Expert Predictions: Cancer Care 10 Years From Now

Wafik El-Deiry, MD, PhD, Fox Chase Cancer Center

Widespread Data Sharing Necessary to Accelerate Advances in Precision Medicine

Precision medicine – tailoring treatments to each patient – will continue to evolve over the next decade. But in order for precision medicine to improve more quickly, widespread sharing of cancer research data is essential to accelerate our collective experience and knowledge. In particular, the cancer field needs accurate progression-free survival data that accounts for all therapy options for each patient's tumor. In addition, researchers need to adopt a standardized approach to analyzing molecular data from patients in clinical trials and share this data widely and in real time. We also need clinical trials that suit each patient's tumor so we can improve on the status quo of clinical outcomes. And, importantly, scientists and cancer patients need to engage in ongoing conversations about the state of cancer care and what more needs to be done. 

Lewis L. Lanier, PhD, University of California, San Francisco

Improvements in Cancer Immunotherapies, Combination Treatments on the Way

As an immunologist, I’m delighted that the newest success in cancer treatment is harnessing the immune system to eliminate tumors that have been resistant to all prior forms of therapy. The next decade will be the age of immunotherapy breakthroughs. Having demonstrated the potential for immunotherapy, the future will bring significant advances in the field as we learn to combine the existing immunotherapeutics with conventional treatments - and the discovery of new pathways to improve immune responses against cancer.

Kenneth C. Anderson, MD, Dana-Farber Cancer Institute

Genomic Profiling, Immunotherapy Will Move Multiple Myeloma Research Toward a Cure

The outcome for patients with multiple myeloma has been extended three fold due to the translation of scientific advances rapidly from the bench to the bedside. Specifically, a deeper understanding of how tumor cells grow, survive, and resist drugs has allowed for discovery and validation of immunotherapies and drugs that can inhibit specific proteins. These agents can overcome conventional drug resistance. In the future there are several trends that will extend this progress and ultimately achieve cure in patients with multiple myeloma. First, genomic profiling will continue to identify the mutated pathways that allow for the growth and survival of tumor cells. This knowledge can help researchers develop new targeted therapies. Second, immune therapies including monoclonal antibodies, immunomodulatory drugs, vaccines, checkpoint inhibitors, and cellular therapies, especially in combination, will help the body learn how to fight off myeloma on its own and offer long-term disease-free survival. Finally, use of combination targeted and immune therapies earlier in the disease course, prior to the development of more severe symptoms, will ultimately prevent the development of active disease and achieve cure. 

Ethan Dmitrovsky, MD, MD Anderson Cancer Center

Pace of Immunotherapy Work Set to Accelerate

Decades of scientific discoveries uncovered pathways that cause cancers to form. Many of these breakthroughs have moved directly from the laboratory bench into the cancer clinic. This occurred with drugs that antagonize the very pathways that a particular cancer depends on for its growth or survival. There are now many clinical success stories where tumors that were once difficult to treat, like malignant melanoma, are being addressed with drugs that target the root cause of the cancer. At the same time, powerful new clinical tools are able to combat the cancer problem. These include drugs that harness the immune system. In the decade ahead, the pace of this work will accelerate. And we will see even greater benefits for those who suffer from cancer. The American Cancer Society will be instrumental in making this happen.

Charis Eng, MD, PhD, Cleveland Clinic Foundation

Assessing Each Person’s Risk for Cancer Will Become More Precise

Our work currently focuses on identifying and characterizing genes which, when mutated, predispose people to cancer. This type of information allows us to assess cancer risk and provide genetic counseling, including determining if a person is at high-risk and should be carefully monitored for the early detection of cancer or need for preventive surgery. Future research must lead to the ability to know precisely who is at risk for a particular cancer.

Kurt Stange, MD, PhD, Case Western Reserve University

Reducing Research Fragmentation Will Lead to More Integrated, Personalized Care

Increasingly, we will recognize fragmentation as a problem. Fragmented research, which focuses on each part of the problem without considering how these parts relate to the whole, leads to fragmented understanding and disjointed care. More and more we will approach cancer prevention, control, and treatment with a systems understanding that leads to care that is integrated and personalized in the context of the priorities of individuals, families, and communities. This will make the experience of living with cancer feel less lonely and isolated. It will make the process of preventing and controlling cancer more tailored to the needs of whole people and conscious of our connectedness.

