Cancer-fueling genes. Immune-boosting therapies. Circulating tumor DNA detection. These are just a few of the discoveries that are propelling progress in the understanding and management of cancer.
But significant challenges remain. A large percentage of people diagnosed with cancer around the world have metastatic disease. Some cancers develop resistance to treatment, while others do not respond at all. And there is an alarming and unexplained rise in colorectal cancer among younger adults. Laurie Glimcher, MD, President and CEO of Dana-Farber Cancer Institute, recently addressed achievements and hurdles in the study and management of cancer.
What are some of the greatest recent achievements in our understanding of cancer?
I think that the last two decades have been revolutionary. When I was training, it never occurred to me to become an oncologist because at that point, you really couldn't do much for a patient with cancer. Today, we know that cells turn cancerous when they have a specific genetic mutation. Sequencing the genomics of all patients who have a tumor can tell us a lot about what their mutations are, and then one can proceed with choosing treatment.
The second revolution is the ability to activate the immune system. Jim Allison discovered that you could activate T lymphocytes. Gordon Freeman identified an inhibitory receptor called PD-1, which has changed the whole landscape of immunotherapy. About 25 percent of patients respond to immunotherapy, but it's only effective for about 10 to 12 specific cancers. So we still have a long way to go.
Academic medical centers cannot do this themselves. The best thing for our patients is for us to collaborate with industry.
Can you explain the importance of translational research?
At Dana-Farber, 50 percent of our faculty are researchers and 50 percent are clinicians. The clinicians can't wait to help the scientists. So when we talk about bench to bedside, it's also bedside back to the bench. I remember when one of our faculty members discovered two new inhibitory receptors and he saw that they were expressed at a high level in the brain, the first thing he did was run down the hall and talk to a clinician who treats patients with glioblastoma. They started working together, founded a company and are doing a phase 1 clinical trial. At Dana-Farber, we are really about collaboration, not competition.
What progress is being made in early detection?
We are detecting a small number of cancer cells in the blood. If you can detect a few circulating cancer cells or cancer tumor DNA, then hopefully you're going to find it at stage one. We're focusing first on patients at high risk of cancer.
But what does it mean to be high risk? As we get older, having had one cancer increases your risk of a second cancer. Also, 10 percent of cancers are genetic. People with inherited syndromes such as Lynch syndrome, for example, have an elevated risk of certain cancers and may need to have screening tests, such as colonoscopy, more frequently. Nobody likes that, but it's a lot better to detect it early than to be diagnosed with metastatic colorectal cancer. This is particularly important now because there is an alarming incidence of colorectal cancer in young people. We don't know why it is and we have to figure it out.
How can we make cancer care more accessible and equitable?
Any patient with cancer deserves the finest care that they can get. At Dana-Farber, we have established satellite locations with physicians and nurses in underserved communities. We need to get out into communities, churches and wherever people are to educate them about cancer. Patient navigators are very helpful for talking with people about clinical trials. This is important because for about 20 percent of our patients, the best option is a clinical trial. We also need to increase the percentage of people of color in clinical trials.
People want to come into a hospital and see other people that look like them. We have focused intensely on recruiting more faculty and staff of color. In both 2021 and 2022, more than half of our recruits were people of color and 80 percent were women.
What is your message for women in science?
Women need to have more self-confidence. If you're going to be a scientist, you also need to recognize that 90 percent of your experiments are going to fail. Some of your grants and publications are going to be rejected. But if you're really passionate about what you're doing, just keep doing it.
You also have to put your money where your mouth is. Women have to recognize that they need more funding than they're getting and they're not asking for it as much as men do.