The evolution of cancer treatments

by Anne Reilly, M.D.

I’ve been thinking about Alex, and how happy we all are that he is finished his chemotherapy and getting back to his regular life. I’m so glad his lymphoma responded so well to the therapy. It was such a tough six months for him! Even though it is so hard to get through, we are lucky that we have such effective therapy to offer for young people with lymphoma like Alex’s. Fifty years ago, most kinds of cancer were pretty much incurable; these days, about 80 percent of kids diagnosed with cancer will be cured. We all hope that someday that number is 100 percent.

Medicine has changed so much, and the therapies that we have available to us now to offer are the result of years of clinical research. Some of that research has happened at individual hospitals, like Children's Hospital of Philadelphia, where there are large numbers of doctors and nurses who learn and teach how to do good clinical research. Lots of it has been able to grow through large cooperative groups of multiple hospitals like the Children’s Oncology Group (COG). The COG includes over 8,000 experts at over 200 hospitals around the world, all working together to try to find cures for childhood cancers. Over the years, they have run trials in every type of childhood cancer to determine the best treatment at the time. Once they have the best they can do, they try to improve on it in another clinical trial. Each trial brings us closer to finding the cure for every child diagnosed with cancer.       

Even 20 or 30 years ago, most of the drugs we had to fight cancer were traditional chemotherapy drugs – toxic, hard-hitting medicines that kill cancer but also affect lots of normal cells and cause some nasty side effects.

In the last few years, new medicines have been developed that work in different ways, some more specifically targeted to the cancer itself. For example, one of the drugs Alex received is called rituximab. Rituximab belongs to a class of drugs called antibodies. Normally, an antibody is a protein produced by the body’s immune system to recognize and eliminate invaders such as bacteria or viruses; each antibody is directed against a different, specific target. In the case of rituximab, this antibody was produced in a laboratory to specifically fight against a protein called CD20. Alex’s lymphoma cells had CD20 on their surfaces, and so rituximab could be used to get rid of those bad cells.

These days, new drugs like rituximab can be combined with older, traditional chemotherapy drugs to make a virtual “cocktail” of medicines to fight cancer. Maybe someday, there will be enough new, targeted drugs that we will not need the older chemotherapy drugs anymore. Wouldn't that be great!