Cancer is a disease in which some of the body's cells grow out of control and spread to other places. One of the pathological features is the rapid emergence of aberrant cells that grow beyond their standard borders, allowing them to infect neighboring sections of the body and migrate to other organs; this is known as metastasis. Cancer metastases are among the leading cause of death today. In the millions of cells that make up the human body, Cancer can start almost anywhere. Cell division is the process by which human cells expand and proliferate to form new cells as needed by the body. As cells age or become harmed, they die and are replaced by new cells. This well-ordered mechanism can occasionally fail, causing abnormal or damaged cells to develop and reproduce when they shouldn't. These cells can grow into tumors, which are tissue lumps. Tumors can be benign or malignant. Cancerous tumors can infect neighboring tissues and spread to other regions of the body, causing additional tumors to grow (a process called metastasis). Malignant tumors are another name for cancerous tumors. Many malignancies, including leukemia, create solid tumors, whereas cancers of the blood do not. Unlike malignant tumors, benign tumors do not infiltrate or spread into surrounding tissues. Benign tumors rarely reappear after they have been removed, whereas malignant tumors do. Benign tumors, on the other hand, can grow to be quite enormous. Benign brain tumors, for example, can cause severe symptoms or even be life-threatening. Cancer can spread through to other parts of the body through the bloodstream. Bones, liver, lungs, and brain are examples of these parts. When breast cancer spreads to another part, such as the lungs, it is referred to as metastatic breast cancer rather than lung cancer.

In 2020, the International Agency for Research on Cancer (IARC) estimated 19.29 million new cancer cases and 9.95 million people death from cancer. Simply owing to population increase and aging, the worldwide burden of cancer is expected to rise to 28.88 million new cases and 16.3 million cancer deaths by 2040. In economically transitioning countries, the future burden is predicted to be even more significant due to the higher prevalence of various risk factors, such as smoking, unhealthy diet, physical inactivity, and fewer childbirths.

According to World Health Organization (WHO), cancer is the second biggest cause of death worldwide. Lung, prostate, colorectal, stomach, and liver cancers affect men, while breast, colorectal, lung, cervical, and thyroid cancers affect women. Globally, the cancer burden is increasing, putting enormous physical, emotional, and financial strain on individuals, families, communities, and health systems. Many health systems in low- and middle-income nations are unprepared to handle this burden, and many cancer patients around the world lack timely access to high-quality diagnosis and treatment. 

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Most common type of new cases of cancer globally, 2020 (million cases)


Source: WHO

Most common causes of cancer deaths globally, 2020 (million deaths)


Source: WHO

Global new cancer cases and deaths, 2020 (Number of cases and %).


Source: GLOBOCAN 2020.

There are many types of cancers such as Lung Cancer, Breast Cancer, Kidney Cancer, Liver cancer, Ovarian Cancer, Prostate Cancer, Skin Cancer, Pancreatic Cancer, Colorectal, Blood Cancer, and Others.

Lung Cancer:
Lung cancer starts in the lungs' tissues, most commonly in the cells that line the airways. It is among the leading cause of cancer death in both men and women. Tobacco smoking is the main cause of lung cancer. In men, tobacco smoking is responsible for 9 out of 10 incidences of lung cancer whereas, in women, it is responsible for 8 out of 10 cases. The sooner people start smoking, the longer they smoke, and the more cigarettes they smoke every day, the more likely they are to acquire lung cancer. Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer death in 2020, with an estimated 2.20 million new cancer cases and 1.79 million deaths that represent approx. one in 10 (11.4%) cancers diagnosed and one in 5(18.0%) deaths. The most number of incidence cases were reported in the Asia Region with 10,26,171 cases followed by European region 5,31,086. According to, estimates from the International Agency for Research on Cancer (IARC), with 14,35,943 new cases in men while 7,70, 828 cases in women in 2020, Lung cancer is the most common form of cancer among men and third most common form (Following breast and Colorectal) in women.

Lung cancer new cases and deaths, 2020 (Number of cases and %)


Source: GLOBOCAN 2020.

Lung Cancer Region-Specific Incidence, 2020 (Number of cases and %)


Source: GLOBOCAN 2020.

