Cancer: 5 research areas to watch in 2013

December 31, 2012 | by Shawn Le

In 2012, numerous advances, large and small, made a difference in cancer treatment. Research, treatment and care will continue to evolve in exciting ways in 2013. City of Hope cancer experts look to the year ahead, predicting that the following five fields will yield significant advances in cancer research and treatment.
1. Cancer Immunotherapies
white blood cells protect the body White blood cells make up the immune system, keeping the body healthy.
Immunotherapies harness a patient’s own immune cells to kill cancer, avoiding much of the toxicity of current standard therapies such as chemotherapy. In 2012, T cell-based treatments demonstrated promising early results, with researchers at the University of Pennsylvania using neutered HIV to infect a patient's own immune system to produce new anti-cancer T cells. And that’s just the beginning. Stephen Forman, M.D., clinical director in City of Hope's Department of Cancer Immunotherapeutics and Tumor Immunology, expects significant new inroads in this field, with City of Hope already developing its own unique immunotherapies against brain, blood and breast cancers. “Our use of central memory T cells as part of an autologous [bone marrow] transplant is unique to our therapy and sets our approach apart from other T cell treatments in development,” said Forman, the Francis and Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation. “Central memory T cells have the potential to establish a persistent, lifelong immunity to help prevent recurrence of lymphoma after transplant.”
2. Targeted Cancer Therapies
One size doesn’t fit all. Scientists have uncovered how cancer is not one disease, but a multitude of diseases – each with individual genetics and biology. Patients are equally diverse. While medicine has moved toward new drugs that target specific genes, clinical researchers are also looking at how existing drugs can be used in new ways to improve cancer treatments. Karen Reckamp, M.D., M.S., co-chair of City of Hope's Lung Cancer and Thoracic Oncology Program, said 2012 brought a wealth of additional insights into the biology of lung cancers, including discoveries about the molecular changes that cells undergo as tumors develop. Some of these changes in adenocarcinoma, for example, can already be targeted by existing drugs. That’s but one example. Reckamp aims to find targeted uses of existing drugs to improve lung cancer treatment. She’s leading research into how certain lung cancers are responsive to COX-2 inhibitors already on the market, weakening the tumors and making them much more susceptible to existing drug treatments. “At City of Hope, we have explored combination targeted therapy that may improve the efficacy for patients that have a COX-2 activated tumor,” said Reckamp. “In 2013, I’m looking forward to improved therapeutics that can address the problem of resistance. We will continue to work on improving the quality of life for patients and caregivers through our program project grant at City of Hope.”
3. Survival Increases – One Drug at a Time
A cure is not the only goal of cancer research. For Cy Stein, M.D., Ph.D.,  deputy director for clinical research at City of Hope’s comprehensive cancer center – and an expert in genitourinary oncology, finding incremental advances are just as important. Numerous studies presented during the American Society of Clinical Oncology annual meeting reported on treatments that expanded patient survival by months; news that was sometimes received with skepticism about the value of such limited benefits. However, small steps can add up to major leaps. Stein, sees the recent expanded approval for Zytiga as a frontline late-stage prostate cancer treatment as a perfect example of a small but important step forward for prostate cancer patients. “You’re not going to have penicillin for this – it’s not going to happen,” said Stein, the Arthur and Rosalie Kaplan Chair and Professor of the Department of Medical Oncology and Therapeutics Research. “If you get another and another [life-extending drug], and you start to piece them together, you’re going to add years to people’s lives — good years.”
4. The Dark Side of Beating Cancer
There are an estimated 12 million cancer survivors in the U.S., and that population will grow as researchers make more discoveries about cancer and develop better treatments for the disease. But often, survivors win one fight only to fall to other related conditions later in life. As the director of City of Hope’s Center for Cancer Survivorship, Smita Bhatia, M.D., M.P.H., recognizes that remission is only one step in a lifetime. She said survivors need to be more aware of their increased risk of developing other long-term health conditions such as second cancers, congestive heart failure and diabetes. Bhatia doesn’t want to wait until patients experience those symptoms, but wants to intervene right at the start, even during treatment for their current cancers, to either prevent or better manage those long-term risks. “The fact that they’ve survived five years and are cured of this cancer is not the end of the story,” said Bhatia, the Ruth Ziegler Chair in Population Sciences. “These chronic conditions can arise years later, when patients are focused on moving ahead with their lives – not dealing with the aftermath of their cancer.” 5. The “Where” of Cancer Care
City of Hope-Antelope Valley Community Clinic Leaders from City of Hope, Antelope Valley Hospital and elected officials break ground on new clinic
Patients used to have to go to the treatment. Increasingly, treatment is being taken to the patients. Vijay Trisal, M.D., a surgical oncologist and melanoma expert, sees the proliferation of local clinics associated with major medical centers as way to make cancer treatment more accessible, less difficult for patients. In the past year, City of Hope, Mayo Clinic and M.D. Anderson all took  the latest advances in care directly to patients not able to travel to their main campuses. “In community hospitals where a broad health knowledge is necessary to care for wide range of illnesses, it can take longer for advances in specialized fields such as cancer care to filter into daily practice,” said Trisal. “Local clinics like the one City of Hope has in partnership with Antelope Valley Hospital, enable patients to have direct access to the most up-to-date cancer protocols, and our clinic physicians serve as a community resource on specialized care for the hospital.”
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