A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed
Abstract
:1. Introduction
1.1. Mortality of Cancer Cells Caused by Therapies
1.2. Cancer Staging
1.3. Concepts of Cancer Cure
1.4. Measurable for Outcomes of Cancer Patients
2. Current Cancer Therapies and Their Performances
2.1. The Evolving Role of Surgery
2.2. The Pros and Cons of Radiotherapy
2.3. The Contribution of and Concerns about Chemotherapy
2.4. The Contribution of and Concerns about Targeted Therapy
2.5. The Contribution of and Concerns about Immunotherapy
3. Curability by Cancer Type and Stage
4. Cancer Screenings and Their Pros and Cons
5. A Newly Proposed Broad-Spectrum Anti-Cancer Strategy Based on a Dual Stroma-Targeting Approach: Orchestrating with Liquid Biopsy
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
ADCC | antibody-dependent cellular cytotoxicity |
ALL | acute lymphoid leukemia |
ALK | anaplastic lymphoma kinase |
APC | antigen-presenting cell |
CD | cluster of differentiation |
CRC | colorectal cancer |
CT | computed tomography |
PET | positron emission tomography |
CTLA-4 | cytotoxic T-lymphocyte-associated protein 4 |
DFS | disease-free survival |
DNA | deoxyribonucleic acid |
EBRT | external beam radiotherapy |
EGFR | epidermal growth factor receptor |
EMA | European Medicines Agency |
GI | gastrointestinal |
HCC | hepatocellular carcinoma |
HSCT | hematopoietic stem cell transplantation |
ICIs | immune checkpoint inhibitors |
IMRT | intensity-modulated radiation therapy |
KRAS | Ki-ras2 Kirsten rat sarcoma viral oncogene homolog |
MHC | major histocompatibility complex |
MRD | minimal residual disease |
NA | non-applicable |
NCCN | national comprehensive cancer network |
NP | nanoparticles |
NPC | nasopharyngeal carcinoma |
NSCLC | non-small cell lung cancer |
OS | overall survival |
PD-1 | programmed death 1 |
PD-L1 | programmed death ligand 1 |
PDT | photodynamic therapy |
PFS | progression-free survival |
PSA | prostate-specific antigen |
RAI | radioactive iodine |
RECIST | response evaluation criteria in solid tumours |
R1 | rhabdomyosarcoma |
RSR | relative survival rate |
SBRT | stereotactic body radiation therapy |
SCLC | small cell lung cancer |
SEER | surveillance, epidemiology and end results |
TACE | transcatheter arterial chemoembolization |
TCR | T cell receptor |
TKI | tyrosine kinase inhibitor |
TNM | tumour-node-metastasis |
VDAs | vascular-disrupting agents |
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Cancer Therapy * | Mechanism | Curative Potential | Example | Limitations |
---|---|---|---|---|
Surgery | ||||
Open surgery | Physical removal of cancer, adjacent tissue, and involved lymph nodes | For early solid cancer, +++ | Early NSCLC [162], HCC [163], renal cancer [164] | Surgical injury [165], cancer dissemination [166] |
Laparoscopic surgery | Same as above | Same as above | Same as above | Surgical injury [165], cancer dissemination [166], dependence of centralized expert surgeons [53] |
Robotic surgery | Same as above | Same as above | HCC [167], prostate cancer [168] | Same as above, imperfectly confirmed efficacy |
Endoscopic surgery | Same as above | Same as above | Early GI cancer [169,170] | Possible second surgery [171], perforation [172] |
Interventions | ||||
Ablations | In situ necrotizing cancer and adjacent tissue by local hyperthermal ablation, cryotherapy, or absolute ethanol injection. | For early eligible cancer, +++ | HCC [173], renal cancer [174], lung cancer [175] | Often incomplete ablation [176], injury to adjacent tissue [177,178] |
TACE | Embolization of cancer supplying artery combined with local chemotherapy | −/+ | HCC [179] | Often incomplete cell death [179] |
Chemotherapy | ||||
