Article You May Enjoy!: The Coming... - Advanced Prostate...

Advanced Prostate Cancer

20,781 members25,885 posts

Article You May Enjoy!

Moespy profile image
9 Replies

The Coming Revolution in Cancer Care

Genomic medicine, better diagnostics, and targeted treatments will transform cancer care by spotting and eliminating the disease before it takes over.

This article was produced by Hackensack Meridian Health in partnership with Scientific American Custom Media, a division separate from the magazine's board of editors.

By Andre Goy, MD

The Coming Revolution in Cancer Care

Targeted cancer treatments have given oncologists powerful new tools to stop the disease. Credit: Kateryna Kon/SPL/Getty Images

Just a few decades ago, cancer seemed nearly unbeatable. Cancers were diagnosed late, treatments only bought time, prognosis was grim, and survival rates were low. But cancer care is transforming. Thanks to rapid advances in cancer biology, diagnostics, precision medicine, immuno-oncology and drug discovery, oncologists like myself now have growing power over the disease. That means more lives saved—not just in the distant future, but over the next few years.

Already, oncologists can train the full force of the immune system on cancer and prevent its recurrence. What’s more, next-generation genomic sequencing has become affordable. This has opened the door for better prevention, early detection, and targeted treatments that aim to prevent cancers from recurring.

From a practical standpoint, we need to think of the future of cancer care as a war on three fronts: pre-cancer, cancer care, and post-cancer.

If cancers can be detected early enough, almost all of them are curable, or manageable. For example, most ovarian cancer cases are diagnosed at advanced stages, and only one in four of those patients survives more than five years. But in 15 percent of cases, ovarian cancer is found early, and the five-year survival rate for these people leaps to 94 percent.

Accurate screens are currently available for early diagnosis of just a few cancers: mammograms for breast cancer, Pap smears for cervical cancer, colonoscopies for colon cancer, PSA tests for prostate cancer, and low-resolution CT scans for lung cancer. No effective screening methods currently exist for other cancers, which together account for 60 percent of cancer deaths.

CATCHING CANCER EARLY

Soon new screening methods will transform pre-cancer care.

One is the liquid biopsy. Many solid tumors have long required invasive tissue biopsies to diagnose. But now it’s possible to detect early signs of cancer by analyzing blood samples (the ‘liquid’ in liquid biopsies). That’s because every cancer releases into the blood both cancer cells and fragments of DNA, even very early in the cancer’s development. Analyzing them can reveal the nature of a developing tumor.

Another new screening method uses epigenetics. This refers to the chemical modifications to DNA and proteins that do not change what the gene encodes, but can still determine whether the gene is turned on or off. Analyzing just one of these chemical modifications — the addition of a methyl group to the DNA molecule — could potentially detect up to 50 different types of cancers, a large consortium of researchers reported last June in Annals of Oncology.1

One of the easiest opportunities will be in lung cancer screening. Today this screening is done by using serial, low-resolution CT scans to monitor potential lung nodules in patients at risk for lung cancer. By adding liquid biopsies, we’ll be able to discover predictive molecular signatures that help distinguish benign and cancerous nodules, as illustrated by a recently reported lung cancer likelihood in plasma predictive signature.2

Precancer care can now also mean mitigating genetic risk factors and reducing the chances of developing an actual cancer. Women with mutations in the tumor suppressor genes BRCA1 and BRCA2 genes, who are susceptible to breast and ovarian cancer, could receive a prophylactic therapy called a biological modifier that can reduce the chronic inflammation or metabolic syndrome that causes cancer to grow.

TARGETED TREATMENTS

Cancer care itself will become increasingly diagnostic. In the past, too many cancer drugs were simply not effective. Soon, we will be able to understand the initial genetic makeup of the tumor, and better stratify patients based on their genetics to optimize treatment decisions. This is the essence of precision medicine.

This approach to precision cancer care can make a dramatic difference. In a study of 2,000 non-small cell lung cancer patients, patients who did not undergo molecular testing and did not receive a targeted cancer therapy such as a protein kinase inhibitor, the median survival was only 10 months. But patients who underwent molecular testing, and received a protein kinase inhibitor appropriate for their cancer, had a median survival of almost four years.

Since we already have targeted therapy for the two most common mutations causing non-small cell lung cancer, molecular testing is poised to transform treatment of this type of cancer.3 The results also illustrate how optimizing treatments through precision medicine can reduce the cost of care.

PREVENTING RECURRENCES

Even today, most patients respond to initial therapy, whether targeted or not. But the biggest challenge in post-cancer care, also known as follow-up care, is to predict and prevent subsequent relapses.

Our ability to do this is improving as we get better at measuring residual disease, thanks to liquid biopsies and next generation sequencing. Detecting and characterizing residual cancer could help us tailor additional therapies to keep the disease suppressed. And with new technology, we could quantify the immune status of a patient, which largely determines the risk of recurrence. This will help us choose immune-based therapies that could help prevent recurrences.

