What’s next in the world of cancer treatment?
A brand new report from the American Cancer Society announcing the largest single-year decrease in cancer deaths has created excitement and raised hopes in the cancer community and beyond. Experts told SurvivorNet that this incredible feat is largely due to the revolution in immunotherapy for cancer.
Read More1. Closing Disparities — Getting New Treatments to More People
We know that a lot of people with cancer aren’t able to afford treatment at comprehensive medical centers, and don;t have access to the best treatments. In this report, researchers were able to point directly to the disparity in access to new, effective drugs.Dr. Otis Brawley, the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, says this is one of the most important factors to address.
Researchers were “actually able to figure out that people who do not have insurance — and [that usually means] poor people — did not have a decline in the melanoma death rate, whereas insured people did have [an acceleration in the] decline in melanoma death rate,” Dr. Brawley said. “That implies that there are treatments, cures for cancer that Americans cannot get because they cannot afford them.”
He emphasizes that in this case, the report is not talking about treatments that can prolong life for a few month, but treatments that “can clearly prolong life a long time, and in some instances can cure [their cancer],” which Americans cannot get because they cannot afford to pay for it.
Indeed, according to the research, while the rate of mortality from melanoma (skin cancer) dropped by 7% every year during 2013 through 2017 in men and women aged 20 to 64 years, “among men aged younger than 65 years residing in poor counties, there was no acceleration in the decline following drug approval. Our inability to detect a difference in the trend by poverty status among women may reflect their melanoma survival advantage over men 67 and/or their higher prevalence of health insurance coverage.”
2. More Effective Use of New Therapies
There has been an enormous amount of progress in developing immunotherapies for cancer treatment. The field of medicine is trying to figure out when to use them, for whom, in combination with what else, and why don’t they work in some people?
Doctors we spoke with said that getting better at using the new drugs that have been developed will be a big part of the future of cancer treatment.
“This is where research and clinical trials come in,” says Dr. Brendon Stiles, a thoracic surgeon at Weill Cornell Medicine and NewYork-Presbyterian. “We have an unprecedented ability to sequence tumors and understand their immune micro-environment. New targets for cancer therapy are becoming apparent at a dizzying pace. We need to study these in the appropriate clinical context to learn how each fits into the next generation of cancer care.”
3. Combining Targeting Therapies with Immunotherapies
One of the major ways doctors see room to improve the use of new drugs is by combining immunotherapy treatments with new targeted therapies, or cancer treatments that attack specific molecules involved with cell growth.
“We need better integration of ‘real-world’ data sources to accelerate regulatory approval of precision oncology therapies,” says Dr. David Wise, a medical oncologist at NYU Perlmutter Cancer Center. “A better understanding of the effects of novel targeted therapies on the immune system will lead to new ways of combining these agents with immunotherapies.”
Dr. Jim Allison, winner of the 2018 Nobel Prize for Physiology or Medicine, on combining immunotherapies with targeted drugs.
Nobel Prize winner Dr. Jim Allison, chair of the Department of Immunology at MD Anderson Cancer Center, talked to SurvivorNet about the effectiveness of combining immunotherapy as a complementary treatment to traditional “targeted” therapies like chemotherapy and radiation for many types of cancer. “The most powerful combinations coming up are based on providing immune blockers and enhancers [and] drugs that can directly kill tumor cells to really have a double whammy.”
‘4. Early Detection
“Continued efforts in early detection of cancer is the most effective step in preventing death and advanced cancers,” says Dr. Kurt Melstrom, colorectal surgeon and an assistant clinical professor, Division of Surgical Oncology at the City of Hope national Medical Center. More specifically, he says, what we need “more advanced and sensitive blood tests and imaging” to help detect cancers earlier.
And Dr. David Wise, a medical oncologist at NYU Perlmutter Cancer Center, agreed that the future of cancer care is in “better liquid biopsy techniques to assess disease burden at a molecular level.” This “will lead to earlier detection and improved response assessment of minimal residual disease in patients who have had curative treatments,” he says.
5. Vaccines
In order to continue the progress in reducing cancer deaths, Dr. Dana Chase, a gynecologic oncologist at Arizona Oncology, tells SurvivorNet that access must be improved for screening and vaccinations.
"Improving access to and adherence to cancer screening tests, vaccinations such as the HPV vaccination, and promoting awareness in terms of concerning symptoms such as postmenopausal or irregular bleeding and abdominal or pelvic complaints is important," she says.
And Dr. Bobbie Rimel, an OB/GYN – oncologist at Cedars-Sinai Medical Center, agrees that “continued attention to vaccination for HPV is critical to reducing rates of cervical, vaginal, vulvar, and head and neck cancers.”
HPV has been linked to a host of cancers, including cervical, oropharyngeal, anal, penile, vaginal and vulvar cancers, according to the National Cancer Institute. The HPV vaccine series is recommended for girls and boys at the age of 11 or 12, but the series can be started at age 9. A CDC survey reported that in 2018, 51.1% of adolescents ages 13-17 were fully vaccinated.
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