Against cancer, less heavy medicine is progressing slowly but surely in the United States

The testimony of this former specialist in military nuclear reactors, who will turn 74 in July, illustrates the promises and failings of immunotherapy, in which the pharmaceutical industry invests heavily.

John was able to witness graduation ceremonies of three of his children and will be present at the wedding of one of his daughters this summer, while in June 2013 doctors gave him 18 months to live. "I'm happy to be here to attend these events," says John Ryan. However, during his treatment, he met many patients who did not have a chance. "In five years, I've lost a lot of friends," says the retiree.

Fewer side effects

There are two broad categories of cancer treatments. First, chemotherapy that for decades has been aimed at killing tumors. However, the drugs administered are so toxic that they also attack healthy cells, causing terrible side effects: diarrhea, nausea, exhaustion, hair loss, weight loss, etc. This is what John Ryan did in 2013, with no effect on his tumor.

Immunotherapy helps the immune system detect and kill cancer cells that are otherwise often invisible to them. Exhausted by chemotherapy, crippled in wheelchairs, John Ryan was able to participate at the end of 2013 in the clinical trial of nivolumab, a drug known as Opdivo that is taken intravenously to the hospital, all the two weeks, then once a month, in his case.

His tumor quickly disappeared and, 104 injections later, the side effects of the drug are limited to itching.

I am an immunotherapy treatment and I live well, I have a great quality of life.

The patient regained his normal weight. However, recently, a mbad appeared in his right lung had to be treated by radiotherapy.

Thirty drugs in preparation

Some veterans of the fight against cancer are cautious, having been disappointed in the past by new treatments supposed to cure cancer. Many consider immunotherapy a turning point. This explains why more than 30 drugs are in development and that 800 clinical trials are underway, according to the calculation of Otis Brawley, medical director of the American Cancer Society.

Julie Brahmer, John's oncologist, deals with a third of his patients first by immunotherapy. As Johns Hopkins Hospital hosts many clinical trials, this figure is therefore not representative of all US hospitals.

Doctors are very intrigued by the unusually long remission of a minority (10 to 15 %) of patients, as is the case with John, according to William Nelson, director of the cancer center at Johns Hopkins Hospital. Normally, remissions last from one-and-a-half to two years.

Fewer invasive treatments

Chemotherapy and radiotherapy remain the most common treatments. However, in recent years, several clinical trials and studies have shaken the world of oncology, showing that it is possible to better treat cancer without necessarily resorting to heavy medicine.

A spectacular example concerns cancer prostate. The researchers found that the extended screening recommendations had a perverse effect since too many patients were operated on for tumors that would never have developed. However, such surgical procedures can cause incontinence and erection problems.

In the case of bad cancer, a large study published in June stunned doctors by showing that for tens of thousands of patients each year, chemotherapy was not necessary after removal of the tumor. Hormonal treatment alone is just as effective.

Dying of more than cancer

To this must be added the increasingly precise and rapid genetic badyzes of patients' tumors. Johns Hopkins Hospital has a genomics lab to help physicians customize treatments, instead of applying standard treatment according to the type of cancer.

"We have more and more tools to say that such a patient should be treated, but not another. Our recommendations are better than before, "says William Nelson.

Some cancers remain on the sidelines of all these advances, such as brain cancer. For bad cancer, colorectal cancer, prostate cancer and lung cancer, research is progressing slowly but surely, according to Dr. Nelson.

Dr. Brahmer hopes that someday metastatic lung cancer will be treated as a chronic disease. As for John Ryan, he summarizes his experience in these words: "My goal is to die of something other than lung cancer. "