When Wilhelm Sanders’ housekeeper was diagnosed with multiple myeloma in the early 1950s, treatment options were limited. She died of the malignant disease within a short time. Cancer used to be regarded as an inescapable fate that people kept quiet about. Since then, the situation has changed fundamentally. Cancer medicine has advanced enormously, particularly over the past 50 years: molecular and cellular processes are increasingly understood and can be specifically targeted. Thanks to innovative therapies and early diagnosis, cancer is no longer a ‘death sentence’ in many cases, but is now regarded as a treatable, and often even curable, disease. This is the result of decades of research.
A decisive turning point was marked by the National Cancer Act in the USA – the start of the ‘War on Cancer’. In 1971, the then US President Richard Nixon signed the Act, which provided extensive funding for molecular biological cancer research and led to significant advances in the years that followed. At around the same time, the first specialist clinical centres for oncological care and research were established in Germany, supported by university hospitals and the German Cancer Research Centre.
Since then, crucial insights into the molecular basis of cancer have been gained: researchers have discovered genes that promote or inhibit cell growth, and identified signalling pathways through which cells communicate with one another. It became apparent that genetic changes can trigger cancer, in particular mutations in oncogenes and tumour suppressor genes – that is, in genes that regulate cell division, amongst other things. Examples include the TP53 gene, first described in 1979, one of the most frequently mutated genes in human tumours, or the BCR-ABL fusion gene, which arises through the rearrangement of genetic material (translocation) and became one of the first targets for precision medicine.

Targeting cancer with precision medicine

As our understanding of biology has grown, cancer treatment has also evolved. Whilst treatment previously consisted mainly of surgical procedures, radiotherapy and relatively non-specific chemotherapies, the first targeted therapies were tested in the 1980s. These drugs target structures that are important for tumour growth, such as altered proteins in tumour cells. The aim is to spare healthy cells as far as possible. One example is the monoclonal antibody trastuzumab, which has been authorised in the EU since 2000 for the treatment of breast cancer and blocks HER2 receptors. At the same time, for many types of cancer, conventional forms of treatment such as surgery, radiotherapy and chemotherapy are now specifically combined to enhance efficacy within interdisciplinary approaches. The treatments are then implemented in tumour boards, tumour centres or comprehensive cancer centres, involving various specialists.
Over the past few decades, immunotherapy has established itself as another key component of cancer treatment. It targets the mechanisms that cancer cells use to evade the immune system. So-called checkpoint inhibitors are used for this purpose. They release the ‘brake’ on the body’s own defence cells and activate the immune system. Ipilimumab was one of the first drugs of this kind. It was approved in 2011 for the treatment of advanced melanoma and led to long-term survival in some patients who were previously considered incurable.
Cancer medicine has now gone one step further: in CAR-T cell therapy, a personalised form of immunotherapy, immune cells are used as ‘living medicines’. The patient’s own T-cells are extracted from the blood and genetically modified in the laboratory. They are fitted with an artificial receptor – the chimeric antigen receptor (CAR) – which can recognise tumour cells based on specific surface markers. The modified cells are then reintroduced into the body, where they specifically destroy cancer cells. The procedure was approved in Europe in 2018 for B-cell neoplasms and has been used in Germany ever since. It opens up new prospects even for cancer patients whose condition was previously considered incurable, for example in certain forms of lymphoma or leukaemia. CAR-T cell therapy is regarded as one of the most innovative strategies in modern cancer medicine; however, it is technically very complex and is therefore only carried out in a few highly specialised centres.
For some time now, researchers have been driving forward a new form of personalised immunotherapy: therapeutic cancer vaccination. It uses mRNA vaccines developed using modern sequencing techniques. The vaccination specifically activates the immune system against surface structures on tumour cells, enabling T-cells to recognise and attack the tumour cells. Initial promising results are emerging, particularly for the combination of a tumour vaccine with other immunotherapies, such as checkpoint inhibitors in malignant melanoma. Cancer medicine has thus entered a new phase in which treatments are increasingly tailored to the molecular characteristics of a tumour. 

