Strategic plan to cure cancer
Nat Pernick, M.D.
Nat@PathologyOutlines.com
8 April 2021
This is the current version of our strategic plan to reduce US cancer deaths from the current 600,000 per
year in 2021 to 100,000 per year by 2030. Although millions of scientists and health care personnel are
studying cancer, we need to focus on an overall strategy and identify gaps in current activity. Click here
for the initial version of the strategic plan from February 2021.
This plan is divided into 3 major steps with important principles to implement for each step.
1. Kill or disable the primary tumor.
* Counter the rapid instability or chaotic disruption of physiologically important networks which
occasionally causes death shortly after diagnosis in patients with pancreatic, lung or other aggressive
cancers.
* Target dysfunctional tumor networks, not just mutations.
* Target different attributes of tumors, such as rapid cell growth, apoptosis resistance, embryonic
phenotype and metastatic spread.
* Effective treatment may require combinations of 3-5 drugs per attribute; overall, combinations of
combinations of treatment may be required.
* Include treatments that move surviving tumor cells into less hazardous networks.
* Recommend clinical trials for every patient.
2. Attack and monitor systemic networks that promote malignancy.
* For each tumor type, determine relevant systemic networks that nurture and sustain the malignancy.
* Investigate therapies that alter these networks so they no long are tumor promoting.
* Determine how to monitor these networks before and during treatment.
* Confirm that treatment of these networks actually improves survival.
* Consider creating a cancer network score to supplement the TNM score.
Networks to possibly treat and monitor:
* Chronic inflammation in general.
Treatment: trigger pro-resolution pathways; use anti-inflammatory agents; mimic physiologic
halting mechanisms associated with wound healing and liver regeneration.
* Microenvironment that nurtures tumor cells at primary and metastatic sites, including vasculature,
stroma, extracellular matrix and inflammation.
Treatment: attempt to normalize these networks.
* Microenvironment that promotes embryonic features associated with aggressive tumor behavior.
Treatment: use agents that promote maturation, such as retinoids (used for acute promyelocytic
leukemia), myeloid differentiation promoting cytokines, other cancer cell reprogramming drugs or
possibly agents that halt rapid cell division in embryogenesis.
* Ineffective immune system networks that coevolve with carcinogenesis.
Treatment: target alterations to “command and control” aspects of the immune system as well as
the dysfunctional behavior of specific immune cells types.
* Gene networks supporting malignant-like unicellular processes, not stable, multicellular processes.
Treatment: activate multicellular networks and suppress unicellular networks. Target cancer cell
weaknesses by applying a specific cellular stress that is readily dealt with by healthy cells using
multicellular programming but not by cancer cells with predominantly unicellular programming.
* Hormones (estrogens, androgens, insulin) for relevant cancers (breast, uterus, prostate, pancreas).
* Treatment: antagonize hormones that may promote tumor growth directly with anti-hormonal
agents or indirectly with behavior changes such as weight loss, exercise, healthy diet and
reducing alcohol and tobacco use.
* Germline changes that promote malignant behavior.
* Treatment: detect by genetic testing of nontumor cells, then normalize these networks or counter
changes that promote instability
3. Strengthen public health and preventative programs.
* Promote a culture of being healthy and reducing risk factors.
* Publicize the American Code Against Cancer and other healthy lifestyle messages.
* Create better screening programs.
* Identify the most important cancers for screening: those with high mortality which are aggressive
and currently have poor screening options.
* Suggest more effective screening programs to identify premalignant or malignant lesions in both
high risk patients and current cancer patients being monitored for relapse, and determine what
types of treatment would be effective in reducing cancer related deaths.
* Determine what is different about patients who die or die quickly from cancer and how we can
detect it.
* Analyze whether testing or treatment for chronic inflammation is useful and if so, how best to do
it.
* Improving access to medical care.
* Determine the most effective types of medical intervention to reduce cancer deaths.
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