Targeted Therapies Transform Cancer Into a Chronic Condition as Survival Rates Hit Record Highs
Key Insights
A record seven out of ten cancer patients now survive at least five years, up from less than half in the 1970s, driven by the rise of genomically targeted drugs.
Trials selecting patients based on specific genetic markers have nearly doubled the success rate compared to unselected trials, according to data presented at ASCO's recent meeting.
Patient stories illustrate decades-long survival with metastatic disease using drugs like Herceptin, Tagrisso, and the experimental agent CLN-081 targeting rare mutations.
The era of targeted cancer therapy has fundamentally reshaped what it means to live with a cancer diagnosis. Where chemotherapy once stood as the sole systemic option—killing all fast-growing cells indiscriminately—a growing arsenal of drugs now homes in on the specific genetic signatures driving individual tumors. The result: a record seven out of ten cancer patients in the United States now survive for at least five years, up from less than half in the 1970s and 63% in the mid-1990s, according to the American Cancer Society.
The Society estimates that 18 million Americans who have ever had cancer are alive today. "It's taken decades for us to really understand the biology of cancer," said Rebecca Siegel, head of surveillance research at the cancer group. She expects survival rates to continue to rise, though cancer—which becomes more common with age—will likely remain the number two cause of death after heart disease.
The just-concluded meeting of the American Society of Clinical Oncology (ASCO) in Chicago underscored this momentum, highlighting a study showing that cancer deaths among people aged 15 to 49 have dropped 25% since 1990, alongside trial results for new life-extending drugs targeting pancreas cancer (search), skin cancer, and blood cancers.
The Power of Biomarker-Selected Trials
A critical driver of improved outcomes has been the shift toward clinical trials that enroll patients based on specific genetic markers or mutations. These biomarker-selected trials have nearly doubled the success rate of unselected trials, reflecting a more precise matching of drug mechanism to tumor biology.
Yet the regulatory landscape reveals a nuanced picture. To secure approval, a new drug must demonstrate safety and effectiveness, often using measurements like tumor shrinkage rather than overall survival. Less than a third of cancer drugs approved in recent years were shown to extend life spans, underscoring the gap between regulatory endpoints and the long-term outcomes patients seek.
Newer agents are beginning to bridge that gap. Revolution Medicines' daraxonrasib, which targets a variant of the RAS (search) gene that drives cancer growth, exemplifies how next-generation therapies can allow patients to overcome resistance to standard treatments. "This is how you have patients that are living with cancer… If you've been on a targeted therapy, you're going to be probably more sensitive to the older chemotherapy again," said Dr. Vincent Chung, a pancreas cancer (search) specialist at City of Hope (search).
Two Decades on Targeted Therapy
Cathy Smithwick, now 67, embodies the transformation. Diagnosed with breast cancer (search) in 2005, her tumor tested positive for HER2 (search)—a protein found in approximately 25% of breast cancers—and she received Roche's Herceptin, one of the first antibody drugs designed to block a cancer-causing protein. She was not tested for the BRCA1 (search) gene mutation until a sister was diagnosed with breast cancer several years later.
In 2010, following surgery, Smithwick was diagnosed with ovarian cancer (search). Over the years, when her cancer became resistant to one drug, physicians initiated other treatments. She developed an allergic reaction to platinum-based chemotherapy and can no longer receive that modality. Today she takes an estrogen-targeting pill, and if her tumor grows sufficiently, doctors at Kaiser Permanente will perform a biopsy to test for additional genetic markers. "They will test for all available markers," Smithwick said. "Meanwhile I am living my life."
Targeting Rare Mutations
Michelle Vacca, a 59-year-old office manager in Orange County, California, who never smoked, was diagnosed with early-stage lung cancer (search) during an unrelated chest x-ray. After surgery, a biopsy revealed an EGFR (search) mutation, and she was treated with AstraZeneca's tyrosine kinase inhibitor Tagrisso. When the cancer returned, treatment with another drug caused a rash that became infected.
City of Hope (search) subsequently identified that her cancer harbored the EGFR (search) exon 20 insertion mutation, found in only around 2% of lung cancers. Three years ago, she enrolled in a trial of an experimental drug known as CLN-081. "It's still working for me," Vacca said. "I don't really have any side effects… It hasn't stopped me from traveling to K-pop concerts."
The Road Ahead
Dr. Saro Armenian, director of City of Hope (search)'s survivorship program, said the center is "doubling down on research to understand the journey of cancer survivors," while acknowledging that patients can still face a dire prognosis.
ASCO's chief medical officer, Dr. Julie Gralow, captured the imperative driving the field forward: "We're going to have to look at the full genomic profile of every cancer." As the biological underpinnings of malignancy continue to yield to scientific inquiry, the boundary between terminal illness and chronic condition grows ever more porous.