2024-01-14 15:00:00
Major therapeutic innovations, more efficient screening tools, better patient support… The fight against cancer continues to score points.
Five-year survival rates improved for 45 types of tumor or cancer you sang out of 59 studied. This is what the National Cancer Institute (Inca) observed by following patients diagnosed between 1989 and 2015. Over the last twenty years, the gains have even been spectacular for leukemia, lymphomas and prostate cancer. Thanks to improvements in screening and treatment, more than 50% of cancers in women and 40% in men are now considered diseases of the good prognosis, that is to say that the chances of survival five years after diagnosis are greater than 65%. However, cancers associated with alcohol and tobacco (esophagus, liver, lung) generally have a poor prognosis, in both men and women, reinforcing the importance of preventing these addictive consumptions.
Detecting a tumor by blood test, immense potential
“More and more tests in development make it possible to detect, in blood but also in urine or sputum, fragments of DNA or RNA produced by cells and to identify if some are in the process of switching to a tumor process”, explains Professor Bruno Quesnel, director of the cancer thematic institute of Inserm and of the research and innovation center at the National Cancer Institute. The clinical potential of this practical and early screening is immense, especially as artificial intelligence will help refine detection algorithms. But the phase of demonstrating the sensitivity, specificity and predictive nature of the tests could be very long. It takes at least five to ten years of clinical studies to prove that a screening test made it possible to identify a precancerous lesion. And thus demonstrate that removing it is beneficial for the person’s health. “There would be no interest in detecting lesions which would not evolve during the person’s lifetime,” explains the researcher. We have even discovered in recent years that many cancers are metastatic very early, generally in the form of isolated malignant cells. and disseminated in various tissues. But they can remain dormant for a long time and ultimately have no effect on the patient’s life expectancy.”
Pediatric oncology has emerged from oblivion
Pediatric cancers (there are more than a hundred) are rare diseases since they represent approximately 1% of all tumors. For a long time, drug manufacturers were therefore disinterested in this narrow and risky market. Since the end of the 2000s, under the leadership of parent associations, American and European regulations have changed. They thus encourage pharmaceutical laboratories, through patent extensions, to carry out pediatric clinical trials if the target mutation of the molecule they are testing in adults is also present in childhood tumors. Today, nearly 80% of childhood cancers are cured, compared to 50% in adults. “Schematically, cancer in adults is a disease of cellular aging, whereas in children it is, on the contrary, developmental tumors, mutations and DNA repair abnormalities which occur randomly during the process of differentiation of cells during embryonic development”, explains Professor Olivier Delattre, pediatric oncologist and director of the cancer, heterogeneity, instability and plasticity unit at the Institut Curie. These pediatric tumors which develop very quickly are therefore more sensitive to treatment than those of adults. But more than half of cured children have lifelong after-effects from their chemotherapy sessions – and especially radiotherapy. The challenge now is to develop less toxic treatments.
Better managed side effects
Making daily life easier with illness has now become an integral part of the care pathway. Symptoms reported by patients have become a field of research in their own right. At international congresses, oncologists present studies on the benefit of acupuncture against hot flashes caused by hormone therapy or dry mouth caused by the rays. They also present the benefits of therapeutic cannabis against nausea and vomiting linked to chemotherapy. “Adapted physical activity and the demonstration of its effect on pain and fatigue – then on overall survival and the risk of recurrence in many cancers – marked a turning point. We can no longer consider supportive care as the icing on the cake since they are part of the treatment which has proven its effectiveness”, says Professor Carole Bouleuc, head of the supportive care department at the Institut Curie, in Paris. Since 2017, psychological support for the person and their loved ones, social support, pain management, fertility and sexuality disorders, counselingdietary and nutritional hygiene et adapted physical activity must be provided in cancer centers. These different treatments could even soon become, for a health establishment, a sine qua non condition for ministerial authorization to treat cancers.
The use of artificial intelligence will intensify
Most medical examinations, x-rays, scanners, mammograms, are today in digital format. The compilation capabilities of artificial intelligence (AI) are therefore already being used to improve the power of screening tools. Which could even, tomorrow, replace the human eye in medical deserts lacking radiologists experienced in the detection of breast tumors for example. “Studies come out every month on new methods of using AI in oncology. But, here again, the obstacle is the demonstration of the impact on survival and on treatment options, underlines Professor Bruno Quesnel . In my opinion, by the time things really come into practice, AI will be the revolution of the next decade.”