Olufunmilayo Olopade, MD, University of Chicago

Precision Medicine Will Lead to Far Fewer Cancer Deaths

We are in the era of precision medicine. Blood based biomarkers will be used routinely to assess a person’s risk for cancer and personalize cancer treatment. Genomic testing to personalize cancer screening will also be routine in clinical practices all over the world through rapid adoption of technology that allows for assessing cancer risk among the population. These advances will lead to a dramatic drop in deaths from preventable cancers.  

Karen M. Freund, MD, MPH, Tufts Medical

Ensuring Equal Access to Cancer Care Key to Progress

I see major advances in saving lives from cancer in the next 10 years by eliminating cancer health disparities. By implementing our research findings and changing how we organize the care to patients, we can reduce and eliminate cancer health disparities. We now understand that lower cancer survival among minority, low income, and other vulnerable populations is are in part because these groups do not receive guideline recommended cancer care. Vulnerable populations experience delays in receiving their cancer diagnosis after they develop symptoms, they experience delays in starting cancer treatment, and they are less likely to complete lifesaving therapies. We now understand that some of the largest gains in cancer survival in the U.S. can be achieved by ensuring equity in access to quality cancer care to all persons.

Cancer treatment is challenging and hard for every patient. For the patient who loses a day’s pay with every doctor’s appointment, who loses their insurance because they are unable to work, who cannot understand their doctors and require an interpreter, who delay their own care to address a sick child or sick parent, cancer treatment can sometimes seem impossible. We have shown through research that providing additional support to vulnerable patients and to their physicians, to provide education, support, and address the unique barriers they face, we can provide all patients the best care and best hope for a cure. 

Andrew Berchuck, MD, Duke University Medical Center

Understanding of Causes of Gynecologic Cancers Improving Rapidly

We are in an exciting era in which we are learning a tremendous amount about the molecular origins of gynecologic cancers. This knowledge is being translated into tangible advances in diagnosis, prevention and treatment.

For example, we know that cervical cancer is caused by HPV infection and an effective preventive vaccine has been developed. However, implementation of new innovations takes time due to the need for policy changes, social acceptance, and economic barriers. One of the challenges of the coming decade is to develop delivery systems that will allow all girls in the U.S. and around the world to benefit from this life saving vaccine.

In the area of ovarian cancer, we are moving beyond BRCA1/2 and Lynch syndrome to identify other genetic variants that increase risk. This knowledge will allow us to better assess risk for and prevention of this highly lethal form of cancer for which there is currently no effective early detection test. In the coming decade, it may become feasible to screen all women for BRCA1/2 and other inherited mutations. In addition, a better understanding of the molecular alterations present in ovarian cancers is leading to the development and clinical implementation of new treatments, such as PARP inhibitors (drugs that block an enzyme certain cancer cells rely on to survive) and anti-angiogenic drugs (drugs that stop tumors from developing new blood vessels). There is much more work to be done in the area of targeted ovarian cancer therapies, as the cure rate for this disease is still less than 50%.

In the area of endometrial cancer, advances in the understanding of how the disease develops are also fueling a search for targeted therapies to treat metastatic disease. In addition, there is increasing recognition that the rising incidence of endometrial cancer in Western countries is being fueled by the obesity epidemic. Efforts to combat this modifiable risk factor are needed to stem the rising tide of this disease.  

Yang Shi, PhD, Boston Children’s Hospital/Harvard Medical School

Understanding Problems in DNA Packaging May Lead to New Treatments

My area of research is chromatin biology. Chromatin is the term for DNA wrapped around proteins, which is the way DNA is packaged inside cells in the body. Chromatin plays an important role in how DNA is accessed, replicated and expressed – and new research is finding that certain issues with chromatin are linked to cancer. Specifically, we have found that changes in proteins that regulate chromatin are associated with tumor growth, and the development of cancer. In fact, a number of phase I trials are ongoing with treatments targeting these proteins. These treatments represent potentially new, second-generation chromatin drugs for cancer therapies. Understanding better how chromatin regulators work in the context of tumor growth will help us identify and develop new treatments that may either be used on their own or in combination with other cancer drugs in order to achieve the best outcomes for patients.