Richard Jackson, primary school director, likes to plan ahead for vacations, upcoming parties, or just out to dinner with family and friends.
Nothing unusual, you might think, especially for someone who works in the hectic environment of teaching.
But the reason Richard likes to organize his diary is that he was told twelve years ago that he would be dead within nine months.
Doctors diagnosed malignant melanoma, the most aggressive form of skin cancer, and said it had already spread to its lymph nodes, the route by which aggressive tumors usually travel through the body to important organs.
He was 39 and married with two children.
But after taking just one dose of a new immunotherapy drug called ipilimumab – a treatment that uses its own immune cells to fight cancer – Richard and his wife, Judith, watched in surprise as his tumors began to shrink.
Cancer survivors Deborah James (left), Lucy O’Donnell (center) and Richard Jackson (right)
“We hurried to see my oncologist at the Christie Hospital in Manchester and he took a good look and took measurements and photographs,” says Richard, now 50, from Ellesmere Port in Cheshire.
“I remember saying to him,” It feels like they’re shrinking. But we don’t want to get too excited. “I will never forget the exact words of the doctor.” Oh no, “he said.” Let’s all be very excited. “
60 percent of the tumors disappeared within a few months. After a year and five treatment cycles, they were practically gone.
His medical team was surprised. Not least because Richard’s diagnosis was terminal at the time.
I should be dead … but I’ll do a triathlon instead!
Later this month, Deborah James will compete against 5,000 amateur athletes in what is called a “fun” triathlon – swimming in 16 lengths of a swimming pool, cycling 10 km and then running another 2 km.
But unlike its rivals, Deborah will perform the exhausting performance just three weeks after a major cancer operation and after removing no fewer than 12 malignant tumors from her gut, lungs, and liver in the past few years.
First diagnosed in 2016 with aggressive colon cancer that had spread to her lungs, Deborah – who is presenting the BBC’s You, Me And The Big C podcast – was given only seven months to live.
Two and a half years later, she is stable and even enjoyed a short period of complete remission – she was temporarily cancer-free.
Deborah, 37, Hugo’s mother, 11, and Eloise, nine, says: “I had three months when all the tumors were removed from my lungs and there was no evidence of the disease.
“My oncologist said,” We have reached a place that we hope to reach but that we never thought we would reach. “
This remarkable recovery is largely due to a cocktail of new anti-cancer drugs given by doctors at the Royal Marsden Hospital in London.
Two of them, dabrafenib and trametinib, are known to be working on skin cancer with the same genetic mutation as the intestinal tumor of Deborah.
The third is a colon cancer, panitumumab.
This combination blocks three pathways around the tumor, preventing it from spreading further.
Although it is not a cure, it has stabilized her condition.
Deborah says: “Research has kept me alive. I know I shouldn’t be here.
“I live with hope, not resignation. The point is that you embrace what you have. “
Deborah James, 37 (photo), will participate in a triathlon later this month, just three weeks after major colon cancer surgery
Nowadays he is healthy, happy and the subject of cancer only appears in his annual checks.
“With the cancer I felt that I did not have my own future, that it was not mine. Now I have actually had a second chance, “he says.
Richard’s case is not isolated. He was in fact at the forefront of a revolution in cancer treatment that has completely changed the way many experts now think of the disease.
Thanks to blockbuster treatments that stop tumor cell sharing, many top oncologists claim that cancer – even when the diagnosis is at an advanced stage – is now far from a certain death penalty.
The fact is that while more patients survive longer, a small group sees amazing results.
Unfortunately, others still do not respond to therapy.
Scientists’ greatest interest now is to investigate why – and the provisional hope is that even more patients can benefit from it.
It means that one day the most aggressive growths can become nothing more than a chronic disease that is managed with medication – just like asthma, diabetes or high blood pressure.
While one in two of us will get cancer – 166,000 a year – the reality is that we are never inclined to survive.
Twenty years ago, only one in four patients lived longer than a decade. Today half of the patients do that, and by 2030 experts predict that it will be three-quarters.
