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Experts predict what oncology care will look like a decade from now.
Ten years from now, driverless cars might be the norm. Service bots might perform jobs that humans would prefer not to do. And what about cancer care? If a cure hasn’t been found for this deadly disease by then, what type of changes will have occurred? Several positive ones, say cancer care experts. For more on the shifting cancer care landscape, and how it will impact healthcare quality and costs, we asked experts to weigh in. Here, they share their predictions.
Prediction #1: More precise treatments
Carlos L. Arteaga, MD, director at UT Southwestern Simmons Cancer Center in Dallas, which provides care to more than 105,000 hospitalized patients and oversees approximately 2.4 million outpatient visits annually, expects widespread use of precision cancer medicine, which is using a cancer’s molecular profile to determine the best therapy approach for individual patients, such as single-targeted therapies or a combination. The therapy will be applicable to most solid tumors, such as those in the breast, colon, lung, and ovaries. Consequently, traditional chemotherapy will be used less frequently.
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Precision medicine also includes collecting big data sets on individuals and populations and integrating that data to better predict, prevent, diagnose, and treat cancer, says Jeffrey Golden, MD, chair of pathology at Brigham and Women’s Hospital in Boston, which includes 150 outpatient practices with more than 1,200 physicians. Golden is also professor of pathology at Harvard Medical School, which serves as a home base for more than 10,000 physicians and scientists with faculty appointments. Information would include biologic data such as a patient’s genome and other large data sets, as well as routine chemistry, hematology, and microbiology lab test results.
Prediction #2: More effective approaches
Ten years from now, fundamental knowledge about using immunotherapy to treat cancer will provide scientists with a much better understanding of why some patients respond to this treatment while others don’t. “This knowledge-drawn from data from the more than 4,000 immunotherapy clinical trials ongoing today as well as academic centers of excellence where in-depth laboratory analyses are carried out parallel to clinical trials-will affect how treatment decisions are made,” says Jill O’Donnell-Tormey, PhD, CEO, and director of scientific affairs at the Cancer Research Institute in New York, which supports more than 3,000 scientists globally. “These sources will also provide insight into strategies for improving immunotherapy’s effectiveness in more patients and in diverse cancers.”
It may become possible, for example, to draw a patient’s blood and know precisely why their immune system is not keeping their cancer under control. “Armed with this knowledge, doctors will be able to develop personalized treatment regimens that include combinations of drugs designed to counter whatever is preventing the immune system from attacking the cancer,” O’Donnell-Tormey says.
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Prediction #3: Broader use of T-cell based therapies
These therapies will be more effective and more widely used across hematological cancers as well as solid tumors, says O’Donnell-Tormey. Research and engineering technologies will allow for the creation of either autologous (coming from the patient) or off-the-shelf (mass produced) T cells that can recognize multiple targets on cancer cells, making them more specific to cancer and thus reducing damage to normal cells, she says. Advances in genetic engineering will also enable the inclusion of “safety switches” that allow oncologists to control the rate of T-cell expansion or deactivate T cells entirely when they have finished the job of eliminating cancer cells. This also will reduce T-cell therapy’s toxicity and side effects, while maintaining its ability to attack cancer cells.
Prediction #4: Earlier detection
Advanced single-cell (or smaller numbers of cells) and single molecule (or smaller numbers of molecules) analytics will drive improved diagnostics, prognostics, treatment stratification, and more precise entry into clinical trials leading to novel and improved therapies, Golden says. “Recent innovations help to detect tumor cells and tumor DNA in patients’ blood, known as a ‘liquid biopsy,’ without the need for invasive procedures such as surgery,” he says. Through a simple blood draw, tumors are being detected and specific mutations identified. Today this technology is primarily assisting in monitoring therapy, essentially evaluating if treatment is reducing tumor burden, without the need for imaging or other tests. These advances will likely provide improved diagnostics as well as early detection for cancer, or possibly even new prevention strategies.
