one can (never) cure cancer?

[chris0033547]

Dear all,

Recently I stumbled upon an interesting website:

http://www.futuretimeline.net

There is an article there, which includes a timeline for advances in cancer treatment:

http://www.futuretimeline.net/blog/2013/04/1.htm

As you can see in the graph the outlook for the near future is rather pessimistic (or (- and I really hope that I'm wrong -) realistic?) about finding cures for various cancers.

However if you look at the comments under the timeline-graph, you can see one specific comment from someone called 'Diego Delgado'. Here's the video from the comment:

http://www.youtube.com/watch?v=-5KLTonB3Pg

So according to the expert Ido Bachelet significant advances for various forms of cancer treatment (maybe even a cure or in other words a 100%-five-year-survival-rate for all forms of cancer?) may become possible somethere around 2020? Because the video itself was posted in 2013 and Dr. Bachelet mentions that the DNAbots in the video may become usable in humans after five years.

So on one hand we have Dr. Bachelet, who seems to be pretty optimistic (or hopefully realistic) about cancer treatment and on the other hand we have the timeline above, which suggests a cure for today's most notorious cancers around the year 2200 CE.

Speaking of these DNAbots (basically biomicrobots): The following article is also interesting:

http://motherboard.vice.com/read/dna-nan...as-viruses

Why is it that the timeline on that website is so pessimistic regarding a potential cure, while Dr. Bachelet seems so optimistic in the video above? It's also interesting to look at some of the Google search results for the search string "cure for cancer". Then one can find recent articles like this ones:

http://www.telegraph.co.uk/science/scien...essor.html

http://www.theguardian.com/commentisfree...r-cure-doc

So for example Prof. Dr. Greaves seems to be just as pessimistic/realistic(?) about finding a cure for cancers as the timeline above. We have experts like Dr. Bachelet on one side and experts like Prof. Dr. Greaves on the other side and one wonders, who is right? What do you think about this discrepancy in opinions, when it comes to curing cancer(s)?

Personally I feel that the timeline above only extrapolates the current medical technology against cancer into the future without taking completely new approaches (like microbots) against this class of diseases into account. (Basically it's the same as asking "When will all forms of cancer be curable by chemotherapy and macroscopic surgery alone?" or if I use the example from Dr. Bachelet's video: "When will the military invent a gun, which will automatically only kill the "bad" people, while avoiding all the "good" people (so that soldiers aren't needed anymore)?") Am I correct about this? Or is it just wishful thinking on my part and the situation regarding a cure for cancers is really as bad as the two above articles suggest? But then what about experts like Dr. Bachelet? They can't possibly be just "daydreamers". After all in exceedingly rare cases something like this:

http://en.wikipedia.org/wiki/Spontaneous_remission

happens as well without the help of any medical technology. ( This suggests that cancer may not be as "invincible" as some people may think. )

[viperzerofsx]

medicine is difficult, somethings that have great promise prove to be nothing or have bad side effects, other times a cure comes from left field. what I assume this chart is about is about is how Treatment over time will become more effective rather then when they expect a magic bullet cure. you should at least take notice though that the cancers that occur more have a higher success rate. further the ones with a very low survival rate tend to be the ones that go undetected until they have developed to an advanced state. Improvements in screening as well as getting people to see doctors more would do almost as much to boost some of those numbers as any breakthrough. hope any of that helps

[Rynn]

I think most people know but to mention again I'm currently doing a PhD in nanomedicine/tissue engineering. I definitely think we take an optimistic look in OA but that's fine by me, after all it is science fiction and it's meant for enjoyment. With regards to the links I'm not impressed by sites that attempt to predict the future. It's not possible to do so with any real accuracy beyond the very near future so it's more of an exercise in wish fulfilment.

Regarding the video, I can't watch it at the moment as I am at work but it seems to be about DNA origami as a form of delivery mechanism for anti-cancer treatment. That is just one of many fields of research into different approaches to drug delivery currently going on. Professionally speaking I loathe the fact that it has been refereed to as nanobots. "Bot" implies something with robot-like capabilities i.e. environment sensing, planned behaviour, mobility and in some cases communication, energy storage/transfer etc. DNAbots and the like are complex nanoparticles for sure but they aren't robots. Naming them as such is misleading to the general public and simply provides an easy sensationalism for media outlets.

