My comprehensive guide to navigating a cancer diagnosis

Exciting treatment advancements offer hope for a less barbaric future

It was only a matter of time before people started to rebel against the conventional “cut, poison, burn” approach to cancer treatment… and more specifically, whether it’s worth the devastation it causes.

Of course, my patients have pushed back against this status quo for years—which is exactly why they come to see me.

But at long last, more than two decades into the 21^st century, the tide is shifting in mainstream circles, too.

I would like to say it’s because oncologists have come to their senses where quality of life is concerned. But that’s not exactly true. Rather, more and more doctors are simply starting to pay attention to technical advances that can help us target cancer more efficiently—a step in the right direction, even if it is long overdue.

Because believe it or not, this sort of technology has been around for a while. In fact, more than 20 years ago, there were pioneering doctors taking the actual tumor cells of patients and testing various forms of chemotherapy to find the right fit.

Of course, conventional medicine waved off these experimental techniques—here in the states, especially. But this individualized approach has been embraced in Europe, and we’re hitting some serious pay dirt because of it, in the form of solid scientific evidence.

So let’s take a closer look at what’s happening right now in this fascinating field. And hopefully, it offers some hope for a less barbaric future.

Chemotherapy could prove pointless

First things first: When it comes to incredible advances in the fight against cancer, mainstream medicine will point to our greater understanding of genetics. In fact, if you or someone you know has a family history of cancer, there’s a good chance that you have firsthand experience with genetic testing—which assesses your cancer risk.

But there have been great advancements in the understanding of the cancer genome as well. And genomic testing actually uses tumor tissue analysis to help guide treatment decisions.

This type of testing can help assess the aggressiveness of your cancer and tell you how responsive it is likely to be to drug therapy.

In fact, one recent, large European study looked at nearly 6,700 women with early-stage breast cancer. Researchers focused primarily on a sub-group identified as “high-risk” based on typical clinical diagnostic procedures, but “low-risk” according to results of a genomic test called MammaPrint.

(In other words, genomic testing indicated these women had a less aggressive, slower moving cancer… something typical diagnostic procedures can’t really effectively determine.)

Results showed that—in this genomically low-risk group—the five-year, metastasis-free survival rate was only 1.5 percent higher for women who received chemotherapy versus those who didn’t.¹ That’s a pretty measly “benefit” when you stop to consider the personal cost of chemotherapy.

Chemotherapy is powerful stuff that ravages your body. And yet, it offers little in the way of increased survival for a significant percentage of women with breast cancer.

But without genomic testing, ALL of these women would very likely have been subjected to chemotherapy—because it’s simply the mainstream’s go-to cancer treatment (and a very big cash cow indeed).

Up to 85,000 breast cancer patients in the U.S. could skip chemo

There’s a similar type of genomic test, called Oncotype DX, which I use in my own practice. And another recent study shows this tool could also be valuable in helping pinpoint who might actually benefit from aggressive breast cancer treatment—and who might be better off without it.

Starting in 2006, researchers recruited more than 10,000 early-stage breast cancer patients from across the U.S. and five other countries, and followed them through treatment after surgery.

Using the Oncotype DX test, they analyzed the tumors to assess the activity of 21 different genes that can predict risk of recurrence over the next decade. And while previous research focused on low-risk women, this study also dealt with patients in the intermediate-risk category.

Researchers randomly assigned more than 6,700 intermediate-risk women to two different groups: One group received chemo and endocrine therapy (like tamoxifen). The other received endocrine therapy alone.

Data revealed that chemo didn’t make a difference for women over 50 years.² (However, younger women still benefited.)

As I mentioned above, research already shows that low-risk women who have their tumors genetically sequenced can safely opt out of chemotherapy. Now if you include intermediate-risk women in the same category, we’re talking about 70 percent of all women with the most common type of early breast cancer who may be able to safely opt out.

That adds up to more than 85,000 patients per year who could be spared the ravages of chemo—and that’s just in the U.S.

Of course, it’s important to note that the type of cancer we’re discussing here is:

• Hormone receptor positive—meaning the tumor consists of cells that express receptors for certain hormones.
• Has not spread to the lymph nodes.
• HER2 negative—meaning tests show no abnormality in the human epidermal growth factor receptor 2 gene.

