Progress within borders

Numerous achievements have been made in the fight against cancer since we began our careers in the 1980s. Thanks to improvements in early detection, diagnosis and treatment, the average five-year survival rate after diagnosis has been rising by 0.7% a year. Though this change may seem small, today more than half of cancer patients survive the disease for at least five years. This positive result can be attributed primarily to countless small but important improvements in diagnostics, surgery, chemotherapy and radiotherapy.

The international community of cancer researchers gained many fundamental insights in the 1980s and 1990s regarding the development of cancer. For instance, we identified the first genes that mutated into cancer-causing oncogenes, and we began to understand how normal cell division takes place and how cancer disrupts the process. These were exciting discoveries. Frustratingly, however, all the important new insights did little to bring about better treatments for people with cancer.

Enter: the revolution

A revolution took place in 2001 with the mapping of the human genome. We found out what normal human genetic information looks like. Three billion DNA building blocks contain the code for the 20,000-plus genes it takes to make a unique human being. This meant cancer researchers could see how genetic information is altered in cancer cells. Rapid improvements in DNA analysis enabled them to determine the precise DNA makeup of many thousands of tumors within a relatively short time. The findings were staggering. For instance, a large-scale analysis of 2,000 breast tumors found that no two tumors had exactly the same DNA defects. Researchers reached the same conclusion with regard to other types of cancer. And it became clear that along with classifying cancer according to the organ in which it starts (breast cancer, lung cancer), diagnosis should include the DNA defects responsible for causing the illness. We now know of a number of DNA defects that are directly predictive of which treatments will and won’t work. In some cases, looking at gene expression can also enable us to better predict whether a tumour will metastasize, which helps us to choose the correct supplementary treatment. And this is only the beginning.

Personal and self-powered

In parallel with this revolution, which occurred roughly between 2000 and 2015, the pharmaceutical industry developed a new class of cancer drug that specifically targets proteins in cancer cells that have been dysregulated by cancer-specific mutations. These medicines work only on cancers in which these dysregulated proteins are present; this can be determined through analyzing the mutations in the cancer DNA. The drug erlotinib, for instance, works only for patients with EGFR-mutant lung cancers. Along with a microscope, a modern cancer pathologist needs a DNA-analysis machine to determine which patient should take which medication. This new approach of treating cancer with targeted drugs is known as personalized medicine.

Another revolution in cancer treatment is at least as important. After more than 40 years of fundamental research, we now understand how to help a patient’s own immune system to recognize and attack tumors. New medicines developed on the basis of this knowledge are achieving impressive results in fighting different types of cancer.

Founding a new force

All these examples demonstrate that new fundamental insights are finding clinical application with increasing speed, and this is good news for patients. To help make the fight against cancer even more effective, three Dutch government ministries (Health, Welfare and Sport; Economic Affairs and Climate Policy; and Education, Culture and Science) and KWF Kankerbestrijding (the Dutch Cancer Society) launched Oncode Institute on February 5, 2018. This new institute represents the joining of forces of a number of leading Dutch cancer researchers, supported by a team who will work to ensure that all discoveries benefit patients as quickly as possible. Oncode Institute will also strive to keep newly developed medicines affordable. This is becoming acutely necessary in light of the astronomical increase in prices of new cancer drugs.

What will Oncode Institute do for you as a cancer patient? First, it has been firmly established that innovative fundamental research eventually leads to better cancer medicines, earlier detection and effective prevention. This gives us all the more reason to vigorously pursue fundamental research at Oncode Institute. For there are still a great many things we do not know. For example, cancer cells that do not respond, or stop responding, to chemotherapy or immunotherapy constitute an immensely frustrating problem. We do not always yet know why this is so, or how to recognize such nonresponsiveness in a timely manner. More fundamental knowledge is urgently needed.

Second, Oncode will endeavor to subject new ideas to clinical trials more quickly. This means patients will get earlier access to innovative experimental therapies. Third, Oncode will work to bring new cancer therapies to the market at affordable prices. Today, a new cancer medicine can cost more than €100,000 per patient per year. In addition, such drugs often must be taken in combination to be effective. This means some new treatments cost more than the average house in the Netherlands! We at Oncode Institute realize that innovation is only useful if the results are affordable for society. Oncode will therefore establish an active program aimed at bringing medicines to market in accordance with a new model that will allow it to retain more say over the price patients have to pay for a drug.

Oncode Institute

Our motto sums up our mission: Outsmarting cancer, impacting lives. All of us at Oncode Institute are deeply committed to enabling you as a cancer patient to profit from our new discoveries as quickly as possible. And with our annual budget set at €25 million over the next five years, you can expect positive news from us.

The founding scientists,

René Bernards, Anton Berns, Hans Bos, Hans Clevers and Jan Hoeijmakers