Advances In Cancer 2012

The 30,000 member American Society of Clinical Oncology is the world’s leading group of cancer physicians. ASCO is dedicated to curing cancer, supporting research, quality care, reducing treatment disparities and a heightened national focus on value. This month they released their annual Report on Progress Against Cancer, which highlights research, drug development and cancer care innovations.  This hundred-page document is important reading for anyone who wants to be up-to-date regarding cancer care.

Cancer related deaths in the United States are dropping, but still totaled 577,000 in 2012.  While world cancer research funding is rising, in the USA it continues to decrease, with the purchasing power of the largest funding source, the National Cancer Institute, having fallen 20% in the last decade, and a further 8% cut slated for January 1, 2013.   Development is dependent on government and private funding, as well as the willingness of more than 25,000 patients a year who volunteer to be involved in cancer trials.  All these critical supports are threatened. The Federal Clinical Trials Cooperative of the National Cancer Institute (FCLC, NCI) supports research at 3100 institutions in the USA.

The report discusses the many types of cancer which continue to be naturally resistant to cancer treatment, particularly chemotherapy.  In some cases, drugs do not penetrate a part of the body, such as the brain, in other cases even when they reach the tumor, they are not effective.  In such cancers the genetic code of the cancer cells has mutated (changed) such that the particular drug does not kill the cancer.  In 2012, there was increased interest in attacking each cancer cell at multiple targets either by using a single drug, which attacks in several different ways, or multiple drugs at the same time.  This concept improved cancer killing in GIST, colon cancer, certain lymphomas (ALCL) and medullary thyroid cancer.  In addition, unique targeted compounds, such as “tyrosine kinase inhibitors,” show increasing benefit in leukemia, sarcoma and breast cancer.

The area of “precision medicine,” designing cancer treatment around the genetics of the particular patient or cancer, continues to advance.  This personalized approach adjusts for variations in the genetic code between patients and between cancers.  In addition, research is focusing on the constant genetic change that occurs even within the cancer of the single patient, as the cancer grows or spreads.  In some cases, the genetic change may actually produce increased survival rates, but in other tumors a genetically targeted therapy may kill the original mass, but not kill spreading mutated cancer.  Highly unstable lung cancers may have hundreds of genetic mutations in a single tumor and in metastatic sites dozens more appear.  The Cancer Genome Atlas Project (CGAP) is identifying potential new gene targets to help develop new drugs and to reduce side effects.

The ASCO report indicates that at least one third of all cancer cases can be prevented through exercise, diet, decreased environmental exposures, or health screening.  The concept of reducing cancer mortality by several hundred thousand persons per year with these relatively low cost, heath improving measures is very exciting, especially in tight economic times.  In some cases doing less may produce more, as in a study that suggested flexible sigmoidoscopies might be able to replace colonoscopies in many patients.  On the other hand, once again, chest x-rays failed to prevent lung cancer deaths in smokers, although there is some evidence that CT scans may do better.

An extensive list of drugs received FDA approval for cancer treatment, and five current drugs were approved for new indications.  These included:

  • Carfilzomib (Kyprolis) for Multiple Myeloma
  • Micro-encapsulated vincristine (Marquibo) for relapsed leukemia
  • Breast cancer therapies, Pertuzumab (Perjeta) and Everolimus (Afinitor)
  • Enzalutamide (Xtandi) for metastatic prostate cancer
  • Advanced basal cell skin cancer treatment, Vismodegib(Erivedge)
  • Imatinib (Gleevec) for GIST already in remission, to prevent relapse
  • Axitinib (Inlyta) for kidney cancer
  • Pazopanib (Votrient) for sarcoma
  • Three treatments for colon cancer, Cetuximab (Erbitux), Ziv-Aflibercept (Zaltrap) and Regorafenib (Stivarga).

New uses for certain available drugs produced improved benefit, such as the use of lenalidomide to prevent myeloma relapse after stem cell transplant, bendamustine as early treatment for mantle cell lymphoma and the continued development of T-DM1 to treat breast cancer.  It was noted that in 31 trials, there were 15% fewer cancer deaths among patients taking aspirin, although how aspirin may have this benefit or who should be taking it, is not clear.

ASCO legislative staff focused on the increasing problems with sudden national drug shortages.  They worked with Congress, COA, the AMA and The American Society of Health-System Pharmacists to increase awareness of this crisis and propose solutions.  Their three key recommendations were to:

1) Require manufacturers to provide six month warning of shortages

2) Require and support the corporate development of shortage contingency plans

3) Establish FSA user fees for generic drugs to improve funding and supervision of the generic drug process.

The changes described in the report were viewed by the 21 members of ASCO’s Editorial Board, as practice changing.  Together they cast 2012 as a year of significant advance in the war on cancer.  It is the commitment of oncologists and ASCO that the movement toward cancer cure, more lives saved, will continue in the year to come.   How these goals are threatened by decreased funding remains to be seen.


8 replies »

  1. The American Association of Cancer Research (AACR) is the premier cancer research convention for basic and translational research. The AACR was the original cancer research organization that pre-dated its sister organization, the American Society of Clinical Oncology (ASCO). The focus of the AACR meeting is basic research and the presentations are often geared toward PhD level scientific discovery. It provides insights into therapy options that may not arrive in the clinical arena for many years.

    The AACR presentations continue to diverge from those at the ASCO trade shows. At the AACR meetings the word “chemotherapy” is seldom heard, like the alphabet soup combinations that make up the sessions at ASCO. Instead, targeted agents, genomics, proteomics and the growing field of metabolomics reign supreme. Cancer patients are highly unique and AACR sessions reflect the “uniqueness” of each individual. Almost every one of them has doubled back to metabolism as the principal driver of human cancer.

  2. So, people taking aspirin are about 15% protected from cancer? Finally something good to be heard about that one… aspirin has been vilified for long. Although, I don’t think studying only 31 patients is not very convincing…

    Also if simple exercise, diet and overall healthy-ness can prevent one-third of most cancer cases, there’s a lot of hope, then! But I don’t understand – cancer is basically uncontrolled cell growth, right? How would exercise and dieting affect that?

  3. I have them hooked up to a power precision 1000w 2-chan amp in a sealed box, they dont hit as hard as i thought they would. They sound pretty distorted once they start to pound. I had them prof. installed so i know the hook up cant be wrong..Am i doing something wrong?

  4. At least the cancer rates are coming down a little, but as you know there are so many variables to the decrease of cancer. I used to work in a lab where we studied drug transport across the epithelial cells utilizing ussing chambers and I hope more of this type of research continues so we can find a cure eventually.

  5. ‘At least one third of all cancer cases can be prevented through exercise, diet, decreased environmental exposures, or health screening’ – this, at least, is a comforting thought.

    Is this written in fairly easily understable language, if a lay person wants to read it?

    And, what is the state of research and investment money in genomics and stem cell research? It’s always interesting to me how much money is put into chemotherapy which though often effective, is (apologies for the gun analogy but it seems to be top of media and mind lately) a little like an AK47 being used when what is needed is a skilled sniper.

  6. Interesting information. Lots of potential confounding variables.Good luck on your research. I think that with the more and more data collected we can find a way to beat this.