In these cases, I have always felt that the best treatment option is an estrogen blocker that cuts off the cancer’s hormonal supply (like tamoxifen) to reduce and stop its spread. So I’m excited to see scientific evidence finally supporting this stance—and I’m anxious to see how future results may eventually translate to treating other forms of the disease as well.

Treatment doesn’t have to be psychologically stressful

It’s clear that genomic testing could save many women from unneeded and unwanted chemotherapy. It will also spare them the psychological stress of having to make a treatment choice under pressure—hopefully, with fewer doctors clamoring for patients to start treatment immediately.

For the record, results like these are one big reason why I always say prognosis is the true end point, and all we really need to look at when making treatment decisions. Because when faced with a disease like cancer, what you can do and what you should do are often two different things.

The question always boils down to what treatment is going to allow you to live well, for the longest time. And as this research shows, for many breast cancer patients, chemotherapy isn’t necessarily the answer.

The good news is, MammaPrint and Oncotype DX are both widely used in clinical practice. (As I mentioned, I use the latter in my own office.)

But there are other tests out there too that not only help detect breast cancer—like the Breast Cancer Index (7-gene signature), EndoPredict (12-gene signature), and Mammostrat (5-gene signature)—but also other types of cancer. For example, you have the M2Pk test, fecal immunochemical test (FIT), or Cologuard test for colon cancer. And the Prostate Cancer Anitgen 3 (PCA3) test, the 4Kscore test, or MRI/ultrasound fusion biopsies for prostate cancer. Not to mention, we even have more general cancer screening tools in development, like the PanSeer assay or Galleri blood tests (to help detect cancer markers in your blood). And as time goes on, I imagine we can expect even more tests to hit the market.

Of course, these tests aren’t cheap. But if you or anyone you know is facing tough decisions about whether to undergo chemo or not and are able to make the financial investment, they’re definitely worth it. (You should also see which tests, if any, are covered by insurance. For instance, Medicare now covers Oncotype DX.)

Now, let’s turn our attention to another new cancer “breakthrough” that may not quite live up to the hype…

Biologics aren’t a magic bullet

There is now a class of anti-cancer medications on the market known as biologics. These new cancer therapies target genetic abnormalities on cancer cells, so it’s easy to see why the enthusiasm surrounding them is so high.

Unfortunately, however, they’re only effective in a small portion of patients with advanced cancer.

Specifically, recent research found that roughly nine out of 100 cancer patients were eligible for one of these drugs. And maybe five out of 100 of those patients would actually benefit from the drug—seeing their tumor shrink in response to treatment.³

That’s a pretty generous definition of the term “benefit.”

That’s why I feel it’s important to be realistic with regard to our expectations where these treatments are concerned. Granted, smaller tumors do generally mean extended life. And more life lived is a benefit. But, as I pointed out above, when you look closely at the numbers, on average, just 5 percent of cancer patients stand to gain that benefit.

Now, this isn’t to say these drugs aren’t a promising avenue of continued research. But would I go so far as to say they’re a “magic bullet”? Not quite.

Obviously, I’m not a big fan of chemotherapy, and anything that moves us away from its use is progress in my book. But we can’t afford to leave any stone unturned in the quest to find new, better cancer treatments. And unfortunately, biologics—however exciting they appear—don’t look to be the “be all, end all” we’ve been searching for.

Not to mention, they’re expensive. Which is why, in the end, it’s up to you to decide what treatment option may be worthy to you.

The good news is, the newest advances in cancer treatment aren’t limited to drugs alone. In fact, some doctors are now using an immune cell approach to treat and fight this disease—essentially creating a personalized “vaccine” against your particular cancer.

Personalized cancer “vaccines” on the horizon

The story of Judy Perkins—a 52-year-old Florida woman diagnosed with end-stage breast cancer and given just three months to live—provides one especially successful example of how this treatment option works.⁴

After studying Judy’s immune cells, scientists were able to identify white blood cells with the unique ability to identify genetic mutations and beat back cancer—by examining and sequencing small pieces of tissue from the tumors.

Once they pinpointed the immune cells that targeted these mutations, they harvested them and grew an army of them in a lab. Then, they infused Judy with roughly 90 billion of them—alongside an experimental drug called pembrolizumab.

