{"id":"cure-paths","name":"Paths to cures: interception, eradication, control","route":"/roadmaps/cure-paths/","eras":[{"era":"Interception: established","title":"What already prevents cancer","description":"HPV and hepatitis B vaccination, tobacco control, screening with removal of precancerous lesions, risk-reducing surgery in carriers, and tamoxifen or aspirin chemoprevention are the interventions that have measurably reduced incidence. Almost every future interception technology is competing against, or adding to, this list, and none of it is glamorous.","status":"historic","refs":[{"id":"hpv-vaccine","kind":"technology","name":"HPV & HBV vaccination","route":"/technologies/hpv-vaccine/","status":"standard-of-care","tldr":"Vaccines that prevent the viral infections behind cervical, throat, anal, and liver cancers. The most effective anti-cancer intervention ever created."},{"id":"chemoprevention","kind":"technology","name":"Chemoprevention & risk-reducing surgery","route":"/technologies/chemoprevention/","status":"standard-of-care","tldr":"Drugs or surgery for people at high inherited risk, before any cancer appears."},{"id":"colorectal-screening","kind":"technology","name":"Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)","route":"/technologies/colorectal-screening/","status":"standard-of-care","tldr":"Finding and removing polyps before they become cancer. Colonoscopy prevents cancer; stool and blood tests catch it early and get more people screened."},{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/","status":"standard-of-care","tldr":"A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome."},{"id":"risk-reducing-salpingectomy","kind":"technology","name":"Risk-reducing and opportunistic salpingectomy","route":"/technologies/risk-reducing-salpingectomy/","status":"established","tldr":"Removing the fallopian tubes, where most ovarian cancer starts, during other pelvic surgery or in women at inherited risk."}],"trials":[],"papers":[]},{"era":"Interception: next","title":"Vaccinating and monitoring people who do not yet have cancer","description":"Shared-neoantigen vaccines in Lynch syndrome and BRCA carriers, multi-cancer blood tests, and breath analysis all aim to act before or at the very beginning of disease. The bar is high: a healthy person accepts risk today for a probabilistic benefit later, so safety must be near-perfect and trials must run for years with surrogate endpoints. A positive interception vaccine trial would be the single largest change on this roadmap.","status":"emerging","refs":[{"id":"interception-vaccination","kind":"technology","name":"Cancer interception vaccines","route":"/technologies/interception-vaccination/","status":"phase-2","tldr":"Cancer interception vaccines immunise people who do not yet have cancer but carry a high inherited risk, such as Lynch syndrome carriers, against the antigens their future tumour is predicted to express, so memory T cells remove transformed cells early. Because healthy people accept risk for a probabilistic benefit, the safety bar is far higher and trials take years."},{"id":"shared-antigen-vaccine","kind":"technology","name":"Off-the-shelf cancer vaccines","route":"/technologies/shared-antigen-vaccine/","status":"phase-3","tldr":"Off-the-shelf cancer vaccines target antigens shared across patients, such as mutant KRAS or HER2 peptides, so they are made in advance rather than per person. Sipuleucel-T is still the only approved therapeutic cancer vaccine in the US; tolerance to self-antigens and weak past results hold them back."},{"id":"mced","kind":"technology","name":"Multi-cancer early detection (MCED)","route":"/technologies/mced/","status":"phase-3","tldr":"A single blood test intended to screen for dozens of cancers at once, including ones with no screening today."},{"id":"fragmentomics","kind":"technology","name":"cfDNA fragmentomics","route":"/technologies/fragmentomics/","status":"established","tldr":"Fragmentomics reads the sizes and positions of DNA fragments in blood, not the mutations. Cancer cells die messily and leave a recognisable fragmentation pattern."},{"id":"breath-vocs","kind":"technology","name":"Breath and volatile-organic-compound detection","route":"/technologies/breath-vocs/","status":"phase-2","tldr":"Smelling cancer: measuring the trace chemicals a tumour puts into exhaled breath."},{"id":"trained-innate-immunity","kind":"technology","name":"Trained innate immunity","route":"/technologies/trained-innate-immunity/","status":"phase-2","tldr":"Giving the innate immune system a memory, so monocytes and NK cells respond harder the next time they meet a tumour."}],"trials":[],"papers":[]},{"era":"Eradication: established","title":"Removing every cell, and knowing that you did","description":"Surgery with adjuvant systemic therapy cures a large fraction of early cancers; CAR-T and transplant cure a minority of advanced haematologic malignancies. What has changed is measurement: ctDNA-based residual disease testing turns 'we think it is gone' into a testable claim, and the first ctDNA-guided approval arrived in bladder cancer in 2026.","status":"current","refs":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/","status":"established","tldr":"An ultra-sensitive blood test after surgery that detects leftover cancer months before a scan would."