Towards organized lung cancer screening
“From the second half of 2024, several voluntary regions will begin to experiment with lung cancer screening,” announces Professor Sébastien Couraud, head of the pulmonology and thoracic cancerology department at CHU Lyon-Sud (Rhône) and member of the research group. work of the Inca on this future device. How to define the quantity and duration of smoking from which this chest scan screening will be relevant? How can we reach the most vulnerable populations, who are both those who smoke the most and those furthest from the health system? This is one of the key questions of the regional experimentation phase, before generalization to the entire territory. Objective ? Detect more lung tumors at earlier stages. Expectations are high because lung cancer is currently the deadliest in France among men and is expected to become the deadliest among women in 2025.
Awakening immunity, the revolutionary strategy
Helping immune cells to better recognize cancer cells and thus destroy them as quickly as possible: the very concept of immunotherapy is a paradigm shift in cancerology. The first to benefit from it is melanoma in the early 2010s, with spectacular results. Since the tumors of the lung, kidney, breast or even recently of the uterus have proven to be particularly receptive to this type of treatment. The principle was taken to the concept of a therapeutic vaccine. It makes it possible to educate the patient’s T lymphocytes (the immune defense killer cells) to recognize fragments of the tumor in order to destroy them and thus greatly reduce the risk of metastases and recurrences. “Therapeutic sequences, that is to say the order in which we use the different options, are also being revolutionized, explains Sébastien Couraud. In a certain number of cases, the fact of using immunotherapy before a surgical intervention – what we call “neoadjuvant immunotherapy” – can destroy the cancer, sometimes completely.”
Sequencing tumors to personalize treatments
HER2, KRAS, EGFR… Oncologists today speak in acronyms. And for good reason, these anomalies or mutations, present or not in tumors, can guide the choice of treatments from the biopsy stage. “In one week, thanks to sequencing techniques, we have the list of known anomalies present in the patient’s tumor. But these are comparable to locks. If we have the right key, it opens the door to the cancer cell. We can then destroy it using what we call “targeted therapy”,” explains Professor Sébastien Couraud. Huge advantage in side effects compared to traditional chemotherapies which act as weapons of mass destruction (including healthy cells), this method of treatment only attacks tumor cells carrying the genetic anomaly aimed. Since the turn of the 2000s, this approach to tumor profiling and the development of molecules associated with each anomaly have allowed considerable gains in effectiveness against certain forms of cancers of the breast, lung, digestive system, blood or more recently of the bladder.
The word is freed, finally…
Nearly 1,200 French people learn their diagnostic de cancer. Today, the disease is a real social subject, to which exhibitions, illustrated albums, series, films, podcasts are devoted… The affected personalities no longer hide it and even publicize the stages of their fight, like the singer Florent Pagny, the actress Clémentine Célarié or sports journalist Matthieu Lartot. Until now, the business world had remained timid in the face of this disease which nevertheless concerns a growing number of workers, on a personal level or as caregivers. Last year, the president of Publicis, Arthur Sadoun, broke the secrecy by revealing his fight against cancer linked to the papillomavirus. Today he intends to change mentalities by rallying the largest international groups to his initiative, Working with cancer.
Avoidable risk factors
41% of new cases of cancer are linked to preventable risk factors. For men, this mainly concerns tobacco (29%), alcohol (8.5%) and alcohol.unbalanced diet (5.7%) while among women, these are tobacco (9.3%), alcohol (7.5%), overweight and obesity (6.8%). (IARC 2016)
“Our goal is to better understand female cancers”
3 questions to Professor Anne Vincent-Salomon, pathologist at the Institut Curie in Paris, head of the future Institute for Women’s Cancers.
Why this need for a dedicated institute?
Around 20,000 women die from cancer each year. Metastatic breast cancer remains dramatically fatal with a 12% five-year survival rate for triple negative form. Mortality from cervical cancer is worsening even though we have an effective prevention tool with vaccines against papillomaviruses. We cannot resign ourselves to these observations. Our goal is to better understand six female cancers (breast, ovarian, endometrium, cervix, vulva and vagina), better prevent and cure them.
How are they special?
We need to determine how female hormones influence tumor development processes, responses to treatments and also their consequences. For example, chronic fatigue affects 56% of women after cancer compared to 36% of men, without any explanation for such a difference.
When will your discoveries transform care?
As soon as possible ! Our ambition is to be able to prevent or cure 100% of breast cancers in ten years. It involves new molecules, but not only that. We are creating the institute with caregivers and patient associations in order to be as close as possible to the daily challenges of women, in their fight against illness but also in their personal and social lives… They have, among other things, a higher professional interruption after cancer than men. We will look into how to fix it.
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