2014 was another banner year for cancer research, particularly in the areas of treatment, prevention, and early detection. While there were several significant spheres of progress, we find the following five major advances particularly noteworthy.
First is the development of new targeted therapies for cancer. Targeted therapies specifically block key molecules that are crucial for cancer cell growth and survival.
The promise of such therapies was first established about 15 years ago by the development of imatinib (Gleevec), which blocks the oncogene (cancer-promoting gene) responsible for development of chronic myelogenous leukemia (CML), and led to dramatic responses in patients with this cancer. Many more targeted agents have since been developed. This development has been greatly helped in recent years by the sequencing of the human and the cancer genome, which has led to a more complete understanding of genes that drive cancer.
Targeted agents have transformed modern cancer care by keeping cancer under control for longer periods of time and reducing side effects. However, for all but a handful of patients, cancer is able to develop resistance to targeted therapy over time.
A number of newer, more potent targeted therapies were developed in 2014 that further reduce side effects and help overcome resistance, at least for some time. Targeted therapy treatments have evolved and improved for patients with certain forms of lung cancer, leukemia, breast cancer and renal cell carcinoma.
Patients with cancer and their family members should be prepared to ask how specific the targeted treatment is for their own type of cancer (how well does it target their type of cancer cell), how long most people stay on the treatment, the benefits from the treatment, and what the side effects could be like. [more]
More dramatic strides in cancer therapy in 2014 revolved around major advances in harnessing the power of the immune system to fight the disease. Given that cancer often arises slowly in a patient’s body, the immune system gradually becomes more tolerant of the steadily increasing amount of cancer. It eventually ignores the cancer altogether.
In the last few years, scientists have developed powerful new tools that can reactivate the immune system. These treatments are in the form of potent cancer vaccines and other immune-provoking agents. Several such new immunotherapies were approved in the last year alone, particularly for patients with melanoma and lung cancer.
These new immune “awakening” approaches are able to activate the patient’s immune system to attack the cancer and keep it at bay, in some cases for several years. Cancer patients should inform themselves about the very different and, in some cases, milder side effects that immunotherapies bring.
However, only a minority of patients treated with immunotherapy see significant benefits from the treatments. Researchers are looking for better ways to determine which patients are likely to benefit from these treatments and which biomarkers can be used to predict benefits from specific immunotherapies.
Tracking cancer in the body
Another recent discovery that’s helping us figure out how to better care for people with cancer is our growing ability to detect very low levels of circulating cancer cells or pieces of cancer DNA in the blood.
Progress is being achieved in learning, for example, when an ongoing treatment is working in a patient, when resistance to treatment is starting, and perhaps most significantly, in catching disease that cannot be found even through the most sophisticated modern cancer imaging techniques, such as PET and MRI scans.
While this method is not ready for wide-spread use, research so far strongly suggests that this will become a powerful tool to help us manage the cancer experience in a more timely, accurate way.
Better imaging tests to find cancer early
Speaking of improved imaging, it’s not only in the area of cancer treatment that these advances are making a difference.
When expert organizations, including the American Cancer Society, recommended using CT scans to screen high-risk smokers for lung cancer in order to detect the disease earlier and save lives, they understood this could have enormous impact on the number of lives lost to lung cancer. There are up to 90 million current or former smokers in the United States today, many of whom stand to gain from being screened for lung cancer.
This adds momentum to significant progress in screening for breast, colorectal (commonly called colon), cervical, and prostate cancers. These cancers, along with lung, are the among the most common in US adults, and better tools to find these cancers early will save many lives.
Current and former smokers who are at high risk for lung cancer, including those who have been successfully treated for prior tobacco-related cancers, should ask whether evidence supporting lung cancer screening applies to them.
Using radiation instead of surgery
Interestingly, it’s the therapeutic application of radiation that represents the final major area of progress. Radiation therapy has long been known to be a powerful and highly effective treatment for controlling cancers in defined areas. However, for patients whose disease is localized to one area and a few surrounding lymph nodes, surgery has long been the first and often the best approach.
Recent evidence strongly suggests that a few highly accurate treatments with high-dose radiation therapy can approach and even equal the success of limited surgery. This would provide a powerful tool in the hands of doctors treating patients who are poor candidates for surgery due to their general health or other illnesses.
This increasingly effective approach, called Stereotactic Body Radiotherapy (SBRT), has opened up a number of opportunities for those patients who couldn’t have surgery. Patients who are not ideal candidates for surgery (your health care team would have told you this) should strongly consider this approach, and discuss it with their cancer care team.
These exciting and revolutionary advances all arise from discoveries in laboratory-based and clinical sciences. They represent a major return on the longstanding commitments of the United States government (through the National Institutes of Health, Department of Defense, National Science Foundation and other agencies) and major philanthropic organizations, such as the American Cancer Society, to funding biologic discovery. Without this support, none of these major strides in cancer treatment would be possible.
Cancer patients today are having their diseases detected earlier, are facing a higher likelihood of cure, and are living with a better quality of life. Even patients with metastatic disease are living substantially longer compared to just 5 years ago. Still, while much progress has been made, much more remains to be accomplished so that our cancer patients’ lives can be managed more like the lives of those with heart problems, diabetes, or other chronic diseases. For this goal to become a reality, the continued support and growth of our fundamental and clinical science research efforts through funding and support has never been more vital.
Dr. Khuri is executive associate dean for research at the Emory University School of Medicine; professor and chair of hematology and medical oncology, adjunct professor of medicine, pharmacology and otolaryngology; Roberto C. Goizueta Distinguished Chair in Translational Cancer Research; and deputy director, Winship Cancer Institute, Emory University. He also serves as editor-in-chief of CANCER.