Authors: George Weiner, Mohammed Milhem
Date: 2016-09-22 08:22:15

We are in a remarkable time in cancer medicine. The investment in cancer research over the past several decades has helped us in our understanding of the biology of malignant cells, and how such cells interact with their microenvironment, especially the immune system. We have learned that cancer is more complex at the molecular level more than we ever imagined.

This progress in research is tremendous. There is a clear impact on cancer care across a number of cancer types. When most of us received our medical training, advanced cancer of a given organ was treated with a standard chemotherapy recipe that, more often than not, was only marginally beneficial. With our new knowledge, we know that cancers in two different patients that come from the same organ, e.g. lung cancer, can look identical histologically but have very distinct genetic drivers (such as EGFR or ALK mutations) and will respond very differently to different treatments. In many cases we are able to identify those genetic drivers, and increasingly can target those drivers with specific medications. This has revolutionized our approach to cancer based therapy, a huge leap from chemotherapy to targeted therapy.

Exciting and rapidly evolving research in the field of cancer and the immune system has led us to a point where an an increasing number of cancer patients can be treated with cancer immunotherapy. Indeed, a significant minority of patients who have advanced cancer and are treated with cancer immunotherapy go into long-lasting remission – something unimaginable just a few years ago.  The FDA has now approved immunotherapy treatments for a number of cancers including melanoma, lung cancer renal and bladder cancers. The side effects of immunotherapy are different from those seen with chemotherapy and are managed differently as well. This requires enhanced awareness among health care professionals in multiple fields who encounter cancer patients. Instead of cancer treatment resulting in immune suppression and infection as happens with chemotherapy, we are seeing immunotherapy patients develop autoimmunity which sometimes can masquerade as progression of the cancer. As an academic medical center, we are at the cutting edge of research into both targeted therapy and immunotherapy of cancer, and are involved in a growing number of early phase clinical trials testing these new and exciting approaches.

While not every cancer patient benefits from these advances today, the pace of progress has never been faster. Sepsis, “consumption” and HIV were met with a sense of hopelessness before Disruptive Innovation turned them into treatable diseases. We believe we are just at the cusp of the same happening in cancer. These new therapies are beginning to change the overall survival of some patients with advanced cancer. For example, a recent report suggests 5 year survival of patients with advanced melanoma has increased to 40%.

You may have seen recent advertisements for the Holden Comprehensive Cancer Center that say “See Cancer Differently.” This is not just a message for the community - it is for our own faculty and staff as well. If you are asked to participate in the care of a cancer patient being treated based on this new paradigm, we hope you will reach out to an oncology colleague to learn more about the exciting advances taking place in cancer medicine. “Seeing Cancer Differently” will allow us all work together more effectively to help those we serve at this incredibly exciting time in cancer medicine.