They came from around the world to discuss one question: are we winning the war on cancer? A few said yes, some said no, most believed that war was the wrong metaphor for the struggle against a complex set of diseases that will affect one in three people.
A hundred of the world's leading cancer specialists descended on Lugano in Switzerland last weekend to formulate a 10-point action plan to finish off what President Richard Nixon started in 1971, when he signed the US National Cancer Act. Most Americans thought a cure for cancer would be discovered within five years – emulating the technological success a decade earlier when the country landed a man on the Moon. But more than 40 years later, few experts talk of a single cure for the 200 known types of cancer. The optimism of the early 1970s has given way to the dogged determinism of a cancer community under siege from the growing global epidemic.
"Curing cancer is certainly more complicated than landing on the Moon," said Peter Krammer of the German Cancer Research Centre in Heidelberg, one of the attending experts.
People need to realise that there are two types of war on cancer – one focused on a cure for patients and the other based on the elimination of the disease from the population, said Umberto Veronesi, a veteran oncologist.
"In 40 years we've nearly doubled the curability rates," Dr Veronesi told the forum. "But the second goal of eliminating cancer from the population is a Utopian dream because the incidence of cancer is increasing not decreasing. We can cure a patient but as soon as we cure one patient, another patient arrives."
Some cancers are indeed curable, compared with 40 years ago – provided, of course, that they are detected early enough. Many kinds of cancer are now treatable and survival rates across almost the entire spectrum have improved dramatically.
But cancer is still a leading cause of disease worldwide, accounting for around 13 per cent of all deaths in 2008. In 1998, following a front-page story in the New York Times about the success of drugs targeting the growth of blood vessels to a tumour, there was widespread hope that a cure may have finally arrived, Douglas Hanahan, director of the Swiss Institute for Experimental Cancer Research said. The optimism was soon dashed, however, when it was realised that these angiostatins only worked for a while, and in any case cost far too much for widespread deployment. The same story of shattered hopes has emerged in more recent times with a new generation of "targeted" drugs designed to work against tumours with a certain genetic make-up.
One such drug, called BRAF inhibitors, produced near-miraculous results when first trialled, with tumours visibly receding within weeks of treatment. However, six months later, the tumours returned with a vengeance.
A possible solution to the problem of cancer resistance is the use of one or more drugs or treatments in combination. However, many of these combination drugs are expensive and hardly affordable even when taken alone, let alone when taken together.
On top of that, drug companies appear to be sometimes reluctant to cooperate with competitors holding patents on the other half of the combination therapy.
Even when drugs are cheap, as they are when "off patent", Dr Hanahan said that the pharmaceuticals industry sees little financial incentive if clinical trials involve drugs not covered by many years of patent protection.