Breast Cancer: 
Breast cancer is a disease in which malignant cells in the breast tissue proliferate uncontrollably. It has a more significant impact on women than it does on males. Breast cancer is caused by uncontrolled cell division of breast cells, which are the most numerous cells in the lobules and ducts of the breast. A lump or block in the breast, bloody discharges from the nipple, and a change in the contour of the nipple or breast are all signs of breast cancer. With an expected 2.26 million new cases in 2020, female breast cancer has surpassed lung cancer as the leading cause of cancer incidence worldwide, accounting for 11.7% of all cancer cases. It is the fifth-highest cause of cancer death globally, with over 684,000 deaths. Breast cancer is the most common cancer in women, accounting for 1 in every 4 cases and 1 in every 6 deaths, and it is the most common disease in the great majority of countries. It is most common in the eastern asia countries comprising of 5,51,636 new cases followed by north America with 2,81,591 cases and South-Central Asia  with 2,54,881. The Breast cancer incidence rates are 88% higher in transitioned countries than in transitioning countries (55.9 and 29.7 per 100,000, respectively) (55.9 and 29.7 per 100,000, respectively.

Breast cancer new cases and deaths, 2020 (Number of cases and %)

Source: GLOBOCAN 2020.

Breast Cancer Region-Specific Incidence 2020 (Number of cases and %)

Source: GLOBOCAN 2020.
According to GLOBOCAN 2020 report, the following figure represents the distribution of all-cancer incidence and death by world region for both sexes combined and individually for men and women. In 2020, Asia accounted for one-half of all cases and 58.3% of cancer deaths for both sexes. Moreover, despite accounting for 9.7% of the global population, Europe contributes for 22.8% of all cancer cases and 19.6% of cancer deaths, followed by the Americas with 20.9% of incidence and 14.2% of mortality. Because of the distinct distribution of cancer types and greater case fatality rates in these regions, the percentage of cancer fatalities in Asia (58.3%) and Africa (7.2%) is more significant than the share of cancer incidence (49.3% and 5.7%, respectively). Additionally, In 2020, the global incidence rate for all malignancies was 49.3% in Asia and 22.8% in Europe.

America new cancer and deaths cases, 2020 (Number of cases and %)


Source: American Cancer Society

In the U.S., in 2020, an estimated 893,660 new cases of cancer among men and 912,930 new cases of cancer among women were predicted.
 
According to the International Agency for Research on Cancer (IARC), 2.28 million new cancer cases and 612 thousand cancer deaths occurred in America in 2020. Owing to the rising and aging population the burden of Cancer in America is expected to rise to 3.12 million new cases and 904 thousand cancer deaths by 2040.

EU incidence and mortality, 2020 (Number of cases)

Source: ECIS
In Europe, around 2.7 million persons in the EU's 27 countries are predicted to be diagnosed with cancer in 2020, with nearly 1.3 million dying from it. In 2020, Ireland, Denmark, the Netherlands, and Belgium are predicted to have the highest overall cancer incidence rates, with age-standardized rates more than 10% higher than the EU norm. 

EU Incidence by gender and main causes, 2020 (Number of cases and %)

Source: ECIS
In 2020, more men than women were predicted to be diagnosed with cancer across the EU (54% men and 46% women). Prostate cancer, which is estimated to account for 23% of all new malignancies diagnosed in 2020, is the most common disease in men, followed by lung cancer (14%) and colorectal cancer (13%). Breast cancer is the most common disease in women, accounting for 29% of all new cancer cases, followed by colorectal cancer (12%) and lung cancer (9%). 

Leading causes for cancer and its impact: 
1. Tobacco Smoke
Tobacco smoke is a leading cause of mouth and throat cancer, as well as cancers of the esophagus, stomach, colon, rectum, liver, pancreas, voicebox (larynx), trachea, bronchus, and kidney and renal pelvis, urinary bladder, and cervix, and causes acute myeloid leukemia. Tobacco smoke contains thousands of compounds, including at least 70 cancer-causing agents. The chemicals that cause cancer are known as carcinogens. Tobacco smoke contains a variety of compounds, including Nicotine, Hydrogen cyanide, Formaldehyde, Lead, Arsenic, Ammonia, Radioactive elements, such as polonium-210, Benzene, Carbon monoxide, Tobacco-specific nitrosamines (TSNAs), Polycyclic aromatic hydrocarbons (PAHs), and others. These substances cause cancer. As a result of smoking, both men and women have a 25-fold increased risk of lung cancer. Tobacco use has been linked to cancer in nearly all of the human body's major organs and systems, from the cervix to the soft palate.