Direct | Alteration of DNA synthesis and structure or cytoskeleton | For chemotherapy sensitive cancer, +++ | Early lymphoma [180], ALL [181], seminoma [182] | Pancytopenia, nausea, infertility, neuropathy [136], secondary cancer [183] |
Indirect | Immunomodulation, vascular disrupting effect | −/+ | NA | Venous thrombosis [184], recurrence [185] |
Radiotherapy | ||||
External beam | Alteration of DNA structure via radicals | For radiotherapy sensitive cancer, +++ | Early lymphoma [186], NPC [187], +++ | Unintentional destruction along entrance channel [188], secondary cancer [189] |
Radioiodine | Same as above, for thyroid cancer with iodine intake | For thyroid cancer with iodine intake, ++ | Thyroid cancer [108] | Side-effects [190], secondary cancer [109] |
Radiopharmacy (Lutetium 177) | Same as above | −/+ | NA | Side-effects [191], secondary cancer [192] |
Brachytherapy | Same as above | −/+ | NA | Side-effects [193], secondary cancer [194] |
Targeted therapy | ||||
Direct | Inhibition of signaling pathway, ADCC for monoclonal antibody | −/+ | NA | Acquired resistance [195]; narrow spectrum of optimal patients [196] |
Indirect | Anti-angiogenesis | −/+ | NA | Acquired resistance [197], low response rate [198], rare but fatal side-effects [198,199,200] |
Immunotherapy | ||||
Immune checkpoint inhibitors | Restore anticancer immunity | Only possible in responded cases (about 10%) [201], + | Melanoma [148] | Unpredictability of response [158], rare but fatal side-effects [161] |
Cellular immunotherapy | Elimination of cancer cells by immune cells with or without engineering | −/+ | Leukemia [202] | High cost [203], severe side-effects [204] |
Bone marrow transplantation | Elimination of cancer cells by intensive chemotherapy and graft-versus-leukemia effect | Yes, for high-risk haematological cancer [205], +++ | Leukemia [206]; lymphoma [207]; | High mortality rate (5%) [208] and extensive post-transplantation care [209] |
Endocrine therapy | Inhabitation of growth by altering hormone signaling | Unknown #, for hormone receptor positive patients, ++ | Prostate cancer [210], breast cancer [211] | Secondary cancer [212] |
Cancer Type | Current Treatment | Curative Possibility, 5-Year RSR | Curative Methods | Stages Distribution (Localized, Regional, Distant) ‡ | 5-Year RSR by Stage ‡ |
---|---|---|---|---|---|
Head and Neck | Surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy [221] | ++, 68.6% | Surgery, radiotherapy | 30,2%, 52,4%, 17,4% | 85.8%, 67.3%, 40.8% |
Thyroid | |||||
Papillary | Surgery, radioiodine therapy (131I), targeted therapy [222] | +++, 99.7% | Surgery, radioiodine therapy (131I) | 63,6%, 33,8%, 2,7% | 100.0%, 99.4%, 82.1% |
Follicular | Surgery, radioiodine therapy (131I), targeted therapy [222] | +++, 94.3% | Surgery, radioiodine therapy (131I) | 55,5%, 39,1%, 5,5% | 99.1%, 93.2%, 33.8% |
Medullary | Surgery, targeted therapy [222] | +++, 80.9% | Surgery | 37,0%, 38,9%, 24,1% | 100.0%, 92.2%, 24.4% |
Anaplastic * | Surgery, radiotherapy, targeted therapy, chemotherapy [222] | +, 4.7% | Surgery | 9,5%, 42,9%, 47,6% | 0.0%, 11.3%, 0.0% |
Breast | |||||
Breast | Surgery, chemotherapy, radiotherapy, targeted therapy, endocrine therapy [211] | +++, 90.8% | Surgery | 63,2%, 29,3%, 7,5% | 99.1%, 88.3%, 36.3% |
Lung | |||||
Non-small cell lung cancer | Surgery, radiotherapy, chemotherapy, immunotherapy, targeted therapy [223] | +, 21.0% | Surgery, radiotherapy [224] § | 18,3%, 24,1%, 57,6% | 58.3%, 32.2%, 4.7% |
Small cell lung cancer | Surgery, radiotherapy, chemotherapy, immunotherapy [225] | +, 7.0% | Surgery | 19,3%, 80,4%, 0,3% | 23.9%, 18.4%, 3.1% |
Gastrointestinal cancer | |||||
Oesophagus | Surgery, radiotherapy, chemotherapy, immunotherapy [226,227] | +, 22.3% | Surgery, endoscopic resection | 21,4%, 32,6%, 45,9% | 56.0%, 28.0%, 4.2% |
