The Changing Face of Cancer Treatment

reprinted from Issue 24, Spring 2017 of Frontiers of Medicine (PDF)

Robert Wachter, MD

Chair, Robert M. Wachter, MD

In 1971, President Richard Nixon boldly declared a national “War on Cancer.” Nearly half a century since that declaration, the war has proved to be one of attrition. While there have been small victories, fundamental outcomes have not improved very much. Why? Despite the war, until recently our understanding of cancer was relatively primitive, and our weapons – primarily chemotherapy, radiation and surgery – have obvious limits.

In the past few years, we’ve turned a corner in this tragic and costly war. While in most of medicine the promise of precision medicine is just that, a promise, in oncology it feels very real. Our deepening understanding of the molecular underpinnings of cancer has created opportunities to develop new kinds of targeted therapies.

In this issue we profile some of the superb UCSF scientists and clinicians who are tackling cancer with new molecular tools, including those designed to unleash the power of the immune system. I am pleased that the work has attracted a number of generous donors, including Internet pioneer Sean Parker, whose Parker Institute for Cancer Immunotherapy is accelerating research in this exciting area.

Not only is the science evolving, but the new knowledge calls into question our organizational model for cancer. In the old days, cancer was defined by the organ in which the malignancy originated. And so there were lung cancers, colon cancers, breast cancers and prostate cancers, each with its own natural history, workup, prognosis, treatment options and specialists.

With our new discoveries and therapeutic armamentarium, does this organ-based grouping still represent the best organizational structure? Perhaps cancers should be organized by their genetic defect, or by their potential susceptibility to a given class of therapies. At UCSF, we are asking these hard questions, and coming up with novel answers. Today, patients with many different cancer types (as viewed through the traditional organ-system lens) might see Larry Fong and his colleagues in the UCSF Cancer Immunotherapy Clinic. Those with a given genetic profile might see Pamela Munster and her colleagues in the BRCA research clinic.

The progress is dizzying, and we are committed to marrying scientific advances with fresh thinking about care delivery. Our goal is to make it as easy as possible for patients to access the best treatments, to participate in cutting-edge clinical trials and to speed the discoveries we need to finally win the War on Cancer.


Robert M. Wachter, MD
Professor and Chair, Department of Medicine
Holly Smith Distinguished Professor in Science and Medicine
Lynne and Marc Benioff Endowed Chair in Hospital Medicine

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