Radical oncology: what could change the war by 2035

Changing the gut bacteria of a patient whose immunotherapy stopped working, in the hope of restarting the response.

Deliberately treating a big tumour unevenly, with a lattice of very high dose peaks inside it, instead of a uniform dose.

A drug that does nothing until ultrasound hits it, then kills the cells that took it up. Being tested in brain tumours because sound reaches where light cannot.

Treating the wasting that kills many cancer patients, by blocking the hormone that suppresses appetite.

Testing cheap old drugs, aspirin, metformin, statins, beta-blockers, as cancer treatments, because they are safe, available and sometimes work.

Nanoparticles that turn ordinary radiotherapy X-rays into a much bigger dose exactly where they sit.

Bacteria that seek out the low-oxygen core of tumours, then manufacture a drug on the spot.

Cells or drugs that fire only when two conditions are true at once, so healthy tissue expressing just one of them is spared.

Molecular glues are small molecules that stick two proteins together so the cell destroys one of them. They are smaller and more drug-like than bifunctional degraders.

Designing a protein from scratch on a computer to grip a chosen target, instead of finding one in an animal or a library.

Treating one tumour so aggressively that the immune system learns to attack every other one, using the tumour itself as the vaccine.

Destroying a tumour mechanically with sound, rather than heat, leaves the debris intact enough for the immune system to learn from it.

Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes.

Radioactive atoms that spray very short-range electrons, lethal only if the atom sits on or inside the cell's DNA.

Actinium-225 releases four alpha particles as it decays, but the daughters escape and irradiate the kidneys and salivary glands. Nanocarriers try to hold them in place.

Rotating the proton beam continuously around the patient instead of firing from a few fixed angles, to spread the entrance dose and sharpen the target dose.

Using very fast electrons instead of photons or protons: a possible way to deliver FLASH-speed radiation to deep tumours from a compact machine.

Magnetic nanoparticle hyperthermia injects iron-oxide nanoparticles into a tumour and heats them from outside with an alternating magnetic field.

Gold nanoshells that accumulate in a tumour and cook it when a near-infrared laser is shone on them.

Instead of testing blood every three months, sampling constantly, so a relapse is caught the week it starts.

Smelling cancer: measuring the trace chemicals a tumour puts into exhaled breath.

Choosing treatment from a map of where each cell type sits in the tumour, not just from a list of its mutations.

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.

Using a model of what would have happened to a patient on standard treatment, so fewer people have to be randomised to it.

Building a trial around one patient, or letting one trial swap drugs in and out as evidence accumulates.

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.

In vivo base and prime editing would rewrite a cancer's DNA letter by letter inside the body. It works in the liver for inherited disease; nobody has yet corrected a cancer this way in a person.

Switching a gene off for good without changing the DNA sequence, by writing chemical marks onto it.

An ADC that carries a gene-silencing strand instead of a chemotherapy, so it can switch a protein off rather than poison the cell.

Programmable DNA-targeting therapeutics are an experimental idea: a drug that reads a cell's DNA, recognises a cancer-specific sequence, and kills only cells that carry it. Change the guide, and the same drug becomes a new drug.

RNA drugs that copy themselves inside the cell, or are made as a loop so they last longer. Both aim to get more protein from a smaller dose.

Loading the tiny vesicles cells naturally use to talk to each other with a cancer drug, so the body treats the carrier as its own.

Folded DNA machines that open only when they touch a tumour, releasing a payload or clotting the tumour's blood supply.

Instead of attacking the cancer cell, engineering T cells to strip away the scaffolding and the suppressive immune cells that protect it.

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.

Chemotherapy leaves behind zombie cells that will not divide but poison their neighbours. Senolytics aim to clear them.

Stiff, high-pressure tumours squeeze their own blood vessels shut, keeping drugs out. Softening them is a way in.

Some tumours contain bacteria and fungi that shelter cancer cells and break down chemotherapy. Killing them may make treatment work.

A harmless molecule that turns into a poison only where there is no oxygen, which in the body means inside a tumour.

Giving the innate immune system a memory, so monocytes and NK cells respond harder the next time they meet a tumour.

Folded DNA machines that open only when they touch a tumour, releasing a payload or clotting the tumour's blood supply.

Using viruses that infect bacteria, not human cells, as programmable delivery shells for cancer drugs and vaccines.

Brighter, longer-lasting fluorescent particles and targeted microbubbles that make tumours visible during surgery or on an ultrasound scan.

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.

Removing an amino acid or nutrient that certain tumours cannot make for themselves, while normal cells can.