An NCI-designated Comprehensive Cancer Center
By Samantha Bonar and Abe Rosenberg | February 4, 2020
February 4 marks the 20th anniversary of World Cancer Day, an international day to raise awareness of cancer and to encourage its prevention, detection and treatment. It began in Paris in 2000 with a charter highlighting the need for "access to quality care, funding for cancer research, greater understanding, and above all respect and dignity for all individuals living with the disease."
The organization behind the day, the Union for International Cancer Control, has declared 2020 “a year to ignite action to accelerate the reduction of unnecessary cancer deaths and to achieve equal access to cancer care for all.”
While there is still progress to be made, on this World Cancer Day, there is much to celebrate.
Cancer care is changing rapidly, and the pace of change is accelerating. In just the last year, major advances in precision medicine, gene-based therapy, immunotherapy and many other areas brought new hope to countless patients.

Cancer Death Rate Drops

According to the latest data from the American Cancer Society, the cancer death rate in the United States showed its largest single-year drop ever reported, falling 2.2% from 2016 to 2017. Over the last three decades, the rate has dropped almost 30%, which translates to about 2.9 million fewer cancer deaths than would have occurred otherwise.
The decline is largely attributed to reduced smoking rates and advances in lung cancer treatment. In addition, novel immunotherapy treatments for melanoma have helped extend life for many people, even those with metastatic disease.
On the downside, progress has slowed for those cancers that can be found through screening such as colorectal, breast and prostate. After years of declining rates, prostate cancer now exceeds breast cancer as the most commonly diagnosed cancer. Experts attribute the increase in these sometimes-preventable cancers to the rising rate of obesity among Americans, as well as significant racial and geographic disparities in access to health care.
The rate of obesity-related cancers, including malignancies of the liver, kidneys, pancreas and uterus, cancers of the breast in postmenopausal women, and colon and rectal cancers in adults younger than 55, are increasing. Metabolic and hormonal abnormalities and chronic inflammation associated with extra pounds and lack of physical activity could be precipitating factors.
"Some epidemiologists hypothesize that rising rates of obesity, decreases in exercise and activity levels, and changes in the diet may be contributing to the well-established increase in the rate of colorectal cancer in patients under the age of 50," said Trilokesh Kidambi, assistant clinical professor in the Department of Medicine, Division of Gastroenterology, and director of the colon cancer screening program at City of Hope.
Highlighting the need for more research, cancer remains the second leading cause of death after heart disease in both men and women. The American Cancer Society predicts that in 2020 there will be about 1,806,590 new cancer cases and 606,520 cancer deaths in the U.S. Prostate, lung and colorectal cancers are projected to account for 43% of all cases in men. For women, the three most common cancers are predicted to be breast, lung and colorectal, accounting for 50% of all new diagnoses; breast cancer alone will account for 30% of female cancers, according to the report. While declining in incidence, lung cancer is still predicted to be the most deadly, killing more people than breast, prostate, colorectal and brain cancers combined.
In the last decade, several important advances in diagnosing and treating cancer have helped prevent patient deaths, including more accurate imaging technologies, less invasive surgical procedures and novel immunotherapy approaches.

Immunotherapy a Game-Changer

“Immunotherapy has been a game-changer for melanoma patients, particularly because chemotherapy is not very effective for skin cancer," said Kim Margolin, M.D., a melanoma expert and clinical professor in the Department of Medical Oncology & Therapeutics Research at City of Hope. 
On the early-detection front, so-called “liquid” biopsies can detect tumor DNA in the blood, making for a much less invasive method for detecting cancer. As our DNA knowledge base continues to grow, liquid biopsies are becoming ever more accurate, at ever earlier stages.
“Liquid biopsies detect early progression or resistant disease faster than other methods,” said Stephen Gruber, M.D., M.P.H., Ph.D., director of City of Hope’s Center for Precision Medicine. “And this is likely to be increasingly used in the U.S. for measuring residual disease and recurrence.”
“A simple blood test can now detect disease recurrence up to one year before it can be detected by imaging or other routine tumor markers,” added colorectal cancer specialist Marwan G. Fakih, M.D.
“These methods,” said stomach cancer surgeon Yanghee Woo, M.D., “will be especially important in early detection of stomach cancer in high-risk patients.”
In terms of early treatment, the relatively new field of theranostics — a combination of “therapeutics” and “diagnostics” — makes it possible to diagnose and treat cancer at the same time. One example is to use a radioactive agent in the imaging process to “light up” cancer cells, then immediately deploy a second agent to attack those cells.
“We will see a further role of image-guided management in diseases including prostate cancer,” predicted radiation oncologist Arya Amini, M.D., “where we can utilize imaging to detect microscopic disease that routine scans would not be able to identify. This work will likely grow from prostate cancer into other areas including colorectal cancer.”
Perhaps no recent advance has created more excitement than CAR T cell therapy — when a patient’s own immune cells are reengineered to seek out and attack cancer. The Food and Drug Administration has approved two CAR T cell products for treating blood cancers, and clinical trials continue for a broad array of solid tumors.
Because each CAR T cell treatment originates from a patient’s own cells, the process is slow and very expensive. But efforts are underway to develop “off-the-shelf” CAR T treatments created with donor cells that are specially treated to eliminate the possibility of rejection. 
Finally, oncologists are beginning to use big data and artificial intelligence to glean insights about individual patients that few could have imagined only a few years ago.
“The digitization of electronic medical records, radiology and pathology will allow application of artificial intelligence in precision medicine,” said diagnostic radiologist Ammar Ahmed Chaudry, M.D. “AI can help find a needle in a haystack. Synthesis of this information will allow for early detection and patient-specific treatment optimization.”
Bottom line, it’s an exciting time for all, and City of Hope scientists and clinicians are on the front lines. On this World Cancer Day, City of Hope is proud to be a member of the global cancer-fighting community that has come together to fight the deadly triad of “fear, ignorance and complacency.”

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