As we enter this new decade, it behooves us to both appreciate and laud advances that have been made in Oncology over the past thirty years, to critically assess the missteps, and to boldly envision the tremendous successes we can surely expect and those we may bravely hope for if all we stakeholders, from industry to academia to government to NGOs can collectively move boldly, take risks, think out of the box, balance incremental with exponential innovation, at all times putting the patients first.
To simply reduce the past three decades to a few key paradigm shifts is of course fraught and misleading, especially as it is this reductionist thinking that has sometimes led us astray as we have pursued that wily enemy cancer, with which we have imbued such anthropomorphic animosity as to declare war on it, when in fact the metaphor perhaps could really have been one of seeming peaceful coexistence. So, from the vantage of 2020, with 2020 hindsight, we can proudly proclaim the success of foundational chemotherapy agents like taxanes, the dawn of biotech’s reign of innovation with the novel monoclonal antibodies, the continuation of the age of "targeted therapy" with oral kinase inhibitors, the development of the concepts and reduction to practice of precision medicine with mutation and aberration directed drugs, and finally, in the last, past, eventful decade of the 2010s, after a hundred years of being relegated to a heretical backwater, the arrival of the age of immunotherapy, with multiple checkpoint inhibitors, a cancer vaccine, an oncolytic virus and adoptive cell therapies approved.
So with all these advances, are we as far along in conquering cancer (again with the bellicose figures of speech)? And assuming, despite the wonderful achievements, that we still have a long way to go, what has held us back? Is it only the pace of scientific discovery, or might certain preconceptions, even misconceptions, have tripped us up and slowed us down? And where will we, where must we, go next in this new decade?