There's arguably no scarier diagnosis a patient can receive from their doctor than cancer. But the grim reality, based on data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, is that 38.5% of all people, men and women, will be diagnosed with cancer at some point during their lifetime.
This year alone, the American Cancer Society (ACS) is projecting 1.69 million Americans will be diagnosed with cancer, and that nearly 601,000 people will die as a direct result of cancer. That makes it the No. 2 killer in the U.S., trailing only heart disease. However, with heart disease drugs improving and eating habits getting potentially healthier, cancer is expected to surpass heart disease and become the nation's leading killer by the next decade.
A silver lining
If there is a silver lining to be had in all of this, it's that most cancer types have seen marked improvement in five-year (long-term) survival rates since the 1975 through 1977 period. With the exception of uterine and larynx cancers, all other relatively major cancer types have seen improvement in five-year survival rates.
Some of the most notable include prostate cancer, female breast cancer, and colorectal cancer. Prostate cancer, which accounts for about 20% of all cancer diagnoses for men in 2017, has a 99% five-year survival rate as of 2006-2012 compared to just 68% in 1975-1977. Meanwhile, 91% of female breast cancer patients were alive after five years as of 2006-2012, up from 75% in 1975-1977. Colorectal cancer, which is very preventable with common screenings, has a 66% long-term survival rate, up from 50% a little over three decades prior.
Cancer types with the worst outlook
While there have been some clear wins for the drug industry and medical community, other cancer types have showed only minimal progress. The following five cancer types currently have the poorest long-term outlook, based on ACS data.
- Pancreatic cancer: No diagnosis is scarier than pancreatic cancer, which has just a 9% long-term survival rate. Yes, that's triple what it was more than three decades ago (3%), but it's still far too low to cheer about.
- Liver and intrahepatic bile duct cancer: Back in 1975-1977, liver cancer had just as poor a long-term outlook as pancreatic cancer, at 3%. A little over three decades later, five-year survival rates have jumped to 18%. While improved medicinal options and screening have likely helped, we need to do better.
- Lung and bronchus cancer: The deadliest of all cancer types in sheer number, lung cancer will be responsible for more than a quarter (155,870) of all cancer-related deaths in 2017. Just 19% of lung cancer patients live five years, which is up from 12% more than three decades prior.
- Esophageal cancer: Though cancer of the esophagus will only account for about 1% of all diagnoses in 2017, the long-term outlook for these patients isn't promising. Just 21% live for five years, which is actually more than quadruple the 5% that lived as long a little over three decades ago.
- Stomach cancer: Lastly, only 31% of those diagnosed with stomach cancer live for another five years. On the positive side, that's more than double the 15% long-term survival from over three decades ago; it's still inadequate to the roughly 28,000 who'll be diagnosed with stomach cancer in 2017.
Next-generation therapies take aim at the toughest cancer types
Though drug developers have focused their efforts on a wide gamut of cancer types, special attention has been paid to the cancer types with the worst long-term outlooks. Here are just some of the ways pharmaceutical and biotech companies are looking to put the ball in the court of patients and physicians, despite their exorbitant costs.
Topping the list of game-changing therapies are cancer immunotherapies. These are drugs that aim to remove the immunosuppressant quality of cancer cells, thusly exposing them to the immune system. Some may even be able to send your immune system into overdrive to attack cancer cells.
Some of the most promising immunotherapies to date are Merck's (NYSE: MRK) Keytruda and Bristol-Myers Squibb's (NYSE: BMY) Opdivo. Both have taken on, and gained approval, to treat various stages of advanced lung cancer.
Opdivo, for instance, demonstrated a 19% response rate for advanced second-line non-small cell lung cancer (NSCLC) patients. While that may not sound like much, remember that we're talking about stage 4 cancer patients who've already tried a previous line of therapy and progressed. For those who did respond, Opdivo delivered a median duration of response of 17 months! That compared to just six months of average duration for the docetaxel arm in clinical studies.
Meanwhile, Merck's Keytruda is making waves in first-line advanced NSCLC, where Opdivo failed to produce positive results. In patients whose tumors had at least 50% PD-L1 expression -- PD-L1 is a ligand that interacts with PD-1, the target protein of Keytruda -- Keytruda improved progression-free survival by better than 70% (10.3 months vs. 6 months) over the placebo. Look for these two drugmakers and other industry giants to lean on immunotherapies as single and combination treatments for the foreseeable future.
Another means of treating the scariest cancer types is with targeted therapies. These are drugs that have been developed to target specific proteins, receptors, or biomarkers to effect positive biologic change. In many instances, these biomarkers will narrow the potential patient pool of a drug, but it'll increase the response rate and effectiveness in the process.
A good example is Novartis' (NYSE: NVS) Zykadia, which was first approved three years ago to treat advanced NSCLC patients whose tumors were anaplastic lymphoma kinase (ALK)-positive, and who'd progressed while taking Xalkori. In May 2017, the Food and Drug Administration (FDA) gave Novartis the green light to expand its label to first-line advanced NSCLC patients after a phase 3 trial involving Zykadia showed an overall intracranial response rate of 57% for patients with measurable brain metastases, and a 73% overall response rate.
This compared to just a 22% intracranial response rate for the chemotherapy control arm. Furthermore, those patients who responded had a median progression-free survival of 16.6 months, which was more than double the chemotherapy control arm at 8.1 months.
Targeted therapies won't get much glory given their small patient pool, but patients who possess the mutations or biomarkers these drugs target are far likelier to see a response, along with extended periods of stable disease, or even remission. Other ideas, including gene therapy, anti-cancer stem-cell drugs, and stem-cell transplantation therapy, are all means by which drugmakers are attempting to fight back.
Cancer won't be a disease that gets cured overnight, but continued investment in these deadly cancer types should lead to a brighter future ahead for those who'll be diagnosed with the scariest disease on the planet.
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