The National Cancer Institute reports that each year, approximately 1.6 million people are diagnosed with cancer in the United States. According to the National Institutes of Health, spending on cancer care has now reached $156 billion and is projected to grow to $174 billion by 2020 at the current pace.
“Expenditures for cancer care are projected to skyrocket because the trend for treating these patients involves personalizing therapies,” says James P. Thomas, MD, PhD, medical director, Cancer Clinical Trials Office, and associate director, Translational Research, MCW Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin. “The newest products and discoveries are often for small niches of patients, and treat genetically-defined populations. Therefore, the same economies of scale are not the same as treatments of the past. In fact, the initial cost of some personalized treatments can exceed $25,000 a month for many patients.”
Another reason oncology care is so expensive is the high cost to develop drugs. For example, individual immunotherapy drugs can exceed $100,000 annually for melanoma, lung, bladder, and other cancers given their clear survival advantage to standard approaches, says Santosh Kesari, MD, PhD, neuro-oncologist and chair, department of translational neurosciences and neurotherapeutics, John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California. Another pricy example is Novartis’s chimeric antigen receptor T cell (CAR-T cell) personalized genetic immunotherapy treatment for leukemia Kymriah (tisagenlecleucel), which was FDA approved in August 2017 at a cost of $475,000 for a one-time treatment.
“We now stand at the threshold of the beginning of precision-based therapies designed to interact with specific targets,” says William DeRosa, DO, FACP, chief of oncology, Summit Medical Group MD Anderson Cancer Center.
It’s also becoming more evident that what was once thought to be a single tumor type might actually have multiple, simultaneously existing and genetically unique tumor cells. This has been found in subtypes of adenocarcinoma of the lung, in addition to many other malignancies such as multiple myeloma, DeRosa says.
Researchers are gaining an appreciation for how dynamic subclone variability is—including the fact that it can drive and is responsible for tumor progression. “This, coupled with a deepening understanding of the role that the microenvironment plays, along with the use of various biomarkers, is quickly becoming the best way to identify the most effective therapy for each patient,” DeRosa says.
One approach that has greatly enhanced the understanding of the biologic underpinning of cancer is genomic sequencing. “The many companies providing this testing commercially have made it a powerful clinical tool in making therapeutic decisions by providing the ability to identify actionable mutations that can be exploited by the many targeted therapies that have been developed,” DeRosa says. For example, the discovery of EGFR, ALK, and ROS-1 mutations in non-small cell lung cancer allowed for the development of oral small molecule targeted therapies.
Here’s a closer look at some advancements in cancer treatments to watch, beginning with immunotherapies such as checkpoint inhibitors and CAR-T cells. “These agents result in the ability to unleash the power of the patient’s own immune system against their cancer in a way not previously possible,” DeRosa says. Other advances include precision oncology and biomarkers.