Medical advances have significantly improved the chances of survival for cancer patients. Around 50 years ago, fewer than half of those affected were still alive five years after a cancer diagnosis. Currently, the average five-year survival rate in Germany stands at 65 per cent for women and 61 per cent for men. For certain types of cancer, such as malignant melanoma or thyroid cancer, the figure is considerably higher. This development is not solely attributable to modern treatments – advances in diagnostics and early detection also play a crucial role.

From biopsy to high-tech diagnostics

Over the past 50 years, cancer diagnostics have undergone a fundamental transformation: whereas they were once limited to basic imaging and biopsies, state-of-the-art technologies are now used. This means that tumours can not only be detected earlier, but also characterised more precisely. This enables personalised treatments and improves the prognosis for many patients.

Computed tomography and magnetic resonance imaging, which were introduced in the 1970s, remain among the most important diagnostic methods in cancer medicine. Today, they are complemented by molecular techniques that identify genetic mutations and tumour biomarkers. Tests for mutations in genes such as BRCA1/2 in breast cancer not only enable a more accurate risk assessment but also provide guidance for selecting targeted therapies. Liquid biopsy, which is currently being trialled in studies, allows the detection of circulating tumour DNA in the blood or other bodily fluids and can be used to monitor cancer. In addition, artificial intelligence is increasingly being used, for example in the analysis of medical imaging data, the consolidation of vast amounts of clinical laboratory data, or the prediction of disease risks. 

Preventing and detecting cancer early

Alongside treatment and diagnosis, prevention is also becoming an increasingly important focus. Epidemiological research in recent years shows that, when it comes to our personal risk of cancer, much is within our own control. Certain types of cancer are linked to risk factors such as smoking, excessive alcohol consumption, UV radiation or being overweight. According to one study, an estimated 38 per cent of all newly diagnosed cancer cases can be attributed to 30 modifiable risk factors and could therefore be prevented. In addition to lifestyle changes, vaccinations against cancer-causing viruses can effectively help to reduce risk. In 2006, for example, the first vaccine against the human papillomavirus (HPV) was authorised in Germany. It is now clear that the HPV vaccine can effectively prevent cervical cancer and its precancerous stages.

As cancer cannot be completely prevented, early detection is particularly important. Screening programmes make it possible to detect tumours at an early stage, when they are often still easily treatable. In Germany, these primarily include the nationwide mammography programme for the early detection of breast cancer, introduced in 2005, and bowel cancer screening, for example via colonoscopy. Studies confirm that people who regularly take part in these programmes have a significantly lower risk of dying from breast or bowel cancer.

Freedom through research funding

How might Sanders’ housekeeper’s cancer have progressed today? As recently as 2004, the median survival time following a diagnosis of myeloma was only around four years. Since then, treatment has become significantly more effective: more than 15 new drugs have been developed for the treatment of multiple myeloma; the combination of precision medicine, immunotherapy and stem cell therapy has continuously improved treatment. With the current first-line therapy, myeloma patients can achieve a disease-free survival of more than 17 years, and many can even be cured. New immunotherapies such as T-cell-activating antibodies or CAR-T cells even allow for curative approaches in the event of a relapse. So Sanders’ housekeeper would have a good chance of survival today.
These advances are not the result of isolated breakthroughs, but the outcome of continuous research. Nevertheless, cancer medicine continues to face challenges: tumour cells can undergo genetic changes and consequently cease to respond to treatment. The high level of genetic diversity within a tumour also often complicates treatment. Only through new scientific insights can obstacles such as these be overcome.
Long-term, independent research funding drives forward the necessary basic and therapeutic research and creates the scientific freedom to do so. This is where charitable funding organisations such as the Wilhelm Sander Foundation play a key role. This financial support enables research to be conducted beyond short-term considerations, ensuring that new treatment options can continue to emerge in the future – for multiple myeloma as well as for other forms of cancer.