Fabrice Andre, director of research at Gustave-Roussy in Villejuif (Val-de-Marne), discusses significant innovations in the treatment of these diseases on Sunday 4 February, World Cancer Day. and on strategies that promote the transformation of French discoveries into the treatments of tomorrow.
Why, in your opinion, should we no longer classify cancers according to the organ of origin, but according to the identified molecular abnormalities?
This revolution has been going on for two-three decades. However, academic societies have not taken advantage of it so that patients get its full benefits. There remains a gap between the current classification of cancer, which is based on anatomy and the affected organ, and the need to optimize the effectiveness of new treatments, which target the molecular changes characteristic of each tumor. This discontinuity hinders access to this treatment. A second challenge, linked to the first, is to improve the methodology of clinical trials to optimize the evaluation of these new drugs.
Can you give an example of an innovative treatment that has slowed access?
Consider nivolumab, an anti-PD-1 drug. This immunotherapy received European marketing authorization in 2015 for advanced melanoma. It is an antibody that works by promoting the elimination of tumor cells by the immune system. In early 2012, a trial showed that it shrank tumors in 49 of 236 patients with melanoma or metastatic lung or kidney cancer. The main factor determining response was not the organ of origin but the abundance of a molecule called PD-L1 on the surface of the tumor cells.
The logical next step was to test this antibody in people with metastatic tumors containing large amounts of PD-L1, regardless of the organ affected. But, due to the lack of relevant statistical methods, it was necessary to conduct a series of clinical trials for each organ. The result: millions of people were unable to access this treatment. Some breast cancer patients, for example, had to wait seven to ten years.
We rarely talk about innovative local treatments, such as surgery or radiotherapy…
Newer drugs can extend the survival of patients previously condemned to metastatic cancer by a few months or years. So their impact is very much felt at the individual level. This is less the case for local treatments given earlier in less advanced cancers. However, they are also the subject of technological developments with a major impact on public health. Examples include robotics in surgery, or even regenerative medicine, which can remove as much cancerous tissue as possible, then reconstruct the damaged organ. American start-ups are working to reconstruct the bone or bladder.
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