Gastric | Surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy [42] | +, 20.2% | Surgery, endoscopic resection | 22,5%, 28,9%, 48,5% | 52.8%, 28.3%, 3.1% |
Hepatocellular carcinoma | Surgery, intervention, targeted therapy, radiotherapy, chemotherapy, immunotherapy [228] | +, 21.2% | Surgical resection, transplantation, local ablation | 53,4%, 31,6%, 15,0% | 35.1%, 9.6%, 2.1% |
Pancreatic cancer | Surgery, targeted therapy, intervention, radiotherapy, chemotherapy [229] | +, 8.4% | Surgery | 21,0%, 78,9%, 0,1% | 32.5%, 10.8%, 3.3% |
Colorectal | Surgery, chemotherapy, targeted therapy, radiotherapy, immunotherapy [230] | ++, 66.7% | Surgery, endoscopic resection | 42,6%, 35,6%, 21,7% | 90.2%, 75.0%, 13.6% |
Anal | Surgery, chemotherapy, radiotherapy (EBRT, brachytherapy), targeted therapy [231] | ++, 74.3% | Surgery | 54,6%, 35,3%, 10,2% | 83.7%, 67.9%, 44.7% |
Genitourinary cancer | |||||
Renal | Surgery, chemotherapy, targeted therapy, immunotherapy, ablation, radiotherapy [232] | ++, 74.6% | Surgery, local ablation [174] § | 0,2%, 51,8%, 48,0% | 92.9%, 70.0%, 11.4% |
Bladder | Surgery, chemotherapy, targeted therapy, radiotherapy, immunotherapy [233] | +++, 77.3% | Surgery | 0,3%, 77,9%, 21,8% | 90.8%, 44.9%, 3.7% |
Prostate | Surgery, chemotherapy, radiotherapy (EBRT, brachytherapy), endocrine therapy [210] | +++, 99.5% | Surgery | 95,4% +, 4,6% | 100% +, 28.2% |
Testicular | Surgery, chemotherapy, radiotherapy [234] | +++, 96.4% | Surgery, chemotherapy, radiotherapy | 71,5%, 17,9%, 10,6% | 99.9%, 99.1%, 73.8% |
Gynaecological cancer | |||||
Ovarian | Surgery, chemotherapy, radiotherapy, targeted therapy, endocrine therapy [235] | ++, 46.8% | Surgery | 64,8%, 35,0%. 0,2% | 95.0%, 62.8%, 31.7% |
Endometrial | Surgery, chemotherapy, radiotherapy, targeted therapy, endocrine therapy, immunotherapy [236] | +++, 85.2% | Surgery | 0,3%, 63,0%, 36,7% | 96.5%, 71.6%, 32.5% |
Cervical | Surgery, chemotherapy, radiotherapy (EBRT, brachytherapy), targeted therapy, immunotherapy [237] | ++, 69.1% | Surgery | 48,5%, 36,6%, 14,9% | 92.4%, 60.9%, 18.0% |
Melanoma | |||||
Melanoma | Surgery, chemotherapy, radiotherapy, targeted therapy, PDT, immunotherapy [238] | +++, 93.7% | Surgery, PDT, immunotherapy | 0,7%, 68,6%, 30,7% | 99.4%, 68.3%, 17.9% |
Leukemia $ | |||||
Acute lymphoid leukemia | Chemotherapy, targeted therapy, CAR-T, HSCT [239,240] | ++, 74.0% | Chemotherapy, HSCT | NA | NA |
Acute myeloid leukemia | Chemotherapy, targeted therapy, CAR-T, HSCT [241,242] | +, 28.6% | Chemotherapy, HSCT | NA | NA |
Chronic lymphoid leukemia | Chemotherapy, targeted therapy, HSCT, observation ¶ [243] | +++, 82.2% | Chemotherapy, HSCT | NA | NA |
Chronic myeloid leukemia | Chemotherapy, targeted therapy, HSCT, observation ¶ [244] | ++, 70.0% | Chemotherapy, HSCT | NA | NA |
Lymphoma £ | |||||
Hodgkin’s | Chemotherapy, targeted therapy, HSCT, radiotherapy, immunotherapy [37] | +++, 86.7% | Chemotherapy, HSCT | 15,4%, 42,6%, 22,1%, 20,0% | 93.2%, 93.2%, 83.7%, 72.2% |
Non-Hodgkin’s | Chemotherapy, targeted therapy, HSCT, radiotherapy, immunotherapy [36] | ++, 72.6% | Chemotherapy, HSCT | 28,1%, 16,6%, 17,5%, 37,8% | 83.6%, 77.0%, 68.3%, 66.5% |
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Wang, S.; Liu, Y.; Feng, Y.; Zhang, J.; Swinnen, J.; Li, Y.; Ni, Y. A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed. Cancers 2019, 11, 1782. https://doi.org/10.3390/cancers11111782
Wang S, Liu Y, Feng Y, Zhang J, Swinnen J, Li Y, Ni Y. A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed. Cancers. 2019; 11(11):1782. https://doi.org/10.3390/cancers11111782
Chicago/Turabian StyleWang, Shuncong, Yewei Liu, Yuanbo Feng, Jian Zhang, Johan Swinnen, Yue Li, and Yicheng Ni. 2019. "A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed" Cancers 11, no. 11: 1782. https://doi.org/10.3390/cancers11111782