},{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/","status":"approved","tldr":"A patient's T cells are removed, given a synthetic receptor that recognises the cancer, multiplied, and put back as a living drug."},{"id":"allogeneic-hsct","kind":"technology","name":"Allogeneic stem cell transplantation","route":"/technologies/allogeneic-hsct/","status":"standard-of-care","tldr":"Allogeneic stem cell transplantation replaces a patient's blood system with a donor's after conditioning chemotherapy, so donor immune cells hunt down leukaemia left behind. It remains the only cure for adverse-risk acute myeloid leukaemia, high-risk acute lymphoblastic leukaemia and Richter transformation, at the price of graft-versus-host disease."},{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/","status":"standard-of-care","tldr":"Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision."},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/","status":"standard-of-care","tldr":"Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways."}],"trials":[],"papers":[]},{"era":"Eradication: next","title":"Killing the last cell, wherever it is hiding","description":"Micrometastatic disease is where alpha and Auger emitters, in situ vaccination, and logic-gated cell therapy should have their advantage, because each kills single cells rather than bulk. The pairing to watch is a sensitive residual-disease test that says who still has disease, and a single-cell-selective therapy that can clear it, which is the explicit design of several ongoing trials.","status":"emerging","refs":[{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/","status":"phase-3","tldr":"Like radioligand therapy but with alpha particles: far more destructive over a much shorter range, so single cells can be killed with less collateral damage."},{"id":"auger-electron-therapy","kind":"technology","name":"Auger-electron therapy","route":"/technologies/auger-electron-therapy/","status":"preclinical","tldr":"Auger-electron therapy uses radioactive atoms such as iodine-125 or terbium-161 that release cascades of low-energy electrons travelling only nanometres to micrometres, so they kill a cell only if the atom sits on or inside its DNA and spare the neighbours. Terbium-161 can replace lutetium-177 in existing PSMA ligands; true nuclear delivery remains preclinical."},{"id":"in-situ-vaccination","kind":"technology","name":"In situ vaccination","route":"/technologies/in-situ-vaccination/","status":"phase-2","tldr":"Treating one tumour so aggressively that the immune system learns to attack every other one, using the tumour itself as the vaccine."},{"id":"logic-gated-therapeutics","kind":"technology","name":"Logic-gated therapeutics (AND, NOT gates)","route":"/technologies/logic-gated-therapeutics/","status":"phase-1","tldr":"Cells or drugs that fire only when two conditions are true at once, so healthy tissue expressing just one of them is spared."},{"id":"continuous-ctdna-monitoring","kind":"technology","name":"Continuous and near-continuous ctDNA monitoring","route":"/technologies/continuous-ctdna-monitoring/","status":"concept","tldr":"Instead of testing blood every three months, sampling constantly, so a relapse is caught the week it starts."},{"id":"radionuclide-parp-combination","kind":"technology","name":"Radioligand plus DNA-repair inhibitor combinations","route":"/technologies/radionuclide-parp-combination/","status":"phase-1","tldr":"Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes."}],"trials":[],"papers":[]},{"era":"Control: established","title":"Living with cancer as a chronic disease","description":"Endocrine therapy in hormone-driven breast cancer, androgen-pathway therapy in prostate cancer, BTK and BCL-2 inhibitors in CLL, and TKIs in CML already keep many people alive for years or decades. Control depends less on depth of response than on tolerability, sequencing, and managing resistance, which is why supportive care and cardio-oncology belong in this row.","status":"current","refs":[{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/","status":"standard-of-care","tldr":"Pills that block or remove oestrogen signalling, the mainstay of treatment for hormone-driven breast cancer for 50 years."},{"id":"androgen-deprivation","kind":"technology","name":"Androgen deprivation & AR pathway inhibitors","route":"/technologies/androgen-deprivation/","status":"standard-of-care","tldr":"Androgen deprivation lowers testosterone or blocks its receptor, and has been the foundation of prostate cancer treatment since 1941 (Nobel Prize 1966)."},{"id":"kinase-inhibitors","kind":"technology","name":"Small-molecule kinase inhibitors","route":"/technologies/kinase-inhibitors/","status":"standard-of-care","tldr":"Pills that block the specific enzyme a cancer relies on. Imatinib in 2001 proved a cancer could be switched off by design."},{"id":"cardio-oncology","kind":"technology","name":"Cardio-oncology","route":"/technologies/cardio-oncology/","status":"established","tldr":"Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres."},{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/","status":"established","tldr":"Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer."