Anticipating Future Progress
Cancer Progress Report 2016: Contents
In this section you will learn:
The more we know about the biology of cancer and the individual in whom it occurs, the more precisely we are able to prevent, detect, diagnose, and treat cancer.
Research, in particular cancer genomics research, will continue to revolutionize cancer treatment, including expanding the more precise use of existing therapies.
Developing an even more comprehensive, whole-patient understanding of cancer will accelerate the pace of progress toward precision cancer prevention.
We have made significant advances against cancer, with many more people living longer and leading fuller lives after a cancer diagnosis than ever before. Even with this progress, however, it is estimated that in 2016 alone, more than 1.68 million U.S. residents will receive a cancer diagnosis, and more than 595,000 will die from the disease (3).
Despite this enormous burden of cancer, many researchers, including AACR President (2016–2017) Nancy E. Davidson, MD (see p. 102), think the future is bright and that through research, we will be able to power more advances against cancer.
Research is the foundation on which progress against cancer has been and continues to be made. We have found that the more we know about the biology of cancer and about an individual, the more precisely we are able to prevent, detect, diagnose, and treat cancer for that person. Thus, it is clear that more research that provides us with an even more comprehensive understanding of the biology of cancer and its causes is required if we are to make future lifesaving progress.
Recently, discoveries in the fields of cancer genomics and immunology have been particularly fruitful and have firmly established two new pillars of cancer care: precision therapy and immunotherapy. These exciting fields of research also show immense promise for the future because the pace of progress in these areas is expected to accelerate further.
As discussed in
Biomedical Research, however, if we are to efficiently analyze and use the explosion of information generated by cancer genomics research to identify new therapeutic targets and novel genomic signatures of therapeutic response or prognosis, it will be essential to more fully engage computational biology and bioinformatics researchers who can help convert these data into knowledge. Additionally, further progress will be made by rapidly developing and incorporating new research technologies across the entire biomedical research cycle (see sidebar on
One use of cancer genomics research is to identify genomic signatures that identify which patients are likely to respond to a particular treatment. One area where this holds immense promise is immunotherapy (see
Treatment With Immunotherapeutics), in particular, the use of immunotherapeutics that work by releasing the brakes on the immune system, where markers predictive of response have been challenging to identify. One study highlighting the exciting potential of this approach showed that the presence of certain genetic mutations in colorectal cancers predicted response to pembrolizumab (164) and led to the FDA granting pembrolizumab breakthrough therapy designation for use in these patients. Several other studies have used large-scale genomics to identify genetic signatures of melanoma response to ipilimumab (198, 199), although these are early studies that need further validation before the results can be translated into the clinic.
Cancer genomics is not the only research discipline that has the potential to pinpoint new markers that identify which patients are likely to respond to a particular treatment. A number of preclinical studies have shown that the bacterial species in the intestinal microbiota—the microbes that naturally colonize the intestines—of mice influences the anticancer efficacy of cytotoxic chemotherapeutics and immunotherapeutics (200, 201). Whether the intestinal microbiota have similar effects on the efficacy of anticancer therapeutics in humans has yet to be determined, but if it does, it raises the possibility that manipulating a patient’s microbiota may modulate the response of his or her cancer to some types of treatment.
Preclinical research has also shown that one way in which the intestinal microbiota can influence the immune system in mice is through the metabolites produced by the bacteria (202). Metabolites are the breakdown products of larger nutrient molecules. Thus, metabolomics, which is the simultaneous study of as many metabolites in a biological system of interest as possible, such as the blood, urine or a tissue sample, is an area of interest as researchers look for clues to understanding how the intestinal microbiota might influence the response to anticancer therapeutics.
Because the way in which normal cells and tumor cells convert or use energy is often different, metabolomics also has the potential to improve our understanding of cancer biology; to identify markers for cancer detection, diagnosis, and monitoring of treatment response; and to open new avenues of investigation for cancer prevention, detection, diagnosis, and treatment (203).
As our knowledge of cancer biology grows, it is becoming increasingly clear that we cannot study cancer in isolation. We need to know more about the whole person in which the cancer has developed. Nowhere is this more apparent than in the emerging area of precision prevention (see
Figure 2). Precision prevention is a conceptual framework that aims to tailor cancer prevention to the individual patient by accounting for the various factors that may play a role in developing a particular cancer (26). As we develop an even more comprehensive, whole-patient understanding of the way in which cancer starts, progresses, and results in disease, we can expect to see an acceleration in the pace of progress in precision cancer prevention.
Top of page
Progress Report 2016 Contents