Armine Smith, Director of Urologic Oncology, Sibley Memorial Hospital
Technology in medicine is moving at a rapid pace, and oncology has been at the forefront of these advances. Cancer patients are both profoundly affected and benefit immensely from medical innovation, including discovery of disease-specific biomarkers, and novel diagnostic and treatment modalities. Identification of targeted drugs allows designing personalized regimens for patients instead of attacking them with a multitude of toxic treatments with the hope that one of them works. Driving the innovation in the field of oncology has been the improved understanding of the molecular mechanisms behind the development and progression of cancers. In the past few years we have performed genetic profiling of patients and built GWAS databases that associate genetic alterations with diseases. We have learned gene editing using CRISPR technology; this is the powerful tool bacteria use to remove and destroy the foreign DNA of viruses which attack them. We have developed cancer immunotherapy by using medications designed to strengthen one’s innate response and prevent cancer cells from evading the immunity of the host. In certain cancers we have used adoptive cell transfer therapy, which includes isolation of immune cells from the patient, expansion and modification or potentiation of their action in the laboratory prior to infusing them back into the individual.
On the other end of the spectrum, robots have become an integral part of patient care. Since the development of primitive surgical robots in 1985, this field has grown exponentially. Although the first surgical application of da Vinci robotic system was as recent as early 2000s, robot is now used routinely in cancer surgery, and it is no longer the tool of future. With further advances in computer programming and artificial intelligence, we are beginning to use machine-learning in microscopic examination of tumors and radiographic images and training of specialists. The combination of telemedicine with robotic surgery can be used to traverse long distances in global setting to remotely deliver highly specialized surgery to the patients.
Unfortunately, despite the rapid growth of our knowledge and capacity to treat cancers, our quest to rid humanity from this disease is far from complete. Cancers grow and adapt to the host organism, they alter the microenvironment of the host to deregulate the system in favor for their growth and system collapse, and they evolve in response to treatment. These escape mechanisms account for our difficulty in obtaining a lasting cure. Even one surviving cancer cell has the potential to eventually outsmart the host defense and escape the treatment by developing one of the many drug resistance mechanisms. Some cells can evade host defense and remain dormant for a long time, giving rise to new cancerous colonies. Unless the malignancy is totally eradicated, the “cancer swamp” eventually overwhelms the system to cause a lethal shutdown.
The more we learn about cancer the more opportunity there is to further our knowledge and technological innovation, but as we move towards the era of “homo deus” we should be cognizant of the dangers that arise from our ability to conquer and modify nature. How do we efficiently control powers that come with scientific advancement? Where do we stop? There are many questions and uncertainties that accompany our technologic growth. Policing science doesn’t replace accountability, and we all have a moral obligation to ensure responsible use of technology to safeguard our future.