For decades, cancer care was defined by extremes: radical surgeries, toxic chemotherapies, and devastating side effects. Outcomes were often grim, and for much of the medical community, oncology was a field associated with suffering and limited hope. But in just a few decades, the landscape has been revolutionized. The future of cancer therapeutics and care is more effective and now focused on personalization, precision, and preserving quality of life.
“We're in an advent of cancer care that will be transformative,” said Selwyn M. Vickers, MD, FACS, president and CEO of Memorial Sloan Kettering Cancer Center, and a pancreatic cancer surgeon.
This transformation will be the subject of today’s Commission on Cancer Oncology Lecture, “The Promising Future of Cancer Therapeutics and Care” during which Dr. Vickers will highlight how scientific breakthroughs are reshaping cancer treatment and redefining the role of surgeons. The lecture will be held 12:45–1:45 pm in Room W-178.
From Aggressive Beginnings to Targeted Treatments
In the very early years, cancer treatment was radical. Treatment options were summed up in three words: cut, burn, poison. Surgeons performed extensive resections, radiation could be harsh and imprecise, and chemotherapy often was as damaging as the disease itself.
“That was the backdrop of cancer, and these were the only three options available. They typically had limited success and dire consequences, in regard to the lethality of the tumor or the significant morbidity, sometimes mortality, of the treatment,” said Dr. Vickers.
Progress began with the rise of radiological screening and the development of radiation therapy, which offered more precise ways to detect and treat disease. The next turning point came with targeted therapies, designed to interfere with the specific biological mechanisms that allow tumors to grow. Dr. Vickers plans to cover this history in the lecture.
Perhaps the most significant advance was the sequencing of the human genome, which opened new pathways for understanding cancer at the molecular level.
“Its capacity to now have us look for mutations in cancer—in concert with the discovery of oncogenes—are driving greater understandings of how cancers were formed, what defects in the cellular structure fueled them, and if the genetic structure impacted why they divided and metastasized,” said Dr. Vickers, who will detail how this knowledge laid the groundwork for today’s era of personalized medicine.
Immunotherapy Revolution
Immunotherapy represents another landmark shift in oncology. By unblocking the immune system with checkpoint inhibitors, researchers discovered that the body’s natural defenses could be harnessed to fight cancer. Diseases once considered uniformly fatal, such as melanoma, suddenly had curative treatment options, explained Dr. Vickers.
From there, cellular therapies emerged. CAR-T cell therapy—where a patient’s immune cells are removed, engineered to attack tumors, and reinfused—demonstrated remarkable potential. Dr. Vickers will share how advances are now moving toward in vivo CAR-T therapies, which would allow the body to engineer its own immune cells without the need for external manipulation.
Other approaches, such as mRNA vaccines as a “therapeutic arm,” are extending the treatment possibilities even further and will be covered in the lecture as well.
What This Means for Surgeons
As systemic therapies grow stronger, the role of surgeons will continue to evolve.
“There will be cases where surgery is no longer necessary because immunotherapy has cured the disease,” Dr. Vickers said. “But there also will be patients with advanced or metastatic cancers—once declared inoperable—who may benefit from surgery after systemic therapy shrinks or eliminates most of their disease.”
He described the case of a young patient who was treated with immunotherapy for rectal cancer. While the primary tumor disappeared, one small liver lesion persisted. Surgeons successfully removed it after a year of monitoring.
“There will be a new, growing role for surgery,” he said. “Not as the only curative tool, but as one part of a biology-driven, therapeutic armamentarium.”
Data, AI, and Human Wisdom
Other drivers of progress are data science and artificial intelligence (AI). Dr. Vickers explained that AI—"a powerful tool” with the potential to analyze vast datasets, identify treatment patterns, and accelerate discovery—will need to be managed.
“Human wisdom and understanding are necessary and are what will allow tools such as AI to have relevance to our patients,” he said.
Dr. Vickers emphasized a note of caution. “AI will be a copilot, not the pilot. Physicians must remain the ones directing patient care, applying judgment, and ensuring safety.”
Survivorship, Story Behind the Science
According to Dr. Vickers, survivorship is another important topic that he will cover in the Cancer Lecture. As more patients are cured, much attention is shifting to quality of life after treatment.
“We can cure you,” he said, “but we want to make sure you are functional and thriving afterward.”
Dr. Vickers also will underscore the need for patients—and the general public—to better understand the scientific research, effort, enormous investment, and discoveries that make medical breakthroughs, like effective cancer treatments, possible, rather than seeing them as unexplained, remarkable results.
“We have to do a much better job of ensuring that the dining room table conversation is not blanketly ignorant of all that has been foundational. All the sweat and toil. That ‘miracle’ the patient experienced? We have to make sure they draw accurate and informed conclusions of where and how they got there,” he said. “We must explain the journey—from laboratory discovery to clinical cure—so people understand why research matters and why it deserves their support.”