According to the World Health Organization (WHO), tobacco kills more than 8 million people each year. More than 7 million of these deaths are due to tobacco use directly, whereas 1.2 million are due to nonsmokers inhaling secondhand smoke. Moreover, According to Centres For Disease Control and Prevention (CDC), In the United States, cigarette smoking causes more than 480,000 deaths each year, including more than 41,000 deaths from secondhand smoke exposure. This equates to nearly one in every five deaths each year, or 1,300 deaths every day. If the current rate of smoking among youth in the United States continues, 5.6 million Americans under the age of 18 are predicted to die prematurely from a smoking-related ailment. This equates to almost one in every thirteen Americans under the age of seventeen.

U.S. death attributes to Cigarette Smoking (Number of cases and %)

Source: CDC

2. Obesity
Obesity is a condition in which a person's body fat content and/or distribution are harmful. Obesity has been linked to an increased risk of some malignancies through a variety of pathways. Obese people are more likely to develop low-level chronic inflammation, which can lead to DNA damage and cancer in the long run. Obese and overweight people are more prone than normal-weight people to have illnesses or disorders associated to or causing persistent local inflammation, which are risk factors for some malignancies. Excess oestrogen is produced by fat tissue (also known as adipose tissue), and excessive levels of oestrogen have been linked to an increased risk of breast, endometrial, ovarian, and other cancers. Excess estrogen is produced by fat tissue (also known as adipose tissue), and excessive levels of estrogen have been linked to an increased risk of breast, endometrial, ovarian, and other cancers. Insulin and insulin-like growth factor-1 levels in the blood of obese patients are frequently elevated (IGF-1). There is consistent evidence that higher levels of body fat are linked to an increased risk of certain cancers, including Endometrial cancer, Esophageal adenocarcinoma, Gastric cardia cancer, Liver Cancer, Kidney cancer, Multiple myeloma, Pancreatic Cancer, Colorectal cancer, Gallbladder cancer, and others.

According to Centres For Disease Control and Prevention (CDC), each year, more than 650,000 obesity-related malignancies are diagnosed in the United States, with more than 200,000 men and 450,000 women. The most frequent obesity-related cancer in women is breast cancer after menopause. Men's colorectal cancer is the most frequent obesity-related malignancy. More than 90% of new obesity-related malignancies are diagnosed in men and women aged 50 and up.
In 2020, about 40% of adults and 20% of children were obese, and that propagation is growing. It is estimated that by 2030, nearly half of U.S. adults will be obese. Moreover, patients with cancer who are obese have more than a 50% increased risk of death compared with healthy weight patients. 

3. Alcohol Consumption
Ethanol, sometimes known as ethanol, is a chemical compound present in alcoholic beverages such as beer, hard cider, malt liquor, wines, and distilled spirits (liquor); it is produced when yeast ferments carbohydrates and starches. Alcohol is a known cancer-causing substance. Drinking alcohol has been shown to raise the risk of women's malignancies of the female breast, liver, mouth, throat (pharynx and larynx), esophagus, and intestine. Heavy drinking has also been linked to an increased risk of stomach cancer. Ethanol (pure alcohol) and its harmful by-product acetaldehyde can cause cancer by harming cells by interacting with DNA and causing cells to duplicate improperly, affecting hormone levels, which can change how cells grow and divide, and boosting the absorption of other carcinogens. According to the data, the more alcohol a person drinks, especially the more alcohol a person consumes regularly, the greater his or her risk of developing alcohol-related cancer such as Esophageal Cancer, liver Cancer, Breast cancer, Colorectal cancer, and others. Alcohol intake over a long period of time has been associated with an increased risk of liver cancer. Regular and heavy alcohol consumption can harm the liver, causing inflammation and scarring, which may contribute to the increased risk of liver cancer.