Follow-up care today means more than monitoring for disease recurrence. Evidence is growing that wellness and lifestyle changes, especially changes in exercise, nutrition, and overall well-being, support survival and recovery, and also reduce recurrences.

Smarter medicine that’s tailored to patients means better outcomes, longer survival and lower healthcare costs. In the future, stratifying patients early on and delivering targeted, effective treatments will lead to the best possible outcomes. This will lower hospitalization rates for cancer patients, lower healthcare costs to society, and save lives.

Written by
Moespy profile image
Moespy
To view profiles and participate in discussions please or .
Read more about...
9 Replies
AlanMeyer profile image
AlanMeyer

This is a very optimistic article. It will be easier to understand for readers who know the nature of DNA, "epigenetics", "methylation", and some other terms from molecular biology, but I think everyone who reads it will at least get a sense of the truly revolutionary developments in cancer research that are now, and will in the future, greatly extend the lives of cancer patients.

SimonHL profile image
SimonHL

A sobering touch of reality reported in the last week: early screening for ovarian cancer has been a failure : (sciencedaily.com/releases/2...

AlanMeyer profile image
AlanMeyer in reply to SimonHL

I never know how to interpret articles like this. If I read the article correctly, early "multimodal" screening was not a failure, it was a success. It did detect ovarian cancer earlier. What failed was early treatment (assuming that women diagnosed earlier were treated earlier.) It sounds as if women treated earlier in the course of their disease didn't live any longer than those for whom there was no early detection.

Then the article ends with this contradictory statement that says early treatment works:

"Ovarian cancer is so often diagnosed at stage 3 or 4 and shifting diagnosis one stage earlier makes a huge difference to both treatment options and quality of life. Earlier diagnosis will often reduce the amount and intensity of treatment, and this makes all the difference to women and their families who are living with cancer. It may have also given them more precious time with their loved ones."

Huh?

Moespy profile image
Moespy in reply to AlanMeyer

Maybe.....

Early detection with early treatment good.

Early treatment with late detection bad.

j-o-h-n profile image
j-o-h-n

Is this Bullshit???

Dogs have an incredibly sensitive sense of smell that can detect the odor signatures of various types of cancer. Among others, they can detect colon cancer, prostate cancer, breast cancer, and melanoma by sniffing people’s skin, bodily fluids, or breath.

Researchers are currently exploring the possibility of using specially trained medical detection dogs in the diagnosis and tracking of cancer.

Canine cancer detection is a simple, noninvasive procedure with potentially fewer side effects for people. However, further investigation is necessary to validate this method for use in clinical practice.

Last medically reviewed on November 8, 2018

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/20/2021 7:25 PM DST

Moespy profile image
Moespy in reply to j-o-h-n

This is going on a different direction, but I like it.

Trained dogs are able to detect colorectal cancer from people’s breath and watery stool with high levels of accuracy, even for early stage cancers. The presence of gut inflammation or noncancerous colorectal disease does not seem to affect dogs’ ability to detect these cancers.

Dogs can also detect lung cancer from a person’s breath. One studyTrusted Source found that a trained dog had a very high rate of accuracy in distinguishing between the breath of people with and without lung cancer.

They are also able to detect ovarian cancerTrusted Source from blood samples and prostate cancer from sniffing a person’s urine.

I think it's legit.

j-o-h-n profile image
j-o-h-n

Early detection?

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/20/2021 9:20 PM DST

Moespy profile image
Moespy

It appears man's best friend may have a future in early detection of many different types of cancers,

Chadsdad profile image
Chadsdad

Jim, hope this message finds you well. Genomics test was unremarkable. Latest PSA came back at <0.014 as opposed to the 0.00 I’ve been receiving. They used an ultra sensitive test this time and at first made me have a little lump in my throat. Got over that pretty quick and moved on to my <2.5 Testosterone. Same old se’s, fatigue/ hot flushes and restless leg issue. This is 18 months I’ve been doing Eligard and Erleada. Will be nice to hear from you my friend. Larry

You may also like...

Does the new Circulating Tumor DNA blood test have any use for APCa patients?

personalized, tumor-informed assay optimized to detect circulating tumor DNA (ctDNA) for molecular...

Article: ADT May Increase Risk of Death From Cardiovascular Disease in Prostate Cancer

cancertherapyadvisor.com/home/cancer-topics/prostate-cancer/prostate-cancer-androgen-deprivation-the

Enjoyable journey of life on this planet

'Substandard' Control Arms in Clinical Trials– Practice found common in prostate cancer studies

predefined set in a DNA repair gene that had progressed on at least one androgen receptor targeting...

QOL - Fun, Enjoyable, and Happy