Doctors even talk for the time being about curing patients with metastatic disease, known as stage 4, where the cancer has spread to other parts of the body – traditionally considered “incurable.”
Professor Charles Swanton, chief clinician at Cancer Research UK, said: “It’s really great. In the 1990s, cancer was still seen as bed rest and palliative care, where the symptoms had to be easily managed until the patients died. Now, with new drugs, there is much more optimism than ever before. There is a lot of room for hope. “
Remarkably, as many as a quarter of those with stage 4 tumors live months – even years – after their predicted survival time.
In melanoma, the fifth most common cancer in the UK, immunotherapy drugs, such as ipilimumab, mean that half of those diagnosed with metastatic disease now survive.
There is a similar increase in survival for about 20 percent of patients with advanced kidney, lung, and bladder cancer, while an increase in drugs known as targeted therapies that change the DNA of cancer cells limit their growth. benefits.
While some drugs are already available on the NHS, other newer therapies are only offered to eligible patients through the Cancer Drugs Fund or through clinical trials.
Dr. Fiona Thistlethwaite, medical oncologist at the Christie Hospital, said: “Almost always when the cancer has spread, it’s more about control than cure. But we see that a small proportion of patients have very good responses to the point where no disease can be identified, which we call complete remission. Some are kept in remission for more than ten years, which may mean that these patients heal. “
So what are these revolutionary treatments? Here are the developments that the medical professionals are most enthusiastic about.
Magic bullet therapy increases survival
Targeted drugs, often known as magic bullets, extend the lifespan for a decade or more in patients who would otherwise have few options.
Blood tests that can no longer mean biopsies
It is not only cancer treatment that is evolving rapidly – the way the disease is detected can also change.
British researchers are working on a simple blood test that could replace painful biopsies – the surgical removal of tissue for testing.
It can also replace CT scans that expose patients to radiation that can be harmful after abundant screenings.
This is called a liquid biopsy and includes the detection of cancer by searching for traces of its DNA in blood and analyzing for defective genes that stimulate tumor growth.
Doctors can then select the best medicine to treat.
It is far removed from the scatter-gun approach to chemotherapy, which destroys both healthy and cancerous cells.
A trial is currently underway in patients with advanced cancer who have not responded to treatment.
Retired secretary Barbara Stojkovic, 69, from Birmingham, saw her ovarian cancer shrink by nearly 60 percent after undergoing the test and paired with appropriate treatment at The Christie NHS Foundation Trust.
Barbara was diagnosed with cancer five years ago and did not respond to chemotherapy.
But since the blood test, she has been linked to two drugs, one that, in combination with chemotherapy, stopped her tumor growth for eight months.
She says: “I feel good and my granddaughters keep telling me that I look great, so I remain very optimistic.”
Oncologist Dr. Neil Bayman, specialist in lung cancer at Christie Hospital in Manchester, said: “The next step, the Holy Grail, is that you have a blood test instead of a CT scan. We don’t do that for a long time.
“But you can detect traces of cancer in the cells and if you have an early sign, you can be treated.”
They are the result of the enormous progress that scientists have made in understanding the genetic composition of cancer cells and what drives them to multiply.
The drugs target certain components of the cancer cell that are known to help survive.
For example, the breast cancer drug Herceptin, which has transformed treatment for one in five patients with aggressive tumors known as HER2-positive cancers, works by attaching to the HER2 protein, which promotes tumor cell growth. This prevents the cells from dividing.
Professor Andrew Wardley of The Christie Hospital, Europe’s largest cancer treatment center, says: “When I started as a consultant in 2001, patients with this type of disease who had spread would die very quickly. After the Herceptin examinations, we saw patients who lived ten years or more. And it is not uncommon to get patients over five years old without evidence of cancer. “
Combining targeted medicines can prove even better. A major study found that 13 percent of those receiving Herceptin and another targeted drug called Perjeta are in complete remission, said Prof. Wardley.
