February 16, 2021
Curing Cancer – Part 8 – Strategic plan for curing cancer
(as of February 2021)
16 February 2021
This series is about curing cancer based on the principles of complexity theory. Follow my
blog at https://natpernickshealthblog.wordpress.com.
This is the initial version of my strategic plan. The current version is here.
It has now been 50 years since the war on cancer was announced by President Richard M.
Nixon (see President Nixon’s 1971 State of the Union at 15:03).
Watch Video At: https://youtu.be/peb47Z-jPqc
President Nixon Announcing the War on Cancer at 15:03
Although age adjusted cancer death rates have dropped substantially from 1970 to date
(men: 249.3 to 189.5 per 100,000; women: 163.0 to 135.7 per 100,000), the American
Cancer Society still projects that 608,570 Americans will die of cancer this year (Jemal 2010;
US National Cancer Institute website, Cancer Facts & Figures 2021).
This essay provides a strategic plan for curing cancer. Regular updates are anticipated as
our understanding of cancer related networks increases and progress is made in the steps
How to define victory in the war on cancer?
I define “curing cancer” as reducing American cancer deaths to 100,000 per year. Further
major reductions are unlikely, because some patients will be ineligible for curative treatment
due to coexisting medical conditions, some patients will refuse treatment and all of us will
eventually die of something.
What changes are needed to reduce cancer deaths to this level?
The first step in curative therapy is halting cancer cell growth, which involves several distinct
1. Institute more effective treatment for the primary tumor.
1a. Develop more effective treatments to kill the cancer cells that damage critical
tissues and organs. Some patients need immediate treatment because their cancer is life
threatening due to its advanced and aggressive nature. This includes childhood leukemia
patients and some adult patients, such as actor Dustin Diamond, who died of disseminated
small cell lung cancer shortly after diagnosis. We should shift our focus from targeting driver
mutations (i.e. specific mutations common in a particular tumor) towards targeting
dysfunctional cellular networks which include the driver mutations. This is admittedly more
difficult, due to possible alterations in many genes in the network plus all of the components
with which the genes and their products interact (Barabási 2011).
1b. Curative treatment must attack different aspects of the cancer, requiring
combinations of combinations of treatment. Disabling any single cancer attribute, such
as rapid cell growth, will likely require combinations of 3-5 drugs or other treatments
(radiation therapy, hyperthermia) because each attribute develops through activation of a
web of biologic pathways that readily bypasses a single treatment block (Curing Cancer
Blog-Part 4).
Interactions of cell cycle pathways resemble a web (Wikipedia)
Disabling each additional cancer attribute, such as cell migration (metastatic spread),
avoiding programmed cell death (apoptosis) and the systemic networks described below,
may require a different combination of treatments, although there may be some overlap. This
means that patients must typically receive combinations of combinations of treatments.
1c. Treatments must be extensively tested in clinical trials to optimize their delivery,
make them tolerable to patients and ensure that they work well together. Towards this
end, every cancer patient should be enrolled in a clinical trial. In addition, computational
approaches and modeling methods may be useful to determine the effectiveness of
treatment combinations (Curing Cancer Blog-Part 5).
1d. It may be important to “normalize” or reduce the malignant traits of tumor cells
that survive the above steps. This involves treatments that push tumor cell networks out of
their relatively stable “attractor” states towards network states with reduced malignant
properties (Curing Cancer Blog-Part 5).
2. Attack and monitor systemic networks that promote malignancy.
Many systemic network changes promote and maintain the primary cancer and produce new
malignancies (Curing Cancer Blog-Part 6). Curative therapy requires that we attempt to
“normalize” or at least block the most harmful aspects of these network changes and that we
monitor their status as treatment is given. This monitoring should supplement existing
radiologic and clinical studies that determine the size and extent of the known tumor. For
each network, we must determine what biological molecules to monitor, how best to do so