In January, ASCO released its report, Clinical Cancer Advances 2015: An Annual Report on Progress Against Cancer,1 which details research advances over the past decade that have led to longer survival and better quality of life for the more than half-a-million people diagnosed with cancer each year. For the first time, ASCO announced its Cancer Advance of the Year: gains made in the treatment of chronic lymphocytic leukemia (CLL). The Society also cited the approval of four new drugs—two immunotherapy agents for previously untreated CLL, obinutuzumab (Gazyva) and ofatumumab (Arzerra), and two molecularly targeted drugs for treatment-resistant or relapsed CLL, ibrutinib (Imbruvica) and idelalisib (Zydelig)—as filling a major unmet need in patients with the disease.
Now in its 10th year of publication, the current annual report features several new sections, including A Decade in Review, which looks at the biggest changes in cancer care over the past 10 years; The 10-Year Horizon, which previews trends likely to shape the next decade of cancer care; and Progress in Rare Cancers, which examines early achievements in treating three rare childhood cancers and two rare ovarian cancers affecting young women. (See “ASCO Releases Annual Report on Progress Against Cancer” in the February 10, 2015, issue of The ASCO Post.)
In a wide-ranging interview with The ASCO Post, Gregory A. Masters, MD, FACP, FASCO, Co–Executive Editor of Clinical Cancer Advances 2015 and Attending Physician at the Helen F. Graham Cancer Center in Newark, Delaware, discussed the report’s findings, the impact of the Affordable Care Act on cancer care, how CancerLinQ™ will improve patient care, and anticipated big advances in cancer care over the next decade.
Key Advances
Please talk about how far advances in cancer research have come over the past decade and how those advances will translate into a reduction in cancer deaths and increased survivorship?
It’s great to look over the past 10 years with some perspective, because sometimes, in treating patients with cancer and in looking at cancer care, we tend to get caught up in how slow progress seems. But when we take a broader perspective of what has changed over the past decade, we see the development of whole new ways to treat cancer.
Now we have a better understanding of the molecular biology and the genomics of the disease, and that has allowed us to come up with a number of new targeted therapies. Some of these drugs target the mutations that occur in cancer genes, and some target the mechanisms that cancer cells use to grow.
As we increase our understanding of these things, we will be able to use that knowledge not only in the treatment of patients with advanced cancer, but also in treating patients with earlier-stage disease, thereby improving the cure rates.
We are also refining our ability to screen for cancer and our understanding of supportive measures to improve quality of life for patients.
‘Advance of the Year’
Please talk about the significance of the gains made in the treatment of CLL, which ASCO named its Advance of the Year.
CLL affects older patients and tends to linger for many years, so although only about 15,000 people are diagnosed with CLL each year in the United States, there are more than a hundred thousand survivors living with the disease. Also, until recently, CLL patients were treated with fairly aggressive chemotherapy, which can be difficult for older patients to tolerate.
What we have seen over the past few years as newer types of therapies have come on the market is if we can target CLL more specifically, we can treat the disease with safer and more effective treatments and move away from aggressive chemotherapy that is toxic. That is why we thought the approval of the immunotherapy agents obinutuzumab and ofatumumab for previously untreated CLL, and the molecularly targeted drugs ibrutinib and idelalisib for treatment-resistant or relapsed CLL, represented such an important advance in treatment.
Improved Patient Care
A number of improvements in patient and survivorship care were cited in the report, including a new way to preserve fertility in young women. What other major improvements have there been along these lines?
Care provided by oncologists and other cancer care specialists spans the entire spectrum of general health because when we see patients, we are not just treating their cancer and dealing with the side effects of that treatment. We also have to take into account other chronic health conditions and mental health.
Caring for the whole patient in this way is especially important when we have the potential to cure patients. So we need to think about not just the short-term effects of treatment, but the long-term effects as well. Preserving fertility in a young woman with potentially curable early-stage cancer by blocking hormones during chemotherapy is one example of how we can help make the rest of her life as fulfilling as possible.
We also recognize the importance of exercise in improving quality of life for patients. In addition, some studies show that patients who exercise regularly have a better outcome, less chance of recurrence, and longer survival. Over the last decade, we have improved quality of life for patients by addressing treatment side effects like nausea and chronic neuropathy, providing better nutritional counseling, preventing infection, and stimulating blood cell growth.
Progress in Rare Cancers
Another big advance in cancer care mentioned in the report is in rare cancers. Please talk about the progress being made in these diseases.