},{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/","status":"established","tldr":"Geriatric assessment is a structured check of an older patient's fitness, memory, and support that predicts treatment tolerance better than age."}],"trials":[],"papers":[]},{"era":"Control: next","title":"Steering resistance instead of waiting for it","description":"If a cancer cannot be eradicated, the goal becomes keeping the sensitive clone dominant. Adaptive dosing, timing treatment to the body clock, payload switching guided by resistance biomarkers, and treating the host environment all aim at that. Cachexia therapy belongs here too: patients who keep weight and function tolerate more lines of treatment.","status":"emerging","refs":[{"id":"chronotherapy","kind":"technology","name":"Chronotherapy: timing treatment to the body clock","route":"/technologies/chronotherapy/","status":"phase-2","tldr":"Giving the same drug at a different time of day, because the body clock changes how much damage it does and how well the immune system responds."},{"id":"cachexia-therapy","kind":"technology","name":"Cachexia-directed therapy (GDF-15 blockade)","route":"/technologies/cachexia-therapy/","status":"phase-3","tldr":"Cachexia-directed therapy treats cancer wasting by blocking GDF-15, a hormone that rises in advanced cancer and acts on the brainstem to suppress appetite. Pfizer's antibody ponsegromab improved weight in a phase 2 trial and is in phase 2/3 in pancreatic cancer cachexia; whether weight gain translates into function is the open question."},{"id":"cancer-neuroscience","kind":"pathway","name":"Cancer neuroscience (nerve-tumour signalling)","route":"/pathways/cancer-neuroscience/","tldr":"Cancer neuroscience is the study of how tumours talk to nerves. Nerves grow into tumours and feed them signals; brain tumours even wire themselves into neural circuits. Cutting the conversation with common drugs such as beta-blockers is now being tested."},{"id":"senescence-targeting","kind":"technology","name":"Senolytics and senescence-directed therapy","route":"/technologies/senescence-targeting/","status":"preclinical","tldr":"Chemotherapy leaves behind zombie cells that will not divide but poison their neighbours. Senolytics aim to clear them."},{"id":"spatial-omics-guided-therapy","kind":"technology","name":"Spatial-omics-guided treatment selection","route":"/technologies/spatial-omics-guided-therapy/","status":"emerging","tldr":"Choosing treatment from a map of where each cell type sits in the tumour, not just from a list of its mutations."},{"id":"organoid-guided-therapy-scale","kind":"technology","name":"Organoid-guided therapy at scale","route":"/technologies/organoid-guided-therapy-scale/","status":"phase-2","tldr":"Organoid-guided therapy means routinely growing a piece of each patient's tumour and testing drugs on it before choosing, rather than relying on genetics alone."},{"id":"drug-repurposing","kind":"technology","name":"Systematic drug repurposing","route":"/technologies/drug-repurposing/","status":"phase-3","tldr":"Testing cheap old drugs, aspirin, metformin, statins, beta-blockers, as cancer treatments, because they are safe, available and sometimes work."}],"trials":[],"papers":[]},{"era":"The honest caveat","title":"What would have to be true","description":"Every path above assumes measurement improves faster than the cancer adapts: interception needs a test that finds disease while it is still local, eradication needs one that proves nothing is left, control needs one that spots the resistant clone before it takes over. Technology that measures is therefore upstream of technology that treats, which is an unfashionable conclusion but the one the evidence supports.","status":"speculative","refs":[{"id":"mced","kind":"technology","name":"Multi-cancer early detection (MCED)","route":"/technologies/mced/","status":"phase-3","tldr":"A single blood test intended to screen for dozens of cancers at once, including ones with no screening today."},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/","status":"established","tldr":"An ultra-sensitive blood test after surgery that detects leftover cancer months before a scan would."},{"id":"spatial-omics-guided-therapy","kind":"technology","name":"Spatial-omics-guided treatment selection","route":"/technologies/spatial-omics-guided-therapy/","status":"emerging","tldr":"Choosing treatment from a map of where each cell type sits in the tumour, not just from a list of its mutations."},{"id":"continuous-ctdna-monitoring","kind":"technology","name":"Continuous and near-continuous ctDNA monitoring","route":"/technologies/continuous-ctdna-monitoring/","status":"concept","tldr":"Instead of testing blood every three months, sampling constantly, so a relapse is caught the week it starts."},{"id":"total-body-pet-screening","kind":"technology","name":"Total-body PET for screening and ultra-low-dose imaging","route":"/technologies/total-body-pet-screening/","status":"concept","tldr":"Scanners sensitive enough to image the whole body in seconds at a fraction of the radiation dose, which raises the question of whether healthy people should be scanned at all."}],"trials":[],"papers":[]}],"watch":[]}