Editor’s note: Cancer Q&A is a monthly column in which health professionals from Baystate Regional Cancer Program, based in Springfield, address issues related to cancer in a question and answer format.
In what was likely the last bill signing of his presidency, President Obama signed a $6.3 billion measure called the 21st Century Cures Act making new investments in cancer research, drug abuse and precision medicine.
This bill put cancer research in the public eye, but was not without opponents. For example some argued its passage diminished funding for prevention of chronic diseases. Nevertheless, there is significant excitement about new cancer treatments. The following questions and answers probe some of these advancements.
Q: Why don’t we have a cure for cancer today?
A: Actually, we do. For some cancers. Most newly diagnosed breast cancers are cured, many lymphomas are cured. Multidisciplinary approaches are very successful.
Unfortunately, for many with very advanced cancers — such as colon, lung, prostate and breast cancers — cure is not yet a realistic goal. Most exciting, however, are some of the newer approaches using targeted agents and immunotherapy, where previously resistant cancers — lung and melanoma, for example — are showing very long periods, even years, of control. We are all hoping these advances will translate to cures.
Q: Can you elaborate on this?
A: Previously, we did not appreciate the role of the immune system in cancer control. Now, with a better understanding of how to manipulate the immune system to recognize cancers as foreign, there has been an explosion of new research resulting in drugs, often antibodies, that stimulate the body’s own system to fight the cancer. It really is a new era in treatment.
It is important to remember that much of this success comes from investments in basic science made 30 or more years ago.
According to the American Society of Clinical Oncology (ASCO), advances in the scientific understanding and treatment of cancer have led to improved patient outcomes and quality of life. However, federal investment in research has not kept pace with this increasingly complex disease. Additionally, health information technology infrastructure must evolve to support innovative research designs, such as those using big data to gain rapid insight into patient outcomes and experiences.
Q. What does this mean?
A: We have a good understanding of the molecular pathways that are disrupted to make a cancer cell malignant. The number of mutations that can occur to lead to this disruption are enormous. Many cancers have multiple mutations, some of which can be targeted or are “druggable.” How best to analyze specific cancers and find a possible treatment can be quite complex and requires difficult and laborious analysis. Though it can be expensive, this mix of understanding cancer mutations and matching them with treatments is at the core of today’s excitement and optimism.
Q: What are clinical trials and what role do they play in treating cancer?
A: Cancer research is a collaboration among clinicians, industry, academic centers, and the federal government, for example, the National Institutes of Health and the National Cancer Institute. Clinical cancer programs are a key element in research. Good cancer programs incorporate a clinical trials system into the care system. Very often the best care is participation in a therapeutic clinical trial.
In my opinion, every patient with a cancer that is not reliably curable is best treated on a clinical trial if one is available. Treatment on a trial offers a patient significant safety features, the opportunity to try a new treatment, and the excitement of helping to uncover new knowledge.
Q: How can patients learn more about clinical trials that they may be able to participate in?
A: Simply ask your doctor if there is any trial for which you are eligible.
The Baystate Regional Cancer Program offers over 30 active trials and we encourage eligible patients to join studies as appropriate for their cancer. Some of the newer studies at Baystate are collaborations with the National Cancer Institute, where the cancer tissue is analyzed for molecular changes that might match with a specific new drug. This is an ongoing open project and has generated great excitement among the patients and doctors.
Q. What is survivorship research?
A: It is looking at how cancer affects people after treatment.
Survivorship is an important feature of the cancer experience. Patients worry about recurrence and may have social issues related to personal relationships, job and post-treatment effects. It is an exciting time for treatment-related cancer research.
Dr. James Stewart is chief of hematology oncology at Baystate Regional Cancer Program.