2018: 7 Trends That Will Shape Cancer Treatments

We explain the circumstances and important trends expected to affect the lives of cancer patients in 2018. .

1- Less Chemotherapy

According to recent reports, for early-stage breast cancer, over the 2013-2015 period of 2 years, chemotherapy use declined by approximately % 21 to % 34. The reduction in chemotherapy use among women diagnosed with stage 1 and stage 2 breast cancer is noteworthy. Two leading reasons for this trend are general treatment awareness and genetic tests predicting who may not need chemotherapy for early-stage breast cancer. However, although this concept has not yet become firmly established in international breast cancer treatment guidelines, the option of withholding chemotherapy may have been overused, and many uncertainties remain about this approach to breast cancer treatment. As we better understand breast cancer subtypes and genetics, not giving chemotherapy to some early-stage breast cancer patients may become a more frequently preferred option in the future.

• How do we identify patients who will not receive chemotherapy after breast cancer surgery? .

2- New Cancer Drugs

The number of targeted drugs for tumors with specific molecular abnormalities increases every year. Examples include next-generation hormonal treatments for breast and prostate cancers; drugs targeting genetic changes in lung cancer such as EGFR or ALK and other genetic changes, and DNA repair mechanism-blocking drugs approved for certain types of breast cancer and ovarian cancer, called PARP inhibitors. Many of these targeted agents are tablets.

Drugs for cancer immunotherapy , which activate the immune system against tumors, entered cancer medicine after 2012 and launched a new era. These antibody-based immunotherapies act through cell-surface PD-1 and PD-L1 receptors and continue to gain approvals by improving survival in an increasing number and variety of cancers every year.

Rituximab (Mabthera) and trastuzumab (Herceptin) are two well-known antibody-based targeted drugs that have become standard treatments for leukemia and breast cancer. Kadcyla and inotuzumab, recently approved by the FDA under the name Besponsa , are examples of next-generation dual drugs (containing an antibody and a chemotherapy agent in a single drug). In short, antibody-based biological agents have an increasingly important place in cancer treatment. .

3. Growing Concern About Cancer Drug Costs

The financial difficulties cancer creates for individuals and society appear likely to continue, although they may be partly resolved as more drugs become accessible and existing drug patents expire. We should therefore review cancer prevention through appropriate strategies and instill cancer-protective lifestyles from childhood. But can nothing be done in the short term about the high and rising costs of cancer drugs? In fact, action is being taken. Almost all new cancer drugs are first approved by the United States Food and Drug Administration, the leading institution worldwide in this field, the FDA . Of course, FDA approval and reimbursement coverage in the United States do not mean immediate availability in our country or other countries outside the United States. Following FDA approval and broader use, demonstrating a clear benefit from a drug and considering countries’ financial resources bring national approvals onto the agenda. However, “benefit” or “value” is a controversial concept that can differ among oncologists, patients, economists and reimbursement agencies. .

4. The Diagnostic Process and Payment for Genetic Cancer Tests

In cancer medicine, it is now very important to use drugs matched to tumors’ molecular/genetic characteristics and understand these drugs’ properties. Although the number of targeted drugs used based on genetic test results increases every year, to date there is no genetic test in this category reimbursed by our country’s Social Security Institution. The FDA gave its first approval for a comprehensive genetic test to determine suitability for targeted cancer drugs to Foundation One CDx in November 2017, and this test costs 5800 dollars in the United States. Debate in this field concerns the quality of genetic tests as well as their cost. Doctors and patients need reliable, reproducible results. Accreditation of laboratories performing these tests, whose role in oncology drugs and clinical decisions is growing, is therefore becoming increasingly important. .

5. Cancer Drugs Independent of the Tumor’s Organ of Origin

Identifying molecular changes in cancer cells and administering drugs directed at these targets has been a central theme of cancer medicine since 2010. However, for the first time, in May 2017, the FDA approved, for cancers with certain genetic changes (high microsatellite instability), regardless of the tumor’s organ of origin, the immunotherapy drug pembrolizumab (brand name Keytruda).

Another development in this area occurred in June 2017 at the annual ASCO Congress: a genetic change that can be found at high rates, particularly in rare cancers , and a new drug targeting this change attracted attention. In some cancer cells, the tropomyosin receptor kinase (TRK) gene was found to fuse with other genes, producing abnormal proteins that continually signal cancer cells to grow and proliferate. The drug that inhibits these proteins, containing larotrectinib as its active ingredient, shrank tumors across the TRK-positive cancer types tested: 17 different cancer types, with responses in 50 patients including tumor shrinkage in 38.

However, scenarios devised on paper do not always translate into real life. For example, one of the recently developed drugs against HER2 and HER3 mutations in breast cancer, neratinib, showed activity in patients with salivary gland and bile duct cancers carrying the same mutation, but not in colon cancer. .

6. Patient-Reported Outcomes (Pattient-Reported Outcomes = PRO)

How cancer patients feel is important. This has always been true, but in cancer medicine, doctors, healthcare providers and patients have placed greater emphasis on how well treatment works and have paid less attention to subjective experiences of symptoms such as pain, nausea, fatigue . As the number, variety and success of treatments increase, along with the number of people who regain their health through treatment and try to return to normal life, quality of life has also begun moving toward the center of cancer treatment. With technology’s contribution, patients have now begun reporting their own condition, quality of life and treatment side effects using smartphone applications developed specifically for this purpose. Patient-reported outcomesare important for identifying subtle differences between new drugs and for monitoring the risks and benefits of treatments. .

7. Artificial Intelligence

Few doctors, including oncologists, can keep pace with advances in medical science. Cancer professionals are in fact the most affected, both positively and negatively, by the pace of medical progress. Indeed, by 2020, scientific knowledge in cancer is expected to double approximately every 2 months.

There is an enormous amount of molecular information in oncology, and in 2018 approximately 15 million new cancer cases are expected worldwide. IBM’s Watson or other artificial intelligence brands may guide oncology professionals through the ever-growing array of treatment options and accumulated knowledge. .

What Have We Not Mentioned?

CAR-T cell therapy dominated cancer news this year. This biological treatment involves white blood cells taken from each patient, genetically modified to target cancer cells, and returned to the patient. It has offered great hope for certain types of leukemia and lymphoma resistant to all treatments and with no remaining treatment options. However, doubts remain about whether CAR-T treatments can be manufactured safely and effectively.

One of the most important scientific advances of recent years, whose clinical trial results we eagerly await, Crispr genetic technology , will continue to be among the most discussed topics in 2018.

Cancer prevention is another issue: the best way to prevent cancer deaths, side effects and treatment costs is to prevent the disease from developing. However, regarding adopting or promoting lifestyles involving smoking, vaccines to prevent HPV and hepatitis B infections, reducing alcohol and healthy eating, we regret to say that very little progress has been made. Today, organic eatingand using vitamin supplements or herbal extracts are perceived as healthy eating. There is also little encouragement to understand harmful chemicals and how to reduce carcinogen exposure. Perhaps this will change in next year’s list, for 2019.