We Don't Fight Cancer the Way You Think Anymore
If you think cancer care is still defined by chemo, you're missing the real story
When I started practicing oncology in 2014, most of my conversations with patients centered around chemotherapy. Back then, chemo was the backbone of nearly every treatment plan. We worked hard to pick the right regimen, manage side effects, and help people get through. That was the reality.
Ten years later, things look completely different.
Today, I can order a simple blood test that looks for cancer DNA and shows whether a treatment is working in real time. I can use imaging that lights up tumors long before seen on a CT scan. And I can harness the immune system to fight cancer in ways we once thought were impossible.
Here are ten cancer breakthroughs I will be writing more about on Curative, many of which I now use every single day in clinic:
Circulating tumor DNA (ctDNA) and Minimal Residual Disease (MRD) testing: blood tests that can detect hidden cancer after treatment. Sometimes they spare patients from unnecessary treatment, other times they prompt us to act earlier.
Next-generation molecular imaging (PSMA PET, FES PET): scans that light up tumors at the receptor level and change how we stage disease, plan surgery, and decide on systemic therapy.
Theranostics and radioligand therapy: radiotracers that can both find cancer and deliver treatment directly to it. The before-and-after scans from these therapies are some of the most dramatic I have seen.
Immune checkpoint inhibitors: PD-1, PD-L1, CTLA-4, and LAG-3 inhibitors that unlock the immune system. I have patients alive today because of these therapies who a decade ago would have had no options.
Bispecific T-cell engagers (BiTEs): antibodies that bring a T cell directly to a cancer cell and force the immune system into action.
Cell therapies (CAR-T, TILs): re-engineering a patient’s own immune cells as therapy. I remember when this was just theory. Now I have patients with resistant disease respond when nothing else worked.
Antibody–drug conjugates (ADCs): antibodies that carry chemotherapy directly inside cancer cells. These treatments often lead to fewer side effects and, in many cases, remarkable responses.
Personalized neoantigen vaccines: vaccines built from the unique mutations in a patient’s tumor. Still in development, but the idea that we can design a vaccine for an individual’s cancer is extraordinary.
Microbiome modification: one of the most intriguing frontiers in oncology. The trillions of microbes in our gut are proving to be active players in cancer treatment, not bystanders. They can boost or blunt responses to therapy and may hold keys to future breakthroughs.
Metabolic interventions: approaches such as fasting, ketogenic diets, and new agents that target how cancer cells use energy. This is an area of research that is expanding rapidly and beginning to shape how we think about cancer therapy.
What excites me is how quickly these advances have become real. Ten years ago they were just ideas on paper. Now I get to use them in clinic and see the difference they make for patients and their families. That’s what keeps me hopeful about the future of cancer care.
If you’re interested in how cancer care is changing, here are a few more articles on Oncology 2.0 that you may have missed:
A fantastic overview, Daniel. You’ve perfectly captured the fundamental shift in the entire operating system of cancer care.
The old model was a brute-force intervention (chemo). What you're describing now is an intelligent, multi-layered system, using diagnostics to create a precise map of the problem, then deploying a full suite of precision tools to solve it.
It's a move from a single tactic to a sophisticated, personalized strategy. Brilliant summary.
Dr Tom
Thanks for the discussion of potential treatments for cancer. Do these treatments apply to all types of cancer, or is chemo + radiation + surgery best for some specific cancers? After I was diagnosed with Stage IIIC colorectal cancer, my treatment was neoadjuvant chemo and radiation and extensive surgery. It was successful, and I became "cancer-free" in January 2023. My quarterly checkups and an annual colonoscopy show I have no recurrence. Not yet.