Vincent Rajkumar: Cure is a simple word. But there is confusion when it comes to cancer

Vincent Rajkumar shared a post on X:

“Cure is a simple word. But there is confusion when it comes to cancer. What cure is in cancer, and what we should aspire for?

When can we say that a given type of cancer is curable?

There is a difference between when we can say a particular cancer is a curable type versus whether individual patients with a given cancer can be considered potentially cured.

They are not the same.

To call a cancer curable we must be able to treat the cancer for a finite duration, stop all therapy, and know that a certain % of patients will never relapse

Early stage solid tumors, Hodgkin lymphoma, DLBCL, ALL, AML are curable. Real cure. The definition of curable cancer.

In curable cancers, we can look patients in the eye and are able to tell them that with a finite duration of therapy there is a certain probability that the cancer will never return.

We do this routinely in curable cancers like early stage solid tumors, Hodgkin lymphoma, diffuse large cell lymphoma, acute leukemia, testicular cancer.

We are able to treat like we treat many infections: Fixed duration therapy; Stop all treatment and certain % never relapse

This reassurance of curability we offer patients with curable cancers is different from incurable cancers where we are unable to either stop therapy or be confident that with time the cancer won’t return.

When we consider individual patients, cures can occur even in cancers considered incurable: we always have patients who have beaten the odds.

Such occurrences gives hope on potential curability, but does not mean that type of cancer is curable.

There are many cancers where patients can live out a long life but need lifelong treatment (maintenance) or keep getting relapses requiring therapy (recurrent treatments). This is not cure, but is termed control.

Control is good. But cure should be the goal.

Cure has many advantages: Finite duration of therapy.
Less toxicity.
Less cost long term.
Peace of mind.

I discussed what cure means in myeloma COMy Congress, Mohamad Mohty.

But the concepts apply more generally to all cancers.

A few years back we did a study to look at curability of a few cancers which delves into differences between cancers considered curable versus not.

We looked at patients <50 years old with myeloma, diffuse large cell lymphoma, Hodgkins, & follicular lymphoma.
<50 yrs age chosen coz if cured, people in that age group should live out normal life.

Note how PFS curves of the 2 curable cancers look like. There’s a plateau.

For more on cure in cancer, please check out this Q and A that I did with The ASCO Post.”

Source: Vincent Rajkumar/X
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Vincent Rajkumar is a Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and Chair for the Mayo Clinic Myeloma, Amyloidosis, and Dysproteinemia Group. He also chairs the Board of directors of The International Myeloma Foundation and the Eastern Cooperative Oncology Group (ECOG) Myeloma Committee.

His extensive contributions include over 230 peer-reviewed publications, predominantly focusing on multiple myeloma and related plasma cell disorders. Furthermore, Dr. Rajkumar is a Section Editor for multiple myeloma and related disorders for Leukemia and an Associate Editor for the Mayo Clinic Proceedings.