Cancer Revolution: Precision Diagnostics, Interception, and AI-Driven Therapies

Key Quotes

"I think fundamentally it's this sense that there's this disease that you feel like you have no control over what's going to happen that it's growth or a tumor or whatever it is depending on the type of cancer that it's got quote unquote a life of its own and that you feel like almost you're rolling the dice and that fate's going to delineate it and I think what isn't true and I think getting to your point is in many cases we're able to bring exciting effective treatments that actually can you know harness whether it's the ones own body or novel drugs like we're able actually to treat many cancers."

Dr. Ross Levine argues that a common misconception about cancer is the feeling of complete lack of control, as if the disease has a life of its own. He counters this by explaining that effective treatments, which can leverage the body's own systems or new drugs, are increasingly available to manage many types of cancer. This highlights a shift from a fatalistic view to one of active treatment and management.

"I think it's a really important fundamental concept and one that I think the average oncologist or cancer researcher understands but probably not people that aren't thinking about this every day when we began thinking about cancer as a disease and treatments in the late 60s and early 70s you know when it was largely chemotherapy and then surgery we didn't really understand that every cancer is different and even within a cancer classified by where it originates the lung the brain that there are molecularly defined subtypes and that was because one we didn't have the tools to actually understand that you know every puzzle piece looked the same to us."

Dr. Ross Levine explains that a fundamental concept in cancer research, often not understood by the general public, is that cancer is not a single disease but hundreds of distinct conditions. He notes that in the past, due to limited tools, all cancers appeared similar, preventing the recognition of molecularly defined subtypes within specific cancer origins. This lack of understanding historically limited treatment approaches.

"And on the other side I would say that, you know, we should always remember that as we are in a society where things like cardiovascular disease whether they are being prevented or not and the impact for example of GLP 1 agonists on that we're going to learn but if you even take that aside just our ability with medical therapy and stents and to reduce mortality from cardiovascular disease as people get older the incidence of cancer does um increase and so we're dealing with a population living longer and that also is leading to increases in cancers that occur with aging so we almost have this duality where we have some cancers where they are seem they are occurring at a higher frequency in younger people that's something I think a lot we need to get our arms around but we also have to acknowledge that incidence in cancer especially in older adults is quite a victim of our own success in treating many other diseases in really effective ways."

Dr. Ross Levine points out a duality in cancer incidence trends: while some cancers are concerningly increasing in younger populations, the overall increase in cancer, particularly in older adults, is partly a consequence of successful treatments for other diseases like cardiovascular conditions. He explains that as people live longer due to advances in medicine, the natural incidence of age-related cancers also rises. This highlights the complex interplay between longevity, other medical advancements, and cancer prevalence.

"So I think the most important thing for us as doctors and scientists and for the public to appreciate is that there's going to be a lot of information on that but when that information comes from very large powered studies it's going to be very instructive."

Dr. Ross Levine emphasizes the importance of large-scale studies for understanding health trends, particularly concerning new medications like GLP-1 agonists. He states that while a significant amount of data will emerge, information derived from studies involving millions of people will be the most reliable and instructive for drawing conclusions about potential impacts on cancer incidence. This underscores the value of big data in medical research.

"The other aspect of like the MRI is the number of biopsies you do where then the pathologist goes actually it was a growth but it wasn't cancer and how many of that and the confidence that you can tell people that the MRI is meaningful and tells you there's something really to be concerned about because there's two issues one is the emotional part right you go through it and you don't have it but then the other is the next steps often are not without risk a biopsy is not without risk and so I think we need better technology and better use of it they have to refine and we need studies then that show you how it can actually do it but I do believe fundamentally those things are going to happen like I'm not worried about whether they'll get there it's all about when they get there and which ones."

Dr. Ross Levine discusses the challenges with advanced diagnostic tools like MRIs, noting that while exciting, they can lead to numerous biopsies for non-cancerous growths. He highlights the need for greater specificity in these technologies to provide clear next steps for patients and reduce the emotional and physical risks associated with unnecessary procedures. Dr. Levine expresses confidence that these technologies will improve over time and be validated through further studies.

"So one is that, you know, when we develop drugs usually we say all right we develop a drug like a small molecule chemical um entity and I'm going to get right into this pocket that is where the enzyme works and I'll block it and we have many cancer drugs that are like that but as you develop better and better chemistry and better and better AI enabled structural biology AlphaFold being the classic example we can now develop drugs that bind other parts of the protein that then you can predict that they secondarily do that we call those allosteric interactions and the idea that we can open up the space of what's druggable with chemicals therefore is expanding in real time."

Dr. Ross Levine explains a significant shift in drug development, moving beyond blocking specific enzyme pockets to developing drugs that bind to other parts of proteins, known as allosteric interactions. He credits advancements in chemistry and AI-driven structural biology, like AlphaFold, for enabling this broader approach. This expansion of "druggable" targets is rapidly increasing the potential for new chemical therapies in cancer treatment.