What to expect in cancer care

For the past nine years, a panel of scientists and doctors at Cleveland Clinic in Ohio has picked 10 medical innovations they predict will have a significant impact on improving patient care during the upcoming year. The selections are unveiled at the clinic’s annual Medical Innovation Summit. The theme of this year’s summit, held last week, was Innovations in Cancer Therapy. U.S. News talked to two Cleveland Clinic physicians, who shed light on the cancer-specific innovations over the past several years that have the biggest ongoing impact.

Personalized genomics

“A lot of what we have learned is that the one-shot gun approach for all breast cancers or lung cancers [does not work],” says Michael Roizen, an internist who chairs the Wellness Institute at Cleveland Clinic. Tumors have “considerable genetic variability that indicates that certain treatments are appropriate,” he adds. Genomic-based blood tests can determine which treatments would be most effective in fighting the cancer, sparing patients unnecessary and toxic drugs. “Genomics is just now beginning to reach its full potential,” Roizen says. “I think this is the year of the breakthrough of individualized treatments for tumors.”

Immunotherapy

Understanding tumors’ genetic profile can also unveil how they evade our immune system, Roizen adds. “When they learn that, we’ll have a large ability to go past where we are now,” he says. But already, there has been headway in training the immune system to fight cancer. In 2011, the drug ipilimumab emerged for the treatment of multiple melanoma, a form of skin cancer that “was once a death sentence,” Roizen says. Ipilimumab has greatly extended the longevity of melanoma patients. “I expect this is the start of it,” Roizen says. “This class of drugs has huge potential use,” especially in solid tumors.

Hepatitis C drugs stop liver cancers

Hepatitis C is a liver disease that can morph into cancer. Last year, a drug called Sofosbuvir, the first oral Hepatitis C treatment, was in the final stages of Food and Drug Administration approval. A year later, the drug has been approved and is “extremely popular,” Roizen says, adding that the drug holds “tremendous benefit for the baby boomer generation,” which disproportionately suffers from Hepatitis C, since the blood supply was not screened for the disease until 1992.

Intra-operative radiation therapy for breast cancer

Recent studies have shown that a single shot of targeted radiation called intra-operative radiation therapy — which is given at the time of breast surgery — is just as effective in treating breast cancer as whole breast radiation over several courses. The latter approach, which is more toxic, Roizen says, has also been “psychologically and physically problematic.” He adds that targeted radiation “does away with a lot of that, and the outcome is just as good. It’s a treatment that, for many women, will decrease side effects and improve outcomes. Many more women are willing to go through it.”

CT scans for early lung cancer detection

People who quit smoking have traditionally worried about their risk of developing lung cancer. And this has traditionally been a neglected group because X-rays have not been able to pick up small nodules that could morph into cancer. Now a CT scan provides 3-D images of lungs. The scan has “strong prognostic value as to whether you are likely to get lung cancer,” Roizen says. “It’s helping a group of people who have quit smoking stay well. It will spot [nodules] early enough to treat and doesn’t lead to adverse effects for the individual. That’s a real psychological benefit.”

Selective genomic testing

“If we test large populations of patients, are we equipped to handle the information? And if you can’t change one’s risk, how much of a service/disservice are you giving to patients [with the tests]?” asks Brian Bolwell, chair of Cleveland Clinic’s Taussig Cancer Institute. He adds that deciding how much testing is useful is a clinical challenge. While the boon in drugs based on DNA abnormalities is promising for patients, improving outcomes and reducing side effects, “a distinct minority of patients have their outcomes changed,” he says.

Teaching cancer cells to behave

We all have oncogenes in us, Bolwell says. Only in some people, however, do these cancer-causing genes reach their full potential as cancer cells. And while most treatments have focused on killing these cells, recent research has focused on changing the nature of cancer cells. “Can you in fact take a cancer cell and turn it from being malignant into something that doesn’t grow uncontrollably?” Bolwell asks. Encouraging trial data on this approach was presented last summer at the European Hematology Association conference.

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7 Innovations in Cancer Therapy originally appeared on usnews.com