Pembrolizumab is a biologic, which as I explained above, show limited promise on their own. But with the addition of this new form of immunotherapy, we may actually be getting somewhere. Because within just ten days of treatment, Judy’s tumors began to shrink.

What’s more, the infused immune cells remained in her system for at least a year-and-a-half after she first received the treatment. Presumably keeping the cancer from coming back.

This type of immunotherapy is still experimental, and mostly reserved for patients like Judy—with end-stage cancers and only months to live. But if this approach eventually makes its way to a larger patient population, we could possibly have a real-life “miracle” on our hands. At the very least, it’s poised to change the way we treat cancer forever.

It could mean, for example, that each patient starts receiving a unique “drug” designed from the components of their own immune system. Which may sound crazy on the surface. But when you think about it, that’s exactly how your body fights off cancer on its own in the first place.

It’s high time to rewrite the cancer care “cookbook”

Here’s the bottom line: It may have taken decades, but we are finally getting to the point where cancer treatment can be tailored and individualized.

Functional profiling of patients’ own cancer cells, in particular, holds a tremendous amount of promise for ending the barbaric approach to oncology we’ve relied on for far too long. And while these tests might not be commonplace in the U.S. just yet, they are out there for patients who want them.

In addition to the genomic testing I shared earlier, there are tools like The DUTCH test, which evaluates progesterone levels, estrogen metabolism, melatonin, and cortisol levels—all key considerations when breast cancer patients are making treatment decisions.

Plus, there’s the “Greek” test from Research Genetics Cancer Center (RGCC), which tests for circulating tumor cells in your blood, pointing to any type of malignancy. In other words, this test can help detect any type of cancer at its earliest stages, as well as keep an eye on any existing cancer. It can also help generate a profile of your specific cancer—including which treatments are likely to deliver the best outcomes.

My point here is that there is simply no need to rely ONLY on the old-fashioned “cookbook” recipes that conventional oncologists have been using for as long as I have been in the field of medicine (like chemotherapy and radiation).

Treatment choices may still present a guessing game, to some degree. But at least now we are armed with enough knowledge to make an educated guess… without you being the guinea pig.

So, if you or someone you know is faced with a cancer diagnosis, talk with your doctor about what your best outcome looks like to you.

Then, I encourage you to talk with your doctor about what exactly you can expect from treatment. Because for some people, living longer isn’t always worth it if you’re going to be feeling miserable every day. In fact, studies have asked actual cancer patients this very question, and found that successful treatment isn’t simply an increase in survival time. In order for a treatment to be considered truly “successful,” most patients also expected to maintain their quality of life and reach personal goals.⁵

Just remember to take your time with these conversations and decisions. Don’t rush into any treatment plan before looking into your options, including some of the testing we discussed today. And whatever you do, ask questions—as many as you want—and demand clear answers.

(I also don’t recommend trying everything thrown your way. While that’s ultimately your choice, from a clinical perspective, overtreatment is usually not the answer.)

I have found my patients are typically quite attuned to what their body needs, and how best to handle any given health situation—cancer included. And with so many new tools to help you navigate a diagnosis, the path forward has never been brighter.

References:

1. Cardoso F, et al. “70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer.” N Engl J Med. 2016 Aug 25;375(8):717-29.
2. “Most women with a common type of early-stage breast cancer can skip chemo, a new report finds.” Washington Post, 06/03/2018. (com/national/health-science/most-women-with-common-type-of-early-stage-breast-cancer-can-skip-chemo/2018/06/03/8a666228-5f63-11e8-9ee3-49d6d4814c4c_story.html)
3. Marquart J, et al. “Estimation of the Percentage of US Patients With Cancer Who Benefit From Genome-Driven Oncology.” JAMA Oncol. 2018 Aug 1;4(8):1093-1098.
4. “’Remarkable’ therapy beats terminal breast cancer.” BBC, 06/04/2018. (bbc.com/news/health-44338276)
5. Islam KM, et al. “Patient-Defined Treatment Success: Perspectives of Patients With Advanced-Stage Lung Cancer.” J Oncol Pract. 2019 Sep;15(9):e758-e768.