Looking back over the past year, what were some of the big things we learned that contribute to the progress that’s being made against cancer?
Here are ten of the stories that stood out most for me. Some involved new treatments or evolving treatment approaches. Others were about important policy issues, including the high costs of cancer care, and the pressing need for solutions. And again this year we were reminded of the importance of accuracy when it comes to reporting about celebrity cancer stories.
- Early in the year, the drug palbociclib (Ibrance) received accelerated approval from the Food and Drug Administration (FDA) as a treatment for postmenopausal women with hormone receptor-positive metastatic breast cancer. Ibrance is the first of a new type of targeted therapy called CDK 4/6 inhibitors to be approved by the FDA. Then, in July, published results from the PALOMA3 clinical trial showed that when Ibrance was given in combination with fulvestrant (Faslodex), a hormone therapy, it more than doubled the average time to disease progression compared to treatment with just fulvestrant. This combination became a new standard of care available to patients with this subtype of disease.
- For patients with advanced lung cancer, two new immune system therapies received FDA approval this year–nivolumab (Opdivo) and pembrolizumab (Keytruda). Both are PD-1 inhibitors, a treatment that “releases the brakes” on the immune system. Both had been approved last year for advanced melanoma. Ongoing studies are examining whether PD-1 inhibitors are beneficial for treating additional types of cancer. Open questions include whether these drugs should be given at earlier stages of the disease, and why some patients have very strong responses to the therapies while others get no benefit from them.
- New techniques for identifying and measuring genetic biomarkers within a patient’s tumor cells may help in reducing the exposure of patients to unnecessary treatment toxicities. Results from the TAILORx clinical trial reported in September provided additional evidence that women with early stage breast cancer who have a low score on the Oncotype DX test–a 21-gene assay–are at very low risk of recurrence and can safely avoid chemotherapy. And at the San Antonio Breast Cancer Symposium in December, evidence was presented that some patients with hormone-receptor positive breast cancer, even those with positive lymph nodes, may not need chemotherapy.
- The new immune system therapies, like most new cancer drugs, carry extremely high price tags in the United States–typically $120,000 or more per year for a single drug. In an editorial in the journal Mayo Clinic Proceedings, a group of 118 leading cancer experts said “high cancer drug prices are affecting the care of patients with cancer and our health care system” and recommended a set of actions to improve the situation and allow market forces to work better. A Kaiser Family Foundation poll in October found that “making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them is viewed as a top priority by 77 percent of the public and more than 7 in 10 across party lines.”
- The latest information on breast cancer trends and disparities reported by the American Cancer Society shows that breast cancer incidence rates among African American women have now risen to match those of white women. At the same time, mortality rates remain 41% higher in African American women than in white women and black women are more often diagnosed with an aggressive subtype of the disease. Experts said these breast cancer disparities should prompt more efforts to include black women in clinical trials, as well as a greater emphasis on navigation programs for cancer patients and research to understand the impact of environmental exposures, which may affect some socioeconomic groups more than others.
- Growing recognition of the impact on human health of toxic substances in environment and the need for timely action was reflected in a statement issued by the International Federation of Gynecology and Obstetrics. The organization warned that “Documented links between prenatal exposure to environmental chemicals and adverse health outcomes span the life course and include impacts on fertility and pregnancy, neurodevelopment, and cancer.” It said “The global health and economic burden related to toxic environmental chemicals is in excess of millions of deaths and billions of dollars every year.”
- A major clinical trial testing targeted therapies based on the molecular characteristics of a patient’s tumor–rather than the organ in which it originated–opened for enrollment in August. The trial is called NCI-Molecular Analysis for Therapy Choice or “NCI-MATCH”. The initiative will screen about 3,000 patients across the United States with many different types of cancer, with the goal of identifying about 1,000 whose tumor biopsy samples show that certain specific molecular characteristics are present. Patients will be matched with sub-trials designed to test the efficacy of drug therapies targeted specifically to these characteristics.
- The American Society of Clinical Oncology and the American Cancer Society issued new guidelines for follow-up care after breast cancer treatment that covered a number of areas of critical importance to patients including monitoring for signs of recurrence, general health and cancer screening recommendations, and managing long-term side effects.
- An experimental technique, sometimes referred to as a liquid biopsy, has shown promise in a number of studies this year as possibly an important future tool in managing the care of cancer patients. The test requires only a blood draw, and the patient’s blood is then screened for fragments of circulating tumor DNA. For example, one study found that, for patients with early stage breast cancer, periodic testing for circulating tumor DNA may be able to detect signs of metastasis long before symptoms are evident.
- Again this year we saw how the willingness of high-profile figures like former President Jimmy Carter to share their experiences with cancer can be an opportunity to educate and inform the public. But publishers of these stories need to be sure that information is presented accurately and without distortion, as Health News Review discusses in “what the media got wrong about Jimmy Carter’s cancer ‘cure'”.
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