The report includes promising research findings in three childhood cancers: pigmented villonodular synovitis, a rare joint disease that affects about 600 mostly young Americans each year; alveolar and embryonal rhabdomyosarcoma; and diffuse intrinsic pontine glioma.
If early reports from small studies of oral therapies targeting the protein CSF-R1 in pigmented villonodular synovitis are confirmed in larger studies, the therapies may offer patients an alternative to surgery and the possibility of joint replacement or amputation. Our improved understanding in the genetic mechanisms of rhabdomyosarcoma is leading to the first targeted therapy for this disease, which currently is treated with chemotherapy, radiation therapy, and surgery. And findings from two studies are showing new genetic alterations in diffuse intrinsic pontine glioma, which suggest possible therapeutic interventions that may offer hope for improving treatment outcomes in this disease.
The report also cites early results from clinical studies showing that bevacizumab (Avastin) may be active against recurrent sex cord–stromal tumors of the ovaries, a rare form of ovarian cancer. New research is also revealing genetic causes of small cell carcinoma of the hypercalcemic type, a rare but aggressive ovarian cancer that primarily affects girls and women younger than age 40.
One of the benefits of having a greater understanding of the molecular basis of the more common cancers is it has given us insight into the role genes play in cancer development in general and allows us to treat cancers we didn’t have good options for previously.
It is still harder to do research on rare diseases, but the more we understand cancer generally, the better we can apply that knowledge to less common diseases.
Impact of Health-Care Reform
Full implementation of the Affordable Care Act went into effect a year ago. What is its impact so far on cancer care?
It’s too early to know for sure. I look at the ramifications of the Affordable Care Act in two ways. First, the law will benefit all of society if we can get more people insured with good-quality health insurance so they have access to physicians, nurses, and programs that improve their health and allow them to get preventive care. Those things will reduce cancer incidence and improve quality of life. So, to me, improved access to health care is the big plus of the Affordable Care Act.
Second, if one of the goals of the Affordable Care Act is to increase patients’ responsibility for payment for some parts of their care, will it result in pricing the more expensive cancer treatments out of the range of patients with limited access and resources? I’m not saying that is happening. I’m just raising the issue and think it is something we are going to need to monitor.
The questions society has to answer are: How do we pay for this expensive care, and how do we make sure there is equitable care that is accessible to all segments of society? Beyond the United States, how do we make sure there is access to quality health care globally?
Role of Information Technology
How will Big Data systems like CancerLinQ improve patient care, especially for patients with rare cancers?
Health information technology systems like ASCO’s CancerLinQ offer possibilities for improving the quality of cancer care and patient outcomes that we haven’t had before because they allow us to learn from every patient instead of just the roughly 3% of patients who participate in clinical trials. CancerLinQ also gives us the mechanism to store the outcomes of different interventions and shows how different ways of managing specific cancers affect overall survival, functional status, and quality of life. That information will allow us to not only better understand cancer, but also to find better ways to treat and cure the disease.
Next Big Advances
Where do you see the next big advances being made in cancer care?
It is hard to extrapolate from what is happening now and predict where that information will lead us in 10 years and whether we are going to have a better grasp of cancer genetics, immunotherapy, and targeted therapies, because our understanding of all of those areas is still in its infancy.
Nevertheless, recent developments in fundamental and translational cancer research are giving us a glimpse into what the future may hold. For example, the 10-Year Horizon section of the Clinical Cancer Advances 2015 report focuses on cancer stem cells, exploring the theory that cancer stem cells are biologically different from regular cancer cells, have the ability to self-renew, and are more resistant to chemotherapy. These insights are leading to the development of treatments that specifically attack cancer stem cells, which could allow us to treat cancer more effectively.
Other promising areas that may start impacting patient care over the next decade include faster and less expensive next-generation sequencing, liquid biopsies to more accurately detect circulating tumor DNA and microRNA in the blood and determine effective treatment, and cancer prevention vaccines.
Over the next 10 years, we will be able to less invasively figure out what types of cancer patients are most at risk for developing recurrences and determine how to hone in on specific screening or surveillance strategies for those individuals. We are improving our understanding of cancer, and that understanding is leading to more effective treatments for our patients. ■
Disclosure: Dr. Masters reported no potential conflicts of interest. For full disclosures of the authors of Clinical Cancer Advances 2015, visit jco.ascopubs.org.
Reference
1. Masters GA, Krilov L, Bailey HH, et al: Clinical cancer advances 2015: Annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 33:786-809, 2015.
To download a copy of Clinical Cancer Advances 2015: ASCO’s Annual Report on Progress Against Cancer, go to cancerprogress.net/cca/clinical-cancer-advances-2015
