By Anna D. Barker, PhD
Deputy Director, Advanced Technologies and Strategic Partnerships
National Cancer Institute

We are entering a revolutionary period in biomedicine that is being driven by breakthroughs in cancer prevention, detection and treatment. An important part of this revolution, which is increasingly evident in clinical care—cancer care, in particular—is a shift away from a one-size-fits-all approach to treatment, to a more individualized, patient-centric approach. The convergence of scientific research and advanced and emerging technologies, such as advanced imaging and nanotechnology, is building an unprecedented understanding of cancer as a genetic disease, driven by abnormal genes and proteins. These advances are moving us increasingly toward an era when these genetic defects will be understood and used to specifically define treatment—an era of personalized medicine.

We are changing how we look at cancer. For decades the disease model was confined to what we could observe in tissues and organs. However, now with the help of greatly enhanced imaging tools and other technologies, we are beginning to “see” biological processes in real time at the genetic, molecular and cellular levels.

We now can view cancer as a mechanistic disruption of the normal cycle of cell growth and death. By determining which genes and proteins are driving the cancer process in an individual patient, we can define a much more precise target for our treatment interventions. These “biomarkers” will provide earlier alerts to cancer; an advanced technology such as nanotechnology promises to create extremely small-scale devices (one eighty-thousandth the width of a human hair) that will be able to detect changes that signal the presence of cancer and deliver treatment. Each advance, new tool and technique is helping to build a future where cancer is detected early and when we can intervene before the cancer is visible under the microscope.

We are also expanding efforts to understand the tumor microenvironment, which is the local and systemic architecture and pathways outside of a cancer cell. The microenvironment includes other cells, growth factors, enzymes and parts of the blood, lymphatic and immune systems. Dynamic interactions between the cancer cell and its microenvironment can contribute to some of the most destructive characteristics of cancer, including metastasis. The microenvironment and pathways can also influence the access of therapeutic agents to cancer cells, the body’s processing of treatment agents, and the development of resistance to cancer treatments. Therefore, research to understand the tumor microenvironment more fully may provide additional targets for preempting cancer and better methods for treating it.

Recent advances in breast cancer research and treatment illustrate how our deeper understanding of the cancer cellular processes is propelling the shift toward personalized medicine. Herceptin® (trastuzumab) is a good example of the many new targeted treatments emerging for cancer. It is a biological compound designed to exploit the discovery that breast cancer cells overexpress the HER2 protein, which is the case for about one in four women with the disease. The drug is specifically engineered to bind to those cells and stop them from reproducing. Most recently, three studies found that Herceptin, used with chemotherapy, appears to significantly improve the prognosis for an aggressive type of early breast cancer.

This is a time of great discovery in cancer research. Scientists are investigating cancer cells in great depth and characterizing the many steps and complex mechanisms involved in the disease process called cancer. Researchers are beginning to unravel cancer’s mysteries. They are using this new knowledge to develop ways to preempt cancer before it becomes life-threatening, to detect it early and to treat patients on a much more individual basis. The convergence of science and advanced technologies is setting the stage for future exponential progress and providing a foundation to eliminate suffering and death due to cancer in the next decade.