Type of new cancer cases attributed to alcohol drinking, 2020 (Number of cases and %)

Source:IARC

According to a new report, about 740,000 instances of cancer were detected worldwide in 2020, accounting for about 4% of all cancer cases (WHO). At the same time, about 350,000 alcohol-related malignancies were identified in 2020, with esophageal and liver cancers accounting for the majority. According to the study, alcohol usage will be responsible for roughly 20% of liver cancer cases and 26% of esophageal cancer cases detected in 2020.

Regional estimated number of new cancer cases attributes to alcohol drinking,  2020 (Number of cases).



Source:IARC

The highest proportions of cancer cases linked to alcohol were found in Eastern Asia and Central and Eastern Europe, with the lowest proportions finding in Northern Africa and Western Asia. On a country level, Mongolia had the highest proportion of cancer cases connected with alcohol and Kuwait had the lowest.

Diagnosis and Treatments for Cancer: 
Diagnosis for cancer:
Cancer is mostly diagnosed incidentally when assessing or treating other medical diseases. There is no single test that can identify cancer with certainty. A thorough history and physical examination, as well as diagnostic testing, are usually required for a complete evaluation of a patient. Many tests are required to identify whether a person has cancer or if the symptoms of cancer are being masked by another ailment (such as an infection). Effective diagnostic testing is used to confirm or rule out the presence of disease, track the progression of the disease, and plan and assess treatment outcomes. When a person's health changes, a sample collected is of poor quality, or an aberrant test result needs to be validated, it may be necessary to repeat testing. Diagnostic testing entails tests and procedures that are used to confirm the presence of disease and determine the kind, location, extent, and stage of the tumor. There are many approaches to diagnosing cancer, such as a physical exam, laboratory tests, imaging tests, diagnostic procedures, etc.
 
1.Physical Exam: 
The location of the tumor, including site and subsite, a direct extension of the tumor to other organs or tissues, and palpability and mobility of accessible lymph nodes should all be included in the physical examination report for most malignancies.

2. Laboratory Test:
If cancer is suspected, doctors may employ a variety of laboratory testing. In cancer lab tests, abnormal cells or tumor markers are looked for in blood, urine, other bodily fluids, or tissue samples to see if a person has the disease or has a precancerous state.  Different types of laboratory tests used in cancer diagnosis include Blood chemistry test, Cancer gene mutation testing, Complete blood count (CBC), Cytogenetic analysis, Immunophenotyping, Sputum cytology (also called sputum culture), Tumor marker tests, Urinalysis and Urine cytology. These Lab tests can also be used to identify high-risk patients, determine the stage of cancer, determine therapy options, and assess how well the cancer is responding to treatment.

3. Diagnostic procedures:
Most diagnostic procedures used to screen for diseases like cancer require analyzing tissue or blood, which is commonly obtained from a biopsy. The techniques used in diagnosing cancer include Anoscopy, Biopsy, Endoscopic procedures, Lumbar puncture, and others. An anoscopy is performed if abnormalities are discovered on a digital rectal exam (DRE). It is an endoscopic test that uses a thin, illuminated, flexible tube known as an anoscope to reveal abnormalities. A biopsy is a procedure in which a doctor takes a sample of tissue or fluid from the body. Under a microscope, a pathologist examines the cells to see if they are malignant. A biopsy may be used to assess whether cancer started at the biopsy site or if it started elsewhere in the body and spread to the biopsy site if the cells are determined to be cancerous.

4. Imaging Test:
Imaging tests are invasive that used to examine bones and internal organs. A CT scan, bone scan, magnetic resonance imaging (MRI), Nuclear scan, positron emission tomography (PET) scan, ultrasound, and X-ray are some imaging procedures used to diagnose cancer. A bone scan is a type of imaging examination that can detect malignant cells, analyze fractures, and monitor other bone disorders like infections and arthritis. A mammogram is a screening technique for breast cancer. Mammography is a sort of imaging that examines breast tissue using low-dose X-ray equipment.

Treatment for cancer: 
There are a variety of cancer treatments available. The sorts of treatment will be determined by the type of cancer patients have and how far it has progressed. Types of cancer treatment include Surgery, Chemotherapy, Radiation Therapy, Targeted Therapy, Immunotherapy, Stem Cell or Bone Marrow Transplant, and Hormone Therapy. 

