These enhancements come at a critical time. Cancer incidence is expected to grow to 21 million patients worldwide and cause 13 million deaths per year by 2030.
Despite those sobering numbers, scientists are continuously breaking barriers in cancer research and establishing new and viable treatments. Here are five hot topics that impact treatment today.
1. Precision medicine (aka targeted therapy)
With precision medicine, clinicians can treat cancers based on the mutational profile of the tumor rather than the tumor type, adding a powerful new weapon to the anti-cancer armamentarium. Once the human genome was mapped in 2003, techniques were developed for discovering what genetic abnormalities occur in tumors. Clinicians can be informed of a specific mutation in the tumor by testing a panel of genes. Some cancers don’t carry mutations that therapies have been developed for, but others — like lung cancer and colon cancer — can be treated with targeted therapies.
The new paradigm for treating some cancers is to profile patients and see if their tumors have mutations that can be treated with targeted agents. Traditional clinical trials key in on cancer type. But basket trials have joined all patients together regardless of tumor or subtype. The cancer is treated based on its mutational profile, not the histology of the disease. The immune checkpoint inhibitor pembrolizumab became the first cancer treatment to be approved for this indication in 2017.
A patient-derived 3D model of a tumor — or ‘organoid’ — has become a new tool for testing the efficacy of various cancer treatments. Here’s how it works: a biopsy of a tumor is taken, grown and tested for drug sensitivity allowing the organoid to be the recipient of the clinical trial without exposing patients to medications. Researchers at Cold Spring Harbor Laboratory, which has a strategic alliance with Northwell Health, have pioneered these models for pancreatic cancer and the technology can also be used for breast cancer and other solid tumors. Studies suggest that drug testing in organoid cultures can be used to select the most appropriate treatment. For those with recurring disease, organoids can be used to test the tumor again and see if the sensitivity changed.
3. CAR T-cell therapy
Chimeric antigen receptor T-cell therapy (or CAR T) is a novel approach to attacking cancer cells. Scientists remove T-cells from a patient’s blood, engineer them by boosting the cells with proteins and infuse the cells and blood back into the body. When the CAR T-cell receptor attaches to a molecule on the cancer cell, it sends a signal to activate the destructive mechanism of the T cell. This therapy can only be given once as the CAR T cells continue to multiply in the patients body, which can lead to a prolonged cancer remission. The FDA approved this method to treat certain types of relapsed or refractory leukemia and lymphoma last summer. Northwell is one of a few centers across the country to offer CAR T with a trial beginning in August.
4. Rising incidence in younger patients
Recently, the American Cancer Society lowered its recommendation to screen for colon cancer starting at age 45 (down from 50) because of increased incidence in younger patients. While factors such as family genes and environmental issues play a role in many cancers, researchers are currently looking at dietary factors and obesity as a risk factor for colon cancer similar to the role obesity plays in endometrial cancer. Post-menopausal women convert testosterone to estrogen via the aromatase reaction. For obese women, the amount of estrogen is higher due to more body fat. Outcomes can improve if they lose weight and worsen if they remain obese. However, the precise nature of the relationship between obesity and colon cancer remains to be elucidated.
5. Cancer prevention
As researchers and clinicians gain more knowledge about different types of cancer, prevention and understanding the hereditary nature of these diseases has been critical to improving outcomes and increasing survival. For example, screenings, such as mammograms and colonoscopies, have had a significant impact on breast and colon cancer and BRCA gene screening can identify patients at high risk for breast and ovarian cancer. The role of risk reducing surgery continues to be explored including the possibility of just removing the fallopian tubes in patients at risk for ovarian cancer who wish to delay removal of their ovaries for several years. This was first proposed after it was discovered that early occult cancer were found in the fallopian tubes of high risk patients that were removed at the time of prophylactic salpingo-oophorectomy (surgically removing ovaries).
Finally, increased awareness and vaccination rates for adolescents have helped slow the rate of the human papillomavirus (HPV) infection, which causes 33,000 cancer cases each year including head and neck and cervical cancer.
Richard Barakat, MD, is an internationally recognized surgeon and clinical investigator. He leads all of cancer services and research at Northwell Health, including the Cancer Institute. Dr. Barakat joined Northwell after serving as chief of the Gynecology Service at Memorial Sloan Kettering and director of its regional network.