Cancer. It may be the scariest diagnosis on the planet, and arguably the most worrisome six-letter word in the English language.
According to estimates from the World Health Organization, cancer incidents rates are expected to rise in the coming two decades. While today 14 million cases are diagnosed annually, WHO predicts 22 million annual diagnoses two decades from now. It's a sobering statistic in many respects, but it only partially summarizes why cancer is such a global concern.
In addition to rising incidence rates, concern is exacerbated by not being able to predict who will and won't develop cancer. Despite a decent understanding of some of the primary risk factors behind cancer (such as using tobacco products), there's still no concrete answer as to why cancer triggers in one person but not in another.
A first-of-its-kind cancer study yields some interesting findings
We clearly still have a lot to learn about cancer. But a recently released, first-of-its-kind study from Japan's National Cancer Center also demonstrates just how far we've come in our knowledge of fighting this disease.
The study tracked 35,287 cancer patients diagnosed and treated between 1999 and 2002 at 16 facilities belonging to the Japanese Association of Clinical Cancer Centers. After removing deaths unassociated with cancer, the study then examined 10-year survival rates for these patients among various cancer types. Prior studies involving five-year survival rates are somewhat commonplace, but this was Japan's first look at 10-year survival rates for cancer. The study itself yielded a number of interesting findings.
1. Survival rates depend on cancer type
Firstly, the type of cancer a patient was diagnosed with largely determined their chance of survival. Among cancer types studied, patients with thyroid cancer had the best chance of being alive 10 years later at 90.9%. Breast cancer, the most commonly diagnosed cancer within the United States, was another standout with a survival rate of 80.4% after 10 years, dipping from a survival rate of 88.7% at the five-year mark. Other generally high marks included uterine and cervical cancers, with 10-year survival rates above 70%, and stomach cancer, with a 10-year survival rate of 69%.
On the flipside, certain cancer types offered very poor long-term survival potential. Cancers of the esophagus, bile duct, and gallbladder all had 10-year survival rates below 30%, and liver cancer survival rates dipped from 32.2% at the five-year mark to just 15.3% at the 10-year mark. As is the case with nearly all broad cancer studies, the difficult-to-treat pancreatic cancer took the dreadful title of lowest 10-year survival rate at just 4.9%.
2. Recurrence rates appear to differ dramatically
Secondly, I believe the data speaks to the idea that certain cancers are far more prone to recurrence, or perhaps secondary cancers, than others.
For example, stomach cancers only saw a very minimal drop-off of 1.9% between the five-year and 10-year results. The implication is that recurrence rates are probably low for this indication. Conversely, liver cancer witnessed a nearly 17% drop-off in survival rates, implying that recurrence rates are considerably higher.
It's worth noting that the genetic makeup of cancer patients could certainly play a role in determining recurrence or the development of a secondary cancer, but the data released by the National Cancer Center doesn't even begin to examine this aspect.
3. Progress is being made
Finally, I believe this data implies that cancer treatments, and education, are improving.
As noted in the Nikkei Asian Review, Tomomitsu Hotta, president of the National Cancer Center, had this to say following the release of the data:
"Cancer treatment is improving, and the 10-year survival rate of those getting treated now will be even higher."
As a whole, the 10-year survival rate for all cancers was 58.2%, with an obvious trend that showed earlier-stage cancers offered a higher survival potential than late-stage cancers. Specifically, cancers discovered in stage 1 had a five-year survival rate of 90.1% and a 10-year survival rate of 86.3%. In stage 4, survival drops dramatically to just 17.4% at five years and 12.2% at 10 years. Still, without pharmaceutical, diagnostic, and device innovation, I would anticipate both figures being even lower.
A focus on detection, primary treatment, and recurrence prevention
Overall, Japan's data release is both encouraging and scary. It shows we've got a lot of work to do when it comes to detection, but it also suggests we're making progress. Listing off all of the advancements in cancer care and detection over the last couple of years would make for an exceptionally long list, so here are just a handful of treatment options that've emerged (or are in development) which could really begin to swing the pendulum in favor of the cancer patient.
In terms of detection, few developments have been as exciting as Exact Sciences' (NASDAQ:EXAS) Cologuard, a noninvasive colorectal cancer diagnostic test approved by the Food and Drug Administration in 2014. Cologuard works by analyzing the cells shed from the wall of the colon from a patient's stool sample. An abnormal DNA reading would be the patient's cue to get a colonoscopy.
In clinical trials Cologuard was able to correctly identify colorectal cancer 92% of the time (cancer and adenoma detection via colonoscopy has a similar success rate of 90%-95%), and advanced adenomas 42% of the time. Both figures were nearly 20 percentage points higher than the placebo noninvasive test Cologuard was pitted against in a late-stage trial. Since Exact Sciences states that colon cancer is the most preventable form of cancer, the implication is that it could make a serious dent in detection rates and survivability in the coming years.
Cancer care treatments are where we're seeing the most progress, mainly with the emergence of immunotherapies. Immunotherapies are drugs that jolt a cancer patient's immune system into action by turning off cancer's ability to hide, the idea being that killer T-cells can then attack and eradicate the cancer in question.
Merck's (NYSE:MRK) Keytruda is one of just a handful of FDA-approved immunotherapies. Keytruda has demonstrated exceptionally high response rates in patients expressing high levels of PD-L1 in non-small cell lung cancer and metastatic melanoma (often double that of prior standards of care), and it's expected to be one of a handful of new standards of care for treating multiple solid tumor types. It's also the therapy responsible for ridding former-President Jimmy Carter of metastatic melanoma lesions on his liver and brain. Interestingly enough, Dako has developed a companion diagnostic test for Merck's Keytruda to further assist physicians in deciding whether Keytruda is the right cancer treatment for them.
Research into halting cancer recurrence is still a relatively new concept. However, one therapy in development worth eyeing is Galena Biopharma's NeuVax. Currently in late-stage studies, NeuVax is an immune-boosting injection that's administered 11 times over three years and designed to prevent low-to-moderate HER2-expressing breast cancer recurrence. Midstage studies showed a 78% reduction relative to the placebo in recurrence rates. Galena is also working on a similar therapy to block endometrial and ovarian cancer recurrence for women.
For investors, cancer research appears as if it'll remain an area of high potential growth. But more importantly, cancer patients can hopefully look forward to more directed and personalized cancer treatment in the coming years, which may translate into improved survival and quality of life.