1. Chemotherapy: 
Chemotherapy is a cancer-killing treatment that employs chemicals. It works by inhibiting cancer cells from growing, dividing, or multiplying in most cases. As cancer cells grow and divide faster than normal cells, chemotherapy has a more significant effect on them. Chemotherapy can be administered in various methods such as Intravenous (IV) chemotherapy, Oral chemotherapy, Injected chemotherapy, Chemotherapy into an artery, Chemotherapy into the peritoneum or abdomen, and topical chemotherapy.

2. Radiation Therapy:
Radiation therapy is a cancer treatment that kills cancer cells using high-energy beams. X-rays are most commonly utilized in radiation therapy however, protons or other forms of energy can also be used. The most prevalent type of radiation therapy is external beam radiation therapy. Radiation therapy causes cell damage by damaging the genetic information that regulates cell growth and division. While radiation therapy damages both healthy and cancerous cells, radiation therapy aims to harm as few normal, healthy cells as possible.

Global Oncology Estimated Revenue, 2020 ($Bn).

Source –IndustryArc Analysis

3. Immunotherapy:
Immunotherapy is a sort of cancer treatment in which the immune system is aided in the fight against cancer. It improves the way the immune system finds and destroys cancer cells by using molecules created in the body or in a laboratory. There are many types of immunotherapy such as Monoclonal antibodies and tumor-agnostic treatments including checkpoint inhibitors, Oncolytic virus therapy, T-cell therapy, and cancer vaccines.

4. Hormone Therapy: 
Hormone therapy is a cancer treatment that slows or stops cancer growth by secreting hormones. By limiting the body's ability to produce these specific hormones or modifying how hormone receptors behave in the body, hormone treatment may halt or stop their spread. The most prevalent types of cancer treated with hormone treatment are breast and prostate malignancies. Most breast tumors have oestrogen (ER) or progesterone (PR) receptors, or both, indicating that these hormones are required for growth and dissemination.

Innovation and future trends in Cancer and Oncology treatment:

New cell and gene therapies:
Gene therapy is an experimental strategy for treating or preventing disease by using genes. Various gene therapy strategies are now being used in the treatment of cancer. Anti-angiogenic gene therapy, pro-drug activating suicide gene therapy, gene therapy-based immune modulation, oncolytic virotherapy, gene correction/compensation, antisense, genetic manipulation of apoptotic and tumor invasion pathways, and RNAi techniques are only a few examples. These medicines have been used to treat cancers such as brain, lung, breast, pancreas, liver, colorectal, prostate, bladder, head & neck, skin, ovarian, and renal cancer. One of the most challenging parts of modern gene therapy has been transferring genes into cancer cells. Researchers are looking for ways to fix the flaws in this technique. Genes are delivered to cancer cells via a vector, which is a type of carrier. Viruses are the most popular carriers used in gene therapy because they can infiltrate cells and carry genetic material. Viruses are then altered in such a way that they can no longer cause serious illness.

Precision Medicine:
Precision medicine is a revolutionary approach for disease treatment and prevention that considers each person's unique genetic, environmental, and lifestyle factors. Oncology is at the forefront of this movement, with over 160 oncology biomarkers approved by 2019, and over 90% of Clinical trials targeting molecular targets. With the advent of more medicines target subpopulations the high uptake of biomarker testing along with patient mapping and discovery will become a key competitive advantage. Precision medicine is currently being used to help determine which tests and treatments are best for different cancers. Precision medicine in cancer treatment refers to the use of biomarkers and other tests to select treatments that are most likely to benefit the patients while avoiding treatments that are unlikely to help. Furthermore, preliminary attempts are being made to overcome implementation issues so that precision medicine can be used more widely in oncology clinical practice, which is projected to open up a window of opportunity for Precision Medicine in Oncology applications.

