Oncologist's Controversial Proposal Calls for Cancer Management, not Cure

Robert A. Gatenby is in the departments of radiology and integrated mathematical oncology at Moffitt Cancer Center in Tampa Florida, and in a recent piece published online by the journal Nature, Gatenby proposes a "change of strategy in the war on cancer."

Instead of always trying to cure cancer by eliminating it from the body, Gatenby wonders aloud if controlling and monitoring the tumor might not be a better approach.

Instead of giving patients radiation and/or chemotherapy in the current dangerously high doses and risking further damage to their health, Gatenby envisions an alternative: Oncologists ascertain a target size for an individual tumor, one that will allow the patient the highest attainable quality of life, and the docs set about keeping the tumor at that size with regular CT or PET scans and much lower drug doses.

His prime analogy is this: Imagine trying to rid a very large crop field of pests. It's futile to believe you can eliminate the pest problem one hundred percent—this much is obvious. The better practice is pest management. As he told Wired:

• "How people treat invasive species can provide an analogy for thinking about cancer therapy. In treating a field for a pest … you might treat three-quarters of it with a pesticide, and leave the other quarter untreated. Pesticide-sensitive pests remain there, and they spread out into the field after treatment, preventing pesticide resistance from becoming dominant. Using pesticides on an entire field is like what we’re doing with cancer now. And we all agree that we’d rather get rid of the pests altogether, but if you can’t do it, if every time you have an infestation you treat it and get resistance, then you try a different strategy."

This doesn’t mean Gatenby thinks that the search for new and more effective treatment modalities should stop; rather, he says "the lesson we can learn is that the judicious use of drugs can be more effective than the intuitive approach of killing as much as you can."

It's certainly true that a new approach is desperately needed. But we're all so used to the idea of curability, and to the idea of cancer inside one's body as being repugnant enough that we want it out, now. Can anyone really imagine receiving treatment X times a year as a form of tumor maintenance?

You can read more about Gatenby's ideas at Scientific American and Discover Magazine.