Today, how far are we from conquering cancer?

Two scientists from the United States and Japan won the Nobel Prize in Physiology or Medicine for their original results in the field of cancer immunology.

Today, how far are we from conquering cancer?

Humans have been fighting cancer for more than a hundred years. Calmly speaking, there are not many staged victories, and immunotherapy is probably one. American scientist James Ellison and Japanese scientist Benjamin won the Nobel Prize in Physiology or Medicine on October 1 for his original discovery in the field of tumor immunity.

Immunotherapy has opened the third revolution in cancer treatment and is of epoch-making significance. So, when the two scientists won the Nobel Prize for the original research on immunotherapy, how far are we from curing the tumor?

Immunotherapy has given birth to a group of "super lucky ones"

Scientists generally believe that there are three revolutions in the field of cancer treatment, the first is chemotherapy and radiotherapy, targeting tumor differentiation and division; the second is targeted therapy, which is aimed at genetic mutation; the third is the immune test site that won this Nobel Prize. It is aimed at immune escape.

American scientist Ellison has studied a protein that acts as a "brake pad" for the immune system. He realized that loosening this "brake pad" can re-release the potential of human immune cells to attack tumors, and this basic research Developed as a new treatment.

Japanese scientist Benjamin discovered a protein PD-1 of immune cells and proved that this protein acts as a brake, but the mechanism of action is different. Therapies based on this discovery are very effective in combating cancer.

The original discovery of the two scientists brought a series of revolutions in the field of cancer over the past decade. With the attention and participation of more scientists, a series of exciting achievements have gradually been promoted in the clinic.

The reason why immunotherapy is exciting is that: First, it can treat advanced cancer that has been widely metastasized, and advanced cancer patients who have failed all standard treatments have achieved good results after using immunotherapy. Secondly, immunotherapy has " Survival smear effect." Patients who respond to immunotherapy have a high chance of high-quality long-term survival. These late-stage cancer patients who have been sentenced to death are called "super survivors."

In patients with melanoma, lung cancer, and kidney cancer, immunotherapy has created a number of "super survivors," and many of the patients initially treated have survived for more than 10 years. This "tailing effect" is the biggest difference between immunotherapeutics and chemotherapy or targeted drugs.

Ye Sheng, a structural biologist and associate researcher at the Institute of Biophysics of the Chinese Academy of Sciences, said that based on the PD-1 system discovered by Ben Youyou, some broad-spectrum anti-cancer drugs have been approved for marketing, and the effect is very good. The mode of action of these drugs is very different from traditional anticancer drugs: traditional drugs usually act directly on cancer cells, while antibody drugs are directed against PD-1 or PD-L1 bound to them, through the binding of antibodies to them. Preventing these two proteins from recognizing and binding each other prevents the cancer cells from inhibiting immune T cells.

In short, the logic of immunotherapy is to mobilize the body's own immune system to defend against foreign enemies. Professor Wang Liwei, director of the oncology department of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, said that the most important feature of immune anticancer drugs represented by PD-1 is that it does not distinguish tumor types. Nearly 30% of patients in Europe and America have benefited.

To use the right medicine for the right patient

However, it is too early to think that immunotherapy can overcome the tumor. Experts say that although immunotherapy opens a new door to cancer treatment, each method has its own specific clinical indications and indications, and there is no panacea for all diseases.

"At present, the effective rate of tumor immunotherapy for solid tumor treatment is 10% to 50%." Professor Zhang Jun, Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, said lung cancer as an example, responding to PD-1 immunotherapy. About 50% of patients have a long-term survival chance, but for all unscreened patients, the survival period is only extended by an average of three months.

Zhang Jun mentioned that negative regulators do play a very good role in tumor treatment, but it does not mean that immunotherapy can be used as a universal treatment. Currently, the US Food and Drug Administration (FDA) approved PD-1 monoclonal antibody is mainly targeted at patients with solid tumors with missing mismatched gene repair.

Overall, the side effects of immunotherapy are smaller than traditional chemotherapy and targeted drugs. However, 5% to 10% of patients may have more serious immune-related reactions, such as thyroid inflammation, immune pneumonia, immune enteritis, immune hepatitis or even immunomyelitis. These problems may be fatal if they are not detected in time. Therefore, some researchers have also warned that with the prevalence of immunotherapy, grassroots doctors should be familiar with the treatment of side effects of immunotherapy, which is crucial.

"From this perspective, we need to use the right drugs for the right patients at the right time." Zhang Jun said that it is critical to help patients choose the most appropriate treatment by screening biomarkers.

Improving efficiency is the next step in research

If the tumor is likened to a puzzle, now humans may have spelled out the six or seven frames of this picture, but there are still many unsolved mysteries in the middle. Only by splicing the "tumor formation-transfer-development" puzzle, can we finally find a breakthrough point to cure the tumor.

Immunotherapy has its own specific methods and indications, and more clinical trial data on precision medicine and immunotherapy are needed to clarify. In 2015, it was called “the first year of immunotherapy”, and a large amount of clinical data has not yet been obtained.

For example, studies have found that in most patients with solid tumors, the effectiveness of PD-1 inhibitor alone is not high, ranging from 10% to 25%. How to improve the efficiency of immunotherapy is the top priority of the next step.

Some studies have suggested that immunotherapy may require the combination of chemotherapy and radiotherapy, targeted therapy and other cancer treatment methods. A one-shot tumor solution is called a "medicine," but it doesn't seem to be realistic. How to use drugs together is also the next topic for scientists.

The new direction of cancer treatment pioneered by Nobel Prize winners this year has won “overtime” for many patients struggling on the edge of death. This "overtime" may only be a few months, but it may fulfill the wish of a lifetime. The medical civilization of mankind is not only progressed from the extension and efforts of these months and months. To be sure, the Nobel Prize is far from the end on the road to turning cancer into a chronic disease.

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