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What’s on the Horizon? Looking Toward the Future of Cancer Care

Publication: Dallas Medical Journal

Cancer impacts all of us. Whether you’re a physician whose mission it is to care for people with this disease, or you or a loved one have experienced a cancer diagnosis, you understand the toll that cancer takes. Nearly 1.9 million new cancer cases are expected to be diagnosed in 2021, according to the American Cancer Society (ACS).

But one of the most valuable – and dare we say, life-giving – parts of our jobs as physicians is to offer real hope to our patients fighting this complicated disease. After all, more than 16.9 million Americans with a history of invasive cancer were alive as of early 2019, the ACS also reports. These patients currently have no trace of the disease in their body. While this news is encouraging, there is progress to be made in early cancer detection and treatment.

As we look toward the future of cancer care, many new breakthroughs in cancer therapy, screenings, and clinical trials, are changing the way we diagnose and treat cancer – ultimately helping our patients live longer, healthier lives. But what advancements, specifically, will have an impact on not only the detection of cancer and survival rate in our patients, but their well-being during and after treatment? We see much progress – and potential – in the innovations described below.

The New Era of Radiopharmaceuticals

For more than 100 years, radiation therapy has been a common and effective cancer treatment. While successful at destroying cancer cells, we know traditional radiation therapy can damage healthy cells and deals out a host of side effects.

An emerging form of radiation therapy, radiopharmaceuticals deliver radiation specifically to cancer cells in the body while preserving more of the healthy tissue around it. Delivered via IV, radiopharmaceuticals are designed to track and “stick” to a cancer cell. Once this happens, the radioactive compound breaks down on its own, then releases energy to the DNA of the nearby cells, thus killing that cancer cell. The ability for a single radiopharmaceutical to stick to a cancer cell and kill other cancerous cells around it means less radiation is needed in the body, which greatly benefits the patient.

Researchers are gaining more understanding of how radiopharmaceuticals could target specific cancers. In 2018, the FDA approved the use of lutetium Lu 177-dotatate, a radiopharmaceutical, for the treatment of certain neuroendocrine tumors affecting the pancreas or digestive tract. Research released at American Society of Clinical Oncology (ASCO) annual meeting this year found that radiopharmaceuticals could help men with advanced prostate cancer live longer than those who only receive the standard of care. Also, studies have shown that the use of immunotherapy combined with radiopharmaceuticals has the potential to improve the way tumors respond to certain drugs.

Emerging Methods of Cancer Screening

Screenings are the most effective way to identify cancers in their earliest stages – often before patients experience symptoms. For many cancer types, including lung, breast, colorectal, and cervical cancers, advancements in screening and treatment offer promise for earlier detection and more positive outcomes. New, emerging screening methods could change the way we find cancer in its earliest stages.

One of the newest screening methods for lung cancer is the low-dose CT (LDCT) scan. Studies have shown that using the LDCT scan in high-risk patients could save more lives than using chest X-rays. According to the American Cancer Society, unlike chest X-rays, LDCT scans can more accurately find abnormal areas in the lungs that could be cancer. In fact, after several years studies have found that patients who received LDCT scans annually had a 20% lower chance of lung cancer death than those who received chest X-rays.

While breast cancer is the second-deadliest cancer among American women, steady declines in mortality among women in the past 30 years can partially be attributed to early detection of the disease. Today, large-scale research is underway for the use of 3D mammography – also known as digital breast tomosynthesis (DBT) – to screen for cancerous tissue or other abnormalities, and we’re seeing promising results. 3D mammography takes thin “slices” of images of the breast using a X-ray machine and reconstructs the image to look for any cancerous tissue or abnormalities. As more study is completed and its use widens, we’re hopeful for the possibilities of 3D mammography in diagnosing breast cancer early and more accurately in women and men.

We know that the earlier cancer is detected through screenings and self-exams, the better chance of successful treatment. But what about finding cancer where there is no available screening test? Multi-cancer early detection blood tests are an area where researchers are making progress. One such test, developed by GRAIL, with Texas Oncology participating in the research, Galleri is a multi-cancer early detection test that offers detection for more than 50 types of cancers through a simple, single blood draw. In clinical studies, when the Galleri test detected cancer, its prediction of the cancer signal origin was correct approximately 89% of the time. Multi-cancer early detection tests, including the Galleri test, hold incredible potential in finding more cancers at earlier stages and ultimately, improving survival rates.

However, these advancements mean nothing if our patients aren’t getting screened. As physicians, we share in the responsibility to communicate the importance of cancer screenings and make it easy, approachable, and safe for our patients to take this important step in protecting their health.

Precision Medicine and the Future of Clinical Trials

We’re seeing groundbreaking possibilities for the use of precision medicine across the healthcare landscape. For cancer care, precision medicine has the potential to transform how we organize and administer clinical trials.

Clinical trials traditionally organized patients in a central location by similar cancer type. Precision medicine offers the ability to decentralize trials into community-based cancer centers and group patients with a drug therapy that can better target the genetic changes in their tumor identified in genomic testing. We’ve learned that the same cancer-causing genetic changes may be found in different types of cancer. As a result, patients with unique tumors from one another, but that share the same genetic change, can receive the same drug that targets the change, regardless of the type of cancer. This allows us to target the cancerous cells down to a single-patient level and treat the cancer precisely based on the genetics of their tumor.

Though some cancer centers, including Texas Oncology, are already using precision medicine in this way, it will take time for smaller, community-based cancer centers to adapt and leverage this new clinical trial design. But with more research into genetic changes that drive cancer cells to divide and grow, more patients in the future will be able to receive personalized cancer treatments based upon the genetics of their tumor, all within their own community.

The future of cancer care is bright and promising. Challenges lie ahead, but we will never stop learning from our past and evolving for our future based on what new research and this disease is teaching us. With more breakthroughs, come more victories for cancer patients.

For more information visit TexasOncology.com.

By Scott Cheek, M.D., radiation oncologist, Texas Oncology–Baylor Charles A. Sammons Cancer Center and Scott Paulson, M.D., medical oncologist, Texas Oncology–Baylor Charles A. Sammons Cancer Center

This article appeared in the October issue of Dallas Medical Journal.