Lucy O’Donnell, cancer consultant and author of Cancer Is My Teacher, was diagnosed in 2011 with advanced breast cancer that spread to her liver and bones. Only 20 percent have lived with this diagnosis in the last five years.
But Lucy’s HER2-positive cancer has been curbed by a combination of Herceptin and Tamoxifen, a drug that is given to women with hormone-sensitive tumors.
When – and if – that stops working, there are other therapies that she can try, such as Kadcyla, which has been shown to prolong life by an average of six months, with some patients surviving for a few years.
“My oncologist says I’m a walking miracle,” says Lucy.
“Herceptin has been a game changer. My cancer has remained the same for six years. I’m just so happy that I’m alive. I remain positive and active and I know I have other options when it comes back, so I am very relaxed about it. “
A new targeted therapy that generates a lot of excitement is a drug called Alpelisib, which focuses on the PI3K gene that makes tumors resistant to treatment.
It can be life-saving for those in five women with so-called “triple negative” breast cancer, for whom there is currently no targeted therapy.
And it’s not just in the field of breast cancer where the prospects are illuminating.
A drug called Olapirib has prevented tumors from spreading for three years in women with ovarian cancer and has been promising in patients with pancreatic and stomach cancer.
Others, such as Tarceva and Iressa, also improve results for lung cancer patients.
Medicines that use the immune system
Immunotherapy has changed the chances of survival for a small but significant proportion of patients.
Instead of destroying cancer cells, they eliminate the brakes that cancer applies to the body’s immune system. If these inhibitors are present, the immune system cannot fight the disease.
If you release them, a person’s immunity can start attacking a tumor.
The therapy has had incredible results in melanoma, lung and kidney cancer and versions of the drugs are also being tested in other tumor types.
Lucy O’Donnell was diagnosed in 2011 with advanced breast cancer that spread to her liver and bones. She has used a combination of Tamoxifen (left) and Herceptin (right), a medicine that is given to women with hormone-sensitive tumors. The growth of her cancer has stopped for six years
Professor James Larkin, medical oncologist at the Royal Marsden hospital in London, said: “Most solid, metastatic tumors are historically considered incurable. With recent immunotherapy treatments, we know that many survive for a long time.
‘With Ipilimumab or ipi there is a 20 percent chance of long-term survival. But when newer, emerging drugs such as nivolumab (Opdivo) and pembrolizumab (Keytruda) are used in combination with Ipilimumab, long-term survival can be as high as 40 or 50 percent.
“We have a group that has been living for more than ten years with a relatively good quality of life.”
However, some still do not respond. “If immunotherapy doesn’t work, you’re back where you were with limited medication available,” Prof. Larkin added.
For patients who respond, the future looks promising. Immunotherapy continues to work even in the long term, without the cancer returning, when people stop taking the drug.
Prof. Larkin said: “We recommend two years for these drugs. If patients can get to that point, they have a very good chance of not needing further treatment. “
Retraining cells to cure leukemia
While most children with leukemia respond well to treatment, those who do not have little chance of surviving for more than a year.
But a new technique called adoptive cell therapy offers new hope.
A patient’s immune cells are removed from their blood and then reprogrammed in the laboratory to make them more effective at recognizing and targeting cancer cells.
These renewed cells, known as CAR-T cells, are then delivered back into the patient through a vein.
Within four weeks, most patients see that their disease goes into remission for two years or more.
A new technique called adoptive cell therapy offers new hope for cancer patients. It means that cells are removed from their blood and then reprogrammed in the laboratory to make them more effective in recognizing and targeting cancer cells (stock image)
Dr. Karin Straathof, pediatric oncologist at Great Ormond Street Hospital, where treatment is now available at the NHS, said: “These patients would not normally have treatment options, but some will be cured instead.
“If the cancer has not returned after six months, it usually means that it will not return.”
She added: “In the future, we might be able to use it instead of the standard treatments that we now use for leukemia.”
Dr. Straathof also tests therapy for neuroblastoma, an aggressive cancer in children and difficult-to-treat brain tumors.