In terms of curing cancer there are plenty of advances that have helped improve survival rates over time. Hopefully this will continue and I'm optimistic about it. I'm not in cancer research but a few things that I think are quite interesting (if not promising) are:

- Drug delivery systems for conventional treatments. There are already examples of this on the market like doxorubicin. In this example a PEGylated liposome is used to increase the bioavailability of the chemotherapy agent, increasing it's lifetime and distribution in the patients body. There are scores, if not hundreds of different types of nano/microparticle delivery systems under investigation with the goal of increasing potency and reducing unwanted affects. Things like this could give rise to far better uses of current technology as well as provide treatments with more mild side effects.

- Theranostics. Tools that combine both early diagnosis with early treatment. The paper lists a few examples, a particularly cool concept I've seen presented is the use of micro-particles loaded with anti-cancer agents and a detector drug that are injected into breast tissue. The particles are designed to lie dormant and become leaky in the presence of factors over expressed by cancer cells. The anti-cancer drugs then slow down the cancer progression and the detector molecule circulates before being excreted in urine. The idea is that women could regularly check their urine in a very similar manner to a pregnancy test and if the detector molecule is present see a doctor.

- Cancer Immunotherapy. This is about as close as you're going to get for something that could qualify for the term "microbot" (if only in a very loose, still-makes-Rynn-angry manner). There are different experimental approaches but CI aims to treat cancer by programming immune cells to recognise a patients cancer. In some studies t-cells were taken from patients and genetically modified to recognise their cancer. The idea being to put these cells back into the patient and have them hunt out the cancer.

These are just three of many, many different experimental cancer treatments. Honestly it's one of the most well-funded areas of research in the world (which should show how complex a field it is). Whilst I'm not impressed with the future timeline site I do think it's chart is interesting, not for it's baseless extrapolation but because it highlights the fact that cancer treatment has been, and most likely will be, composed of incremental improvements over time. Whilst no one can predict the future it is extremely unlikely that a magic bullet will ever be found for cancer. There's not going to be a time where one treatment arrives on the scene and suddenly all is well. Rather a toolkit of diagnostics and treatments will develop that will push the survival rates up and treatment side effects down. I'm optimistic that at some point in my life time (50-60 years left hopefully) the majority of the cancers will be caught very early with cheap and easy routine check ups and will be dealt with using mild treatments with very high success rates.

[chris0033547]

Thanks for both of your replies. I kind of had the feeling that the video with Dr. Bachelet may unfortunately be too optimistic regarding the abilities of these DNAbots. Your replies confirm that. Theranostics is indeed an interesting concept; never heard of it before so thanks for the link. Personally I kind of hope that with the invention of the first commercial true quantum computer cancer research will make at least one huge leap forward (- something like the moon landing -) instead of just making these small incremental steps. But that's just a vague hope of mine...

[chris0033547]

Actually I have one more question out of curiosity. If the creation of new organs from the cells of a patient was already possible (for example via 3D-bioprinters) then wouldn't that mean that most types of cancer could be effectively turned into a chronic disease as long as the cancer doesn't infest the brain? I mean even if somebody develops an advanced stage of cancer, which has spread to other organs, all, one has to do, is to "print out" new tissues and organs for such a patient and then replace the infested tissues and organs with the new ones.

Of course this would likely not heal the cancer, because if even one cancer stem cell survives, it would simply cause cancer again but it would at least slow down the disease and give the patient more time in which doctors could try out other chemotherapy agents. One could then even try out highly aggressive chemotherapy agents, which would cause huge collateral damage to healthy organs and tissue. As long as this damage is not immediately fatal these organs and tissue could be replaced later on by printing out new tissue on the bioprinter. Actually one could even print out those organs, which would likely be affected the most by the new chemo-agents, in advance to save some time.

Of course if the cancer eventually spreads to the brain or infests the spinal cord 'organ and tissue replacement' wouldn't work anymore.

