An old issue of The Oncologist makes a dour evaluation of cancer research:

Cancer mortality has changed little over the past forty years, mainly because of our failure to develop curative chemotherapy for the common solid cancers.

The rest of the article gives a nice overview of the drug approval process.

The problem (according to him) is that cancer is turning out to be a more delicate problem than meets the eye.  Conditions vary largely from person to person, and chemotherapy agents have very different results depending on the flavor of the disease.

So one size does not fit all, and the matrix of potential cures continues to get more complicated. However, the FDA, drug companies, and clinicians are all biased towards the status quo, even though it papers over a lot of potential cures that go undiscovered.

The Anticancer Drug Approval Process

To approve an anti-cancer drug, it first has to go through a loooonng laboratory testing phase where the agent is tested on rodents and dogs, and then the same compound is tested on humans in clinical trials.

However, the cold hard truth is that you can’t tell how an anticancer drug is going to behave on humans until you test it on humans, no matter how much you test the drug on other animals.  The ideal process would favor clinical trials more than laboratory trials on other species, but instead the emphasis is reversed.

And when clinical trials are conducted, they’re usually performed on advanced cases that are less responsive, making it difficult to tell if something works. The clinical trial process could feasibly be completed in 6 months, but administrative laws passed in the 1970’s increased the cost of conducting clinical trials about 10 fold and extended the length of the process by several years.

The FDA, Pharmaceutical Companies, Doctors, and the Status Quo

So all in all the process is too slanted towards conservatism, and the system creates  solutions that are too big for the problems its trying to solve.  The best thing for everyone would be to loosen up a bit, but no one has a good incentive to do that.

The FDAs biggest problems occur when visible errors happen, but receives no flak for the dog that never barks. Pharmaceutical companies shy away from the all-important clinical trials because they’re too expensive, and clinicians usually stick to conducting studies with well known drugs since that’s the easiest way to get a few publications.

And we’re left with potential cures that go undiscovered, but no one notices.