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Kevin Hrusovsky, founder of Powering Precision Health and chairman and CEO of Quanterix, a company focused on advancing the science of precision health, says studies show promise for the reliability of specific biomarkers, which are found in blood-such as PSA-in determining if a patient has a recurrence of cancer at its earliest stages, while other markers show promise for detecting cancers long before any symptoms present. While blood tests for early cancer detection today are primarily used in research environments, he foresees a day when they will be offered as point-of-care tests and be available in doctors’ offices on a routine basis.
Hrusovsky expects biomarker readings to be part of routine physicals. By taking a baseline reading of a person’s biomarker levels via a blood test, doctors will be able to detect changes to these levels, indicating that diseases like cancer may be emerging, helping doctors potentially catch it before stage one. Consequently, doctors will be able to diagnose and treat cancer earlier, he says.
Prediction #5: More artificial intelligence applications
Digital pathology, which entails creating digital images from glass slides, will advance cancer care by developing artificial intelligence algorithms, Golden says. Recent advances, empowered by technical innovations in computer science, have permitted the analysis of data from digital images, advancing pathologists’ ability to more accurately, more safely, and with higher quality provide additional information regarding the biologic behavior of many abnormal growths.
Golden also predicts better forecasting of growth rates, metastatic potential, and even where cancer might develop. The positioning of artificial intelligence in the pathologist’s arsenal also has promise for clinical trials; improved patient selection will likely better define appropriate therapeutics and ultimately improve the approval of pharmaceuticals by identifying the patient population most likely to respond. Finally, digital images in combination with artificial intelligence will play an essential role in the research, development, and implementation of immunotherapy, he says.
Prediction #6: Drug development changes
Biomarkers will change the way pharmaceutical companies develop drugs, especially for oncology, says Hrusovsky. There’s already evidence of a growing openness to using biomarkers for drug development as a complement to symptomatic clinical endpoints, which are measured in clinical research to determine if a drug is working, with recent new guidance from FDA Commissioner Scott Gottlieb that biomarkers can be a reliable tool for advancing clinical trials, he says. By using biomarkers, researchers have the potential to see a drug’s effect on the body long before traditional symptomatic or imaging endpoints could reveal the drug’s effect.
Pharmaceutical researchers will also increasingly use biomarkers to measure certain drugs’ efficacy and toxicity on individual patients. “Precision medicine approaches can be game changers in oncology treatment, because not all cancers are alike and drugs perform differently depending on the patient and prognosis,” Hrusovsky says.
Prediction #7: Personalized cancer vaccines
Cancer vaccines will become an integral part of patients’ treatment protocols, especially vaccines that provide the immune system with specific cancer targets that are unique to an individual patient’s tumors, O’Donnell-Tormey says. These targets, known as neoantigens, have been shown to stimulate spontaneous anti-cancer immune responses in cancer patients and hold great potential as therapeutic targets. Advances in computational prediction of neoantigen expression will enable doctors to design personalized vaccines that drive the immune system to seek out and destroy unique antigens that are likely to appear in patients’ tumors, says O’Donnell-Tormey. Vaccines will likely be given in combination with other immunotherapies designed to overcome immune suppression at the tumor site and facilitate a targeted immune response.
Prediction #8: More reliance on nonphysicians
Advanced practice providers, e.g., nurse practitioners and physician assistants, will provide care to many more cancer patients, particularly at academic centers, says Arteaga. This will occur due to more treatment options, the significant prolongation of patient survival, and decreased treatment time due to better therapies, as well as a huge emphasis on cancer prevention.
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Already, the use of advanced practice providers in oncology practices is growing-from 52% in 2014 to 81% in 2017-according to the American Society of Clinical Oncology’s annual Practice Census.
Arteaga says advanced practice providers will also provide care to cancer survivors, who will require an increasing use of telemedicine because physical cancer facilities may not be able to accommodate the large number of survivors.