Cancer research, where are we?

Side cancer treatments: rapid innovations

"It takes just 5 years between the discovery of a molecule and the availability of the drug," says Pr Agnès Buzyn, Chair of the Board of Directors of the National Cancer Institute (CNIB). "When we list new molecules, we evaluate them much faster than ten years ago, they are proposed in" routine "to all who can benefit," she says. And this acceleration in access to treatment is accompanied by innovations.
The boom of "tailor-made" therapies

3 or 4 years ago, all patients received standard chemo. The wind has turned. More and more often personalized treatments are proposed, in addition to or instead of chemo. "We are no longer treating" a "breast or lung cancer, but a" biological profile "", explains Prof. Jean-François Morere, Chief of Oncology at Avicenne Hospital (Bobigny) and author of "Cancer for Dummies "(First). "In a blood test or a portion of cancerous tissue, we first search for a" biomarker "that tells us that this or that drug will work better than another. "

Immunotherapy: the comeback

For thirty years, doctors have been looking for ways to activate our own immunity to fight cancer. Without success. Today, trials have finally borne fruit in the treatment of melanoma with metastasis, a skin cancer for which there were so far few solutions. The principle: to collect white blood cells, then put them in contact with tumor cells in vitro to make them react. The "vaccine" obtained is then reinjected into the patient. Cancers of the kidney and uterus would also be good candidates for immunotherapy.

A quick test to determine whether to remove the lymph nodes
Already used in nearly 150 hospitals in Europe, and in France in some hospitals (Rennes, Rouen, Saint-Etienne), this new molecular biology test is called OSNA (One Step Nucleic Acid Amplification). Performed during the operation, it allows to have in 30 minutes a result on the involvement of ganglia, preserve those who can be and thus avoid lymphedema (big arm). No metastasis. The operation ends. The result of the test is positive The lymph nodes must be removed. Interest: without this test, one is obliged to wait nearly 15 days the return of the results and, in case of positive answers, to reoperate.

Better targeted radiotherapy

Used to "burn" the remaining potentially cancerous cells, the technique has also progressed. Better tolerated, it overflows less on healthy tissue. The radiotherapy is more precise. In addition, the National Cancer Institute has given the green light to eight cancer centers for a 24-month trial. Objective: To determine whether a single radiation therapy session during breast cancer surgery (at the time the surgeon removes the tumor) could have the same benefits as the standard treatment of approximately 27 radiotherapy sessions.

Breast cancer: breast reconstruction in full evolution

Doctors are increasingly proposing "conservative treatment". Only the tumor is removed, not the breast. But when ablation is inevitable (30 to 40% of cancers), what are the solutions? Breast reconstruction, proposed in the event of complete removal (and reimbursed), can be immediate or delayed. The surgeon has several techniques: fitting a prosthesis followed by that of a nipple or using an abdominal muscle or dorsal to reform a breast at the cost of a scar in the back or on the stomach.

The filling option.

A more light method has appeared: the filling or injection of fat (taken on the buttocks or the abdomen). Interest? "Thickness is given to the skin if it has been damaged by radiotherapy," says Dr. Isabelle Sarfati, a surgeon at the Breast Institute (Paris). Filling may also be a solution when the prosthesis hardens and forms a shell. You can then replace it with grease, but only if you do it several times.

Rebuild or not?

The question remains sensitive for the 20,000 women per year who have a mastectomy. Nearly 80% have no reconstruction: it is difficult to achieve (the tissues have been weakened by radiotherapy) for some and others refuse it. Most juggle with prostheses to slide into the bra. Others assume their image of amazons. There is an asymmetric bra: the Souti1 © (195 € on www.souti1.com). "It represents the strength of my commitment: cancer has taken neither my life nor my femininity," claims Catherine Malhouitre, creator of this Souti1 ©, after two cancers.

Cancer screening and diagnosis: more accurate machines

If we manage cancer better and better, it is also because we discover them at a stage where they are still curable. And in this area, technology is proving invaluable ...
High tech in support X-ray machines are increasingly equipped with detection aids: the machine analyzes the image and, as soon as it spots something unusual, it marks it on the radio. "It becomes difficult for the radiologist to miss a suspicious nodule," says Dr. Anne Tardivon, a radiologist at the Institut Curie (Paris). These tools are already available for mammograms (digital mammos, as opposed to analogs) and appear in ultrasound and in scans to determine the presence of pulmonary nodules.

Soon a mammoth in 3D?

Current devices are sufficient: almost 88% of breast cancers are detected with this examination alone and a mandatory 2nd reading still catches close to 8% of cases (and ultrasound completes routine screening). However, radiologists are interested in a new technique, tomosynthesis. By producing a "cut" image, we can recreate one in volume, "we can better see the nodules and their contours," says Dr. Tardivon. The machines are available but one must evaluate the benefit of these exams by comparing them to the MRI and train the radiologists. If the results are as interesting as an MRI, it would bring progress because France lacks imaging devices. "

Angiomammography, kezako?

This mammogram, appeared last year at home, is performed by injecting, in addition, an iodine product, contrast. This allows to see, in addition to nodules potentially suspicious, if there is a vascularization of this nodule. Because a tumor needs to feed to grow, it develops small vessels to draw nutrients into the blood.
Test-based tests Cancer could soon be found in a drop of blood or urine. Inserm researchers announced a few months ago to have been able to develop a test to detect patches of cancer cells in body fluids. The find has to prove itself on a large scale, but it could be very effective in colon cancer and leukemia.

After cancer ... Better and better managed

The period of recovery from cancer should preserve the quality of life before. A recent Viavoice survey for the Institut Curie shows that of the 350,000 people affected by the disease each year, 100,000 work. But "if 8 out of 10 employees rework after a cancer, half of them say they encounter difficulties," denounces Dr. Bernard Asselain, Institut Curie, who promises the next edition of an information booklet on this restart period. In the meantime, we take advantage of the advice of Michel Cymes and Marina Carrère d'Encausse in "L'après-cancer" (Hello Doctor, Hachette Pratique).
More conciliatory assurances? • Accustomed to refuse people with cancer, insurance and credit organizations are forced to review their contracts. "You have to consider someone with a condition as someone who is not convicted.

One in two cancers is curable and sometimes more depending on the affected area, "recalls Professor Agnes Buzyn. Negotiations are underway, via the AERAS (Insuring and Borrowing with Enhanced Health Risk) conventions to facilitate access to insurance and credit. But if the awareness is there, everything remains to be done.

Spa treatments specialize?

The center of La Roche-Posay was the first to propose a protocol for women after breast cancer. Results: attenuated scars, softer skin, including irradiated areas, lymphedema (large arms) less important. Three other centers (Vichy, Châtel-Guyon, Le Mont-Dore) evaluate the effect of a cure on women at the end of cancer treatment.