Cart-T Therapy:
T-cell therapy is a treatment in which a patient's T cells (a type of immune system cell) are genetically modified to attack cancer cells in the lab. T cells are extracted from the blood of a patient. The gene for a particular receptor that attaches to a specific protein on the patient's cancer cells is then introduced to T cells in the lab. A chimeric antigen receptor is a unique type of receptor (CAR). CAR T cells are mass-produced in the lab and then injected into the patient. CAR T-cell therapy is used to treat certain types of blood cancers and is also being studied for use in other cancers. Another name for it is chimeric antigen receptor T-cell therapy. The FDA has approved CAR T-cell treatments to treat certain lymphomas and leukemias, as well as multiple myeloma. Kymriah and Yescarta, two chimeric antigen receptor T (CAR-T) cell treatments, were authorised with extraordinary efficacy in acute lymphocytic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL). While the current CAR-T sales are low, hundreds of active agents are in the pipeline that are being tested, as a result the market revenue expected to exceed $6 billion by 2024 according to the recent research.

Table: Industry Players - Acquisition/ Partnership/ Investments/ Product Launch/ - Summary


COMPANY NAME

DEVELOPMENT DATE

DEVELOPMENT TYPE

DESCRIPTION

Pfizer Inc.

August, 2021

Acquisition

Pfizer Acquired Cancer Drugmaker Trillium for $2.3 Billion. The acquisition is predicted to be an essential backbone for immune therapy since Trillium's two lead molecules, TTI-622 and TTI-621 can be used for multiple types of Cancer, especially those of the blood.

Exelixis, Inc.

August, 2021

Partnership

Exelixis and Invenra have expanded their collaboration to encompass 20 new oncology targets for multi-specific antibodies, antibody-drug conjugates, and the development of other biologic candidates in their discovery and licencing agreement. Invenra will receive a $15 million upfront payment and the ability to nominate up to 20 cancer targets in exchange for additional costs.

Johnson & Johnson Inc.

May, 2021

Product Approval

The FDA granted amivantamab-vmjw (Rybrevant, Janssen Biotech, Inc.), a bispecific antibody directed against epidermal growth factor (EGF) and MET receptors, accelerated approval for adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who have epidermal growth factor receptor (EGFR) exon 20 insertion mutations as detected by an FDA-approved test.

Merck

April, 2021

Acquisition

Merck, announced that the companies have entered into an agreement under which Merck, through a subsidiary, will acquire Pandion for $60 per share in cash. This equates to about $1.85 billion in total equity value.

Amgen

April, 2021

Acquisition

Amgen announced that it has completed its previously announced tender offer to buy all outstanding shares of Five Prime Therapeutics. Five Prime Therapeutics is a clinical-stage biotechnology company focused on developing immuno-oncology and targeted cancer therapies. Amgen will pay $1.9 billion in total to complete the subsequent merger.

Pyxis Oncology

March, 2021

Investment

Pyxis Oncology has completed a $152 million Series B financing headed by Arix Bioscience and backed by RTW Investments, LP. Pyxis plans to utilize the funds to expand its distinct portfolio of ADCs, which include PYX-201 and PYX-203. ADCs are an emerging class of therapeutics that deliver very effective targeted treatments directly to cancer cells.

Dr. Reddy's Laboratories

February, 2021

Product Launch

Dr. Reddy's Laboratories launched a generic cancer treatment medicine Capecitabine tablets, in the U.S. The drug is a generic version of Xeloda (capecitabine) tablets that have been approved by the U.S. Food and Drug Administration (USFDA).

Novartis AG

January, 2021

Partnership

Novartis has established a strategic collaboration agreement with BeiGene, Ltd. to in-license tislelizumab. Tislelizumab is an anti-PD-1 monoclonal antibody that is engineered to attach to FcR on macrophages as little as possible. In exchange for an upfront payment of USD 650 million-plus royalties and milestone payments, Novartis will obtain development and commercialization rights to tislelizumab in the United States, Canada, Mexico, the European Union, the United Kingdom, Norway, Switzerland, Iceland, Liechtenstein, Russia, and Japan.

Deciphera Pharmaceuticals

May, 2021

Product Launch

The FDA has approved QINLOCKTM (ripretinib) for the treatment of adult patients with advanced gastrointestinal stromal tumour (GIST) who have previously taken three or more kinase inhibitors, according to Deciphera Pharmaceuticals, Inc. QINLOCK was shown to improve progression-free and overall survival in clinical trials.


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