancer into a chronic disease, like diabetes. Although a laudable medium term goal, I think that’s a failure of long-term ambition.”
As an example, Ashworth cites advances once dismissed as impossible.
“Stage four melanoma was almost invariably lethal, and yet now a significant minority of patients appear to be long term survivors who may well be cured,” Ashworth says. “That came about because of immunotherapy, and most people didn’t see that coming. “Maybe a cancer very hard to treat, and it may be currently incurable, but that doesn’t mean it’s always incurable,” he says.
The immunotherapy of which Ashworth speaks is a prime example.
Lawrence Fong, MD, who leads UCSF’s Cancer Immunotherapy Program, says that in the past seven years, “cancer immunotherapy has become one of the mainstay approaches for treating cancer now.”
Prior to that, Fong says, “we typically used either chemotherapy, radiation therapy, or targeted therapies—drugs that hit mutations as means for cancer treatment. Those are treatments that we felt would directly kill cancer cells. But what immunotherapy does is it actually relies on the patient’s own immune system to kill the cancer cells.”
“We now have that in the form of antibody treatments that serve to turn on a patient’s immune system response,” he says, “and we also have that in the form of cell therapies where we can actually engineer cells from a patient to go after the cancer cells.”
Fong marvels at how far immunotherapy has come in such a short time. It is now a frontline therapy for major diseases like lung cancer; it is now enough of a “standard of care” that first year medical students are learning about it. “I would never have predicted it would be used for as many cancers as it is now,” he says.
Fong imagines where the field is headed as researchers pursue a Holy Grail of looking at people’s genetics, their immune system, and other factors and developing a “bespoke cancer therapy that integrates different elements that we think would be required for a successful outcome.”
Cancer’s extreme heterogeneity – that it may be several hundred different diseases – has been its best defense against more of the cures that Ashworth and Fong talk about. But on this new frontier of cancer research and treatment, things are changing.
“One way to think about precision cancer medicine – and this new building designed in every way around the needs of patients – is that technologic and scientific advances over the past 15 years have led to an unprecedented understanding of cancer and what can be done about it,” Ashworth says. “As we work toward more cures for more types of cancer, this new understanding means that UCSF can offer patients a level of care that is specific to them as individuals and informed by the most current thinking. UCSF has made a significant contribution to this thinking.”