But in principle wouldn't these kind of advances in organ and tissue replacement also cause a huge leap in the treatment of most forms of cancer? Or is organ and tissue bioprinting even more complicated than cancer treatment? In that case the whole argument above wouldn't work, because then one could already cure various forms of cancer long before one could print out new organs and tissue in 3d-bioprinters.

[Rynn]

Tissue engineering of this type would be useful for non-metastasised cancers which currently are fatal due to inoperability. Exactly what percentage of cancers these are I don't know but if you're curious a search of deaths due to inoperable cancers outside of the brain would be a good start.

Even if we got to the stage wherein any organ could be created on demand (the later is a hurdle in itself, you might be able to make organs but if it takes longer than the patient has left...) there are other considerations. Surgery is quite a traumatic experience, having to undergo multiple organ replacements could just kill the patient themselves. There's also the problem of tumours developing in places that surgery can't properly reach. In addition a tumour can be very dangerous beyond just eating away at an organ (see all the known variations of paraneoplastic syndrome)

Lastly there's types of cancer that an organ replacement wont help with, any type of leukaemia for example or brain cancer.

In summary mature regenerative medicine is likely to greatly increase cancer survival rates but it's not going to be a magic bullet.

EDIT: Forgot to answer your last paragraph. Whole organ regeneration is still some way off. There are already some successes in tissues like skin, corneas and the trachea but we're a while off commercial minature organs, let alone whole ones. By the time we have a spread of organ regeneration technologies sufficient to replace pretty much every part (which is a staggering goal) cancer treatments are likely to be wayyyy better.

[Matterplay1]

Agreed, 'cancer' will probably not be 'beaten', since it is not really just one thing. However we are likely to become better every year at beating back particular cancers, sometimes to the point that people are actually cured and/or live long enough to die of something else entirely.

As it happens I know some people who, if they'd contracted the same kind of cancer a decade ago would have been dead within a matter of weeks or months but instead have been alive (if not entirely well) and loving and thinking and even working and travelling for time now measured in years. It may even be that they will live long enough to see even more effective treatments. One can always hope.

In the bigger picture, we now talk so much about cancer because other causes of mortality have diminished enough to bring it to the fore as a major cause of death. Behind those many kinds of 'rebel cell' problems that we call cancer there will, if we ever solve the bulk of them, be something else. Then we will quite rightly talk and worry about whatever that something else is instead along with the few recalcitrant kinds of cancer, if we are fortunate enough to live to see such times.

[chris0033547]

Okay, thanks for your answers everyone. They definitely put some things into perspective.

[iancampbell]

One more thing: A medical technology that would probably cure cancer along with just about every other disease of aging is medical nanotechnology; "simply" reverse the DNA damage that caused the cancer in the first place, while replacing cancerous tissue with healthy and removing excess. I confess to not knowing where in the OA timeline this level of nanotech is available.

Another, rather brute-force technique is "backup and restore" which requires the ability to read and write a complete mindstate, together with the ability to create clones - preferably young clones! It goes like this: Perform a destructive upload of the entire mindstate, download it into a clone with a biological age of 20 or so. One problem with this is that the mindstate has structural components - synapse patterns and the like - which are going to be much harder to duplicate than a software program might be.

Needless to say perhaps, it's rather trivial in either case to remove all other damage as well - including the accumulated damage that manifests itself as aging, but also such things as wound and surgical scars. I suppose restoring the presence of semi-vestigial things such as the appendix might be optional. (Before anyone else points it out, it may well be the case that the appendix has been repurposed in H. sapiens to become part of the immune system and also a reservoir of symbiotic intestinal flora.)

[Rynn]

One more thing: A medical technology that would probably cure cancer along with just about every other disease of aging is medical nanotechnology

Medical nanotechnology, AKA nanomedicine, is an entire class of medicine. It isn't a specific product so whether or not it will cure one thing or all things is neither here nor there. In the setting we have omnimed that comes close but that's composed of very generalist medibots that can give rise to hundreds of different types (that can act in very different ways from the synthesis and release of drugs to binding together to form synthetic tissues). Such technology doesn't really mature til the First Fed at least. In real life such a thing is so far beyond our current understanding that it would be meaningless to make any sort of prediction.