Innovation in cancer diagnosis and treatment is evidence of a steadfast ambition to improve patient care and outcomes. In our article ‘Cancer Inequity: What is it and what can be done?’, we discussed the importance of competition in innovation to address issues of accessibility but also the need for reinvestment into the improvement of care. In this article, we explore the latest developments and current gaps in cancer diagnosis and treatment.
The continued integration of genomics, bioinformatics, and digital tools in oncology is driving a shift towards precision medicine based on patients’ individual disease profiles,1 and several recent developments are supporting this shift:
CRISPR/Cas9 genome editing has been shown to improve the safety and efficacy of CAR-T cell therapies and prevent resistance to chemotherapy and radiotherapy in tumor cells2
- Researchers have identified the gene that enables melanoma cells to spread, prompting the development of gene-targeted treatments to protect patients in3
- The use of artificial intelligence is having a ‘growing impact’ on cancer diagnostics and clinical decision-making in precision medicine4
Despite the progress made so far, widespread implementation of a precision medicine approach remains contingent on international collaboration and investment to alleviate the inequalities in access to treatment.5
Trastuzumab deruxtecan, an antibody–drug conjugate sold under the name Enhertu®, is revolutionizing the treatment of human epidermal growth factor receptor 2 (HER2)-positive cancers, which are defined by an overexpression or amplification of HER2.6 To date, Enhertu® has been shown to be effective in treating HER2-positive breast,7 stomach,8 and lung cancer.9
There is a growing evidence base indicating that non-small cell lung cancer (NSCLC) may be treated more effectively by a combination of immunotherapies than by monotherapy.10,11
Addressing treatment resistance
In addition to the promise shown by new life-extending agents in several tumor types, there is also important research being conducted to further understand and overcome treatment resistance. A Phase 1 trial demonstrated that combining the immunotherapy pembrolizumab and the hypomethylating agent guadecitabine may reverse resistance in patients with immunotherapy-resistant cancers.12
Fecal transplants may also potentially overcome resistance to immunotherapies, suggesting that by harnessing the power of the gut microbiome, it may be possible to improve the body’s response to certain treatments and reduce the severity of side effects.13 Elsewhere, emerging research has shown that treatment-resistant esophageal cancer responds well to phosphodiesterase type 5 (PDE5) inhibitors, which are currently used to treat erectile dysfunction.14
Cancer vaccines have shown promise in early research, although significant further investigation and development is needed before they can be integrated into cancer care pathways.15 The development of mRNA vaccines for COVID-19 showed that mRNA vaccines, which are easier to produce and deliver than DNA- or virus-based vaccines, are generally effective and have good safety profiles. The success of these COVID-19 vaccines has boosted interest and support for the development of vaccines against various cancers using the same mRNA platform.16
While recent innovations have made great strides towards improving cancer diagnosis and treatment, issues around implementation and treatment resistance mean that it may be a while before these innovations can have the intended impact on patient outcomes. Yet, this commitment to innovation represents the importance of maintaining patient centricity in everything we do.
- Lassen UN, Makaroff LE, Stenzinger A et al. Precision oncology: a clinical and patient perspective. Future Oncol 2021;17(30):3995–4009. https://doi.org/10.2217/fon-2021-0688.
- Shojaei Baghini S, Gardanova ZR, Abadi SAH et al. CRISPR/Cas9 application in cancer therapy: a pioneering genome editing tool. Cell Mol Biol Lett 2022;27:35. https://doi.org/10.1186/s11658-022-00336-6.
- Bousgouni V, Inge O, Robertson D et al. ARHGEF9 regulates melanoma morphogenesis in environments with diverse geometry and elasticity by promoting filopodial-driven adhesion. iScience 2022;25(8):104795. https://doi.org/10.1016/j.isci.2022.104795.
- Luchini C, Pea A, Scarpa A. Artificial intelligence in oncology: current applications and future perspectives. Br J Cancer 2022;126:4–9. https://doi.org/10.1038/s41416-021-01633-1.
- 20 years of precision medicine in oncology. Lancet 2021;397(10287):1781. https://doi.org/10.1016/S0140-6736(21)01099-0.
- Iqbal N, Iqbal N. Human epidermal growth factor receptor 2 (HER2) in cancers: overexpression and therapeutic implications. Mol Biol Int 2014;2014:852748. https://doi.org/10.1155/2014/852748.
- Jerusalem GHM, Park YH, Yamashita T et al.
Trastuzumab deruxtecan (T-DXd) in patients with HER2+ metastatic breast cancer with brain metastases: a subgroup analysis of the DESTINY-Breast01 trial. J Clin Oncol 2021;39(15_suppl):526. https://doi.org/10.1200/JCO.2021.39.15_suppl.526.
- Yamaguchi K, Bang Y-J, Iwasa S et al.
Trastuzumab deruxtecan (T-DXd; DS-8201) in patients with HER2-positive advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma: final overall survival (OS) results from a randomized, multicenter, open-label, phase 2 study (DESTINY-Gastric01). Journ Clin Oncol 2021;39(15_suppl):4048. https://doi.org/10.1200/JCO.2021.39.15_suppl.4048.
- Li BT, Smit EF, Goto Y et al.
Trastuzumab Deruxtecan in HER2-Mutant Non-Small-Cell Lung Cancer. N Engl J Med 2022;386(3):241–251. https://doi.org/10.1056/NEJMoa2112431.
- AACR: Combination immunotherapy treatment effective before lung cancer surgery. MD Anderson Cancer Center. 2022. Available at: https://bit.ly/3Sy7BVq
(accessed September 2022).
- Levy BP, Reck M, Yang JC-H et al.
Datopotamab deruxtecan (Dato-DXd) plus pembrolizumab in treatment-naive advanced/metastatic (adv/met) non–small cell lung cancer (NSCLC) with PD-L1 ≥ 50% and without actionable genomic alterations. J Clin Oncol 2022;40(16_suppl):TPS3162. https://doi.org/10.1200/JCO.2022.40.16_suppl.TPS3162.
- Papadatos-Pastos D, Yuan W, Pal A et al. Phase 1, dose-escalation study of guadecitabine (SGI-110) in combination with pembrolizumab in patients with solid tumors. J Immunother Cancer 2022;10:e004495. https://doi.org/10.1136/jitc-2022-004495.
- Eardmann J. How gut bacteria could boost cancer treatments. Nature 2022;607:436–439. https://doi.org/10.1038/d41586-022-01959-7.
- Smith J. How erectile dysfunction drugs could be the key to overcoming treatment resistance in oesophageal cancer. Cancer Research UK. 2022. Available at: https://bit.ly/3E1Spf8 (accessed September 2022).
- Liu J, Fu M, Wang M et al. Cancer vaccines as promising immuno-therapeutics: platforms and current progress. J Hematol Oncol 2022;15:28. https://doi.org/10.1186/s13045-022-01247-x.
- Kaiser J. New generation of cancer-preventing vaccines could wipe out tumors before they form. Science 2022;376(6589). https://doi.org/10.1126/science.abq3411.