Conquering cancer in our lifetime: new diagnostic and therapeutic trends.

Cancer has now surpassed cardiovascular disease as the number 1 killer of both men and women (1 ). Approximately 1 of 3 of us will develop cancer during our lifetime. Despite the war on cancer declared more than 40 years ago by President Richard Nixon, the battle has not yet been won, despite a substantial investment in resources. The US National Cancer Institute has an annual budget of approximately $5 billion and since 1971 has spent $90 billion on the science, treatment, and prevention of cancer (2 ). The pharmaceutical industry has invested several times that sum in developing anticancer drugs and antibodies. Small-molecule inhibitors such as imatinib have changed the natural history of chronic myelogenous leukemia and gastrointestinal stromal tumor. Antibodies that include rituximab and trastuzumab have improved overall and long-term survival for patients with lymphoma and breast cancer, but many new targeted agents approved by the US Food and Drug Administration have extended progression-free survival times by only a few months. Of greater concern is that only 1 in 20 new oncologic agents entering clinical trials proves to be sufficiently safe and effective to achieve approval. Progress has been slow and sometimes inefficient. Some scientists have claimed that the cancer incidence and mortality rates have not changed over the last 15 years. The fact is, however, that the overall cancer mortality rate has declined significantly in the US since 1990, despite the aging of the population. For example, the incidence for the major killer, lung cancer, began to decline in the early 1980s, owing to the antismoking campaigns, and the overall 5-year mortality rate decreased by 1.6% by 2010. The 5-year mortality rate has decreased by 3% for colorectal cancer, 2.2% for breast cancer, 3.3% for prostate cancer, and 1.3% for leukemia. For some other cancers, however, the 5-year mortality rate has actually increased, by 0.6% for pancreatic cancer and by 2.2% for liver cancer. Are we winning or losing the war against cancer? There is no question that clinical outcomes for patients with some hematologic cancers have changed dramatically for the better, whereas the results are far more modest for many solid tumors. Focusing only on median 5-year survival, however, may ignore the substantial improvement in survival for subsets of patients treated with erlotinib or crizotinib for lung cancers that bear the appropriate genotypic changes in the epidermal growth factor receptor or anaplastic lymphoma kinase. Over the last decade, our understanding of cancer at the cellular and molecular levels has continued to increase exponentially, not only by identifying