Pioneering research and the battle against cancer

This year marks the centenary of the birth of Gertrude Elion. Many will know her as the American biochemist who shared the 1988 Nobel Prize in Physiology or Medicine with George H Hitchings and Sir James Black. Born in New York City in 1918 to Lithuanian and Polish immigrants, Elion is said to have acquired a thirst for discovering the cure for cancer in the early 1930s when her grandfather succumbed to the illness. She was just 15 at the time, but she went on to graduate from Hunter College in 1937 and New York University in 1941 with Bachelor of Chemistry and Master of Science degrees respectively. After a time, she acquired a position as assistant to George H Hitchings at the Burroughs-Wellcome pharmaceutical company, New York. She worked in pharmaceuticals for the rest of her life.

Elion’s list of pharmaceutical inventions is impressive. They include trimethoprim, acyclovir, allopurinol, azathioprine and (for malaria) pyrimethamine. Perhaps in fulfilment of her promise to her grandfather, she developed mercaptopurine, the first treatment for acute lymphocytic and chronic myeloid leukaemia, among other illnesses. She was also involved in the development of nelarabine, also for the treatment of leukaemia. Elion’s was a decorated career spanning some six decades until her death in 1999. How different the battle against cancer might have been without her.

Are we winning this battle? According to the World Health Organization,¹ cancer remains one of the leading causes of morbidity and mortality worldwide, with around 14 million new cases diagnosed in 2012. This is expected to increase by around 70% over the next 20 years. As the second biggest cause of death globally, cancer was responsible for some 8.8 million deaths in 2015 and accounts for almost one in six deaths overall. The five most notable risk factors remain diet, obesity, physical inactivity, alcohol and tobacco, with the latter remaining the most important factor as it accounts for some 22% of cancer deaths. The global annual economic impact of cancer was estimated at us$1.16 in 2010. According to the recently-reported CONCORD global surveillance study (of some 37.5 million cancer cases), the five-year net survival remains highest in the US, Canada, Australia, New Zealand and Scandinavia.²

So, what about Ireland? The National Cancer Registry’s projections for Ireland 2015-2040³ warns of a 50% increase in cancer cases by 2025, with rates for new invasive cancer in females and males increasing by 84% and 107% respectively between 2010 and 2040. The biggest rise is anticipated for skin cancer (both melanoma and non-melanoma), followed by cancers of the oesophagus, pancreas and hepatobiliary tract. Cancers of the colon and lung are expected to increase significantly, while cancers of the breast and prostate are statistically less clear. Either way, the need for treatment will rise. Indeed, cancer-related surgery, chemotherapy and radiotherapy are projected to increase by 50-55%, 42-48% and 32-35% respectively between 2010 and 2025.  

But people are living longer, partly because of the emphasis on early detection. Recent media attention has focused on the CancerSEEK blood test, which we are told can detect eight common types of cancer by identifying levels of circulating proteins and mutations in cell-free DNA. According to Cohen et al,⁴ the blood test is sensitive to a median of 70% of ovarian, hepatic, stomach, pancreatic, oesophageal, colorectal, lung and breast cancers, with a false-positive level of less than 1%. In most cases, CancerSEEK is also able to localise the cancer. Just one example, perhaps, of pioneering research in the manner of Gertrude Elion.

References

1. www.who.int (accessed 1/2/2018).
2. Allemani C et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individuals records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet (2018): DOI.ORG/:10.1016/S0140-6736(17)33326-3
3. National Cancer Registry. Cancer Projections for Ireland 2015-2040
4. Cohen JD, Li L, Wang Y et al. Detection and localization of surgically resectable cancers with a multi-analyte blood test. Science 2018; doi:10.1125/science.aar3247