An NCI-designated Comprehensive Cancer Center
By Abe Rosenberg | January 27, 2020
Where will the next cancer breakthrough be found? From earlier-than-ever diagnoses to novel later-stage strategies to easing patients’ pain, fresh thinking is permeating the cancer landscape, offering new and better ways to help more people than ever before. Here are more predictions from City of Hope clinicians and scientists.

Next-Generation Diagnostics

Early detection remains one of the most powerful weapons for fighting cancer. At the same time, detailed cancer screenings can discover a proclivity for the disease even before it develops. Increasingly sophisticated technology — often made possible by gene-based research — is improving both of these tools.
 
“New tools are available for blood tests to detect cancer at an early, treatable and often curable stage,” said Stephen Gruber, M.D., Ph.D., M.P.H., director of the Center for Precision Medicine. “Many entities are introducing new products into the market in 2020. Everyone wants to allow better access to genetic testing for people with both a family history of cancer, as well as patients newly diagnosed with cancer.”
 
“Given the advances made in genomic sequencing, in the coming years, we’re going to see next-generation diagnostics being used,” agreed Ajay Goel, Ph.D., M.S., chair of the Department of Molecular Diagnostics and Experimental Therapeutics. “Expect to see more blood-based tests that can measure circulating DNA, RNA or proteins that can be used as routine diagnostic testing for people whose family/genetic history put them at high risk for certain diseases.
 
“These tests will become a lot more affordable. Cancer will be diagnosed earlier, which means physicians can intercept earlier and provide treatments earlier, resulting in better survival and treatment outcomes.”
 
Imaging technology will play a role, too, with significant advances taking place. Stomach cancer specialist Yanghee Woo, M.D., is excited about “biomarker-directed imaging that not only can show us that there is a mass in the patient, but also inform us whether or not it is cancer, and more details as to what type of molecular biomarker it expresses to help determine the therapeutic response with specific treatments.”

Inhibitors: Molecular Weapons

As the era of targeted therapy expands, a variety of “inhibitors” — agents that block the growth factors that allow cancer cells to multiply — are showing promise in new areas.
 
Marwan G. Fakih, M.D., co-director of the Gastrointestinal Cancer Program, reports that a specific EGFR (epidermal growth factor receptor) inhibitor will gain acceptance “as a proven treatment option for second or third line treatment of BRAF-V600E mutated colorectal cancer,” a significant breakthrough because patients with BRAF-V600E mutations tend to respond poorly to other treatments. Using this inhibitor as part of a trio of inhibiting agents “has proven superior to chemotherapy in the second line (and beyond) treatment in this patient population” and is expected to receive regulatory approval soon, he said.
 
There is similar good news regarding PARP (poly-ADP ribose polymerase, a cell protein) inhibitors and prostate cancer, said Tanya Dorff, M.D., head of the Genitourinary Cancers Program. Many prostate cancer treatments target the androgen receptor in an effort to deprive tumors of the testosterone they need to grow. Dorff believes PARP inhibitors “will be the first targeted therapy not targeting AR to be approved in prostate cancer. This will hopefully just be the first of many more individualized approaches to enter the prostate cancer treatment paradigm.”

Better Radiation Treatment

Much of the fanfare these days may go to "miracle” drugs born in the genome-sequencing era, but radiation oncology — now more than a century old — is racking up its share of leading-edge breakthroughs. Radiation oncologist Arya Amini, M.D., is looking forward to an “exciting” 2020. He expects to see a high-dose form of radiation called SBRT (stereotactic body radiation therapy) taken beyond its traditional use in early-stage cancers to be deployed in cases where cancer has spread to multiple locations. “You will see a much greater role for radiation in Stage 4 cancers, which has changed the paradigm of our field,” he said.

Palliative Care for Everyone

City of Hope’s Department of Supportive Care Medicine will do much more in 2020 than simply work with patients on end-of-life issues. “Right now,” explained Chandana Banerjee, M.D., M.P.A., “some physicians are still reluctant to start working with supportive care medicine because there is a stigma involved with discussing end-of-life care.”
 
That stigma, Banerjee believes, is fading and could largely disappear in 2020 because of the proactive efforts of the City of Hope staff.
 
“We’re going to see hematologists and oncologists place more attention on palliative medicine,” she said, adding that palliative efforts will begin much earlier, perhaps even at initial diagnosis. It makes sense for both patients and physicians. “The reality is that working with supportive care medicine early can provide symptom relief for patients. Supportive care medicine can become an ally with the primary team to help the primary team execute their treatment plan.”
 
In other words, tending to the patient, body and soul — City of Hope’s core philosophy — will remain every bit as important as any research breakthrough, surgical advancement or DNA-based wonder drug.

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