5 Emerging Trends in Cancer Research and Treatment
by Ing Wei Khor
Decades of dedicated research have led to enormous advances in the way that cancer is detected and treated. Some cancers — such as childhood acute lymphoblastic leukemia — have very high cure rates, and patients can go on to have a normal lifespan. Given the diverse nature of cancer and large variations even with the same type of cancer in different patients, many unmet needs remain. Here, we will cover just five of the current trends in cancer research and treatment, ranging from personalized treatment based on the genetic profile of individual tumors to better methods for earlier cancer detection.
1. Targeting Tumors Based on Their Genetic Characteristics
Most, if not all, cancer cells have genetic changes called mutations. Some of these mutations are involved in the development of cancer — a process called carcinogenesis or tumorigenesis. Other mutations do not cause cancer but are produced because the DNA in cancer cells is unstable and prone to changes. A tumor occurring in a particular patient has a unique profile of genetic mutations called a signature. Although the tumor signature differs from patient to patient, some genetic mutations are associated with a particular type or subtype of cancer.
One of the most emerging trends in cancer research and treatment involves using targeted therapies that are specific for tumors with certain genetic mutations. These therapies include immunotherapies that bind to proteins on cancer cells that have a specific mutation. Researchers are also studying CRISPR-Cas9 gene editing techniques to precisely correct mutations in cancer cells. Therapies need to be delivered in a targeted fashion to cancer cells and not to normal cells because cancer mutations usually occur in genes that the body needs to function properly. To direct CRISPR-Cas9 therapies to the target cancer cells, researchers deliver them in vehicles such as viruses (strains that are naturally harmless or treated so they don’t cause disease in humans) and liposomes (pinched-off bits of the cell membrane).
2. Addressing Cancer Resistance
A major cause of cancer death (responsible for 80% to 90% of deaths from cancer) is the eventual decrease in response to cancer treatments, allowing cancer to recur. This phenomenon is called treatment resistance and may be caused by various factors. Resistance has been reported to practically all drugs used in chemotherapy including doxorubicin, paclitaxel, 5-fluorouracil and cisplatin.
A goal in the future of cancer research is eliminating resistance to cancer drugs. Doctors and scientists are examining the mechanisms of resistance to cancer drugs to better understand how to address or avoid resistance. They are developing new methods to combat resistance such as using strategies that detect cancer at earlier stages, fine tuning the dosing and delivery of cancer drugs for optimal efficacy, detecting drug resistance early, involving a combination of drugs with different mechanisms of action and adjusting the environment around the tumor.
3. Targeted Immunotherapy
Immunotherapy has revolutionized cancer treatment and outcomes for some patients such as those with certain types of leukemia, lymphoma, melanoma and lung cancer. However, immunotherapy does not work for all patients. Many patients may respond initially but develop resistance to it over time.
The past two decades have seen the development of powerful immunotherapy agents such as chimeric antigen receptor T cells and checkpoint inhibitors which are antibodies that bind to immune cells and reverse their inhibition by proteins produced by cancer cells. Now, researchers are developing treatments that enhance the efficacy of immunotherapy and reduce resistance. Some of these treatments target cancer stem cells which are thought to be an important mechanism of resistance to immunotherapy. For example, cancer stem cells cause the checkpoint inhibitor PD-L1 to be increased on immune cells. So, therapies that block PD-L1 such as PD-L1 antibodies could specifically reduce the number of cancer stem cells.
4. Advances in Chemotherapy and Radiation Therapy
Although immunotherapy represents a bright new hope, many cancer patients are still treated primarily with chemotherapy and radiation therapy. However, intense research efforts are underway to improve these grande dames of cancer treatment. Newer chemotherapy drugs include drugs that directly inhibit the cancer-causing gene RAS and tyrosine kinase inhibitors of the epidermal growth factor receptor gene. The EGFR TKIs have greatly improved survival for patients with advanced non-small cell lung cancer.
In radiation therapy, researchers are evaluating a new type of drug called radiopharmaceuticals which aim to deliver radiation directly to target cancer cells. These new drugs can help to selectively destroy even small clusters of cancer cells and are more likely to have fewer side effects because they avoid normal cells. One example is lutetium Lu 177-dotatate (Lutathera), a radiopharmaceutical that targets neuroendocrine tumors by binding to hormone receptors on the NET cells. Lutathera greatly improved the treatment of NET.
5. The Future of Cancer Research Starts With Earlier Detection
Even the most promising cancer therapy has a better chance of fighting cancer if the disease is detected at an earlier stage — before metastasis. Researchers are working on several areas of cancer detection including improving methods of detecting small tumors and developing non-invasive techniques for diagnosing cancer. An ideal cancer detection method would be one that identifies tumors in different organs at the same time. This would allow doctors to find tumors before they cause symptoms. Non-invasive techniques such as liquid biopsies detect cancer cells, proteins or DNA in the blood, avoiding painful biopsy procedures.
6. Leading the Way in Cancer Treatment
These five trends in cancer research are only some of the many advances in cancer diagnosis and treatment that are happening now. As researchers continue to push the envelope for earlier cancer detection and more targeted, personalized treatment, people with cancer can hope to live longer and have a better quality of life than ever before.
For 70 years, Yosemite Pathology and Precision Pathology has advanced anatomic pathology in the Western United States. Today, our practice encompasses more than 20 board-certified anatomic pathology specialists. We offer a broad range of specialties including breast, gynecologic, hematology, thyroid, urologic and other pathologies. For more information about our services contact us today.
Ing Wei Khor is a trained scientist and medical writer who is passionate about communicating science and medicine clearly and simply to a wide audience.
International Journal of Molecular Science – “Targeting cancer with CRISPR/Cas9-based therapy”
International Journal of Molecular Science – “Battling chemoresistance in cancer: root causes and strategies to uproot them”
Cancer Drug Resistance – “Recent advances in tumor-targeting chemotherapy drugs”
National Cancer Institute – Radiopharmaceuticals: Radiation Therapy Enters the Molecular Age