Forbes: 2018 cancer treatment trends
A few days ago, Forbes Magazine published Elaine Schattner, Professor of Cornell University's Will Medical School, "The Seven Trends in Cancer Therapy in 2018." In 2018, these major trends and issues will affect the lives of cancer patients who go abroad:
1, chemotherapy reduction
A recent report found that in the most recent two years (2013-2015), the proportion of chemotherapy in the most common types of early breast cancer patients showed a general downward trend, from about 34.5% to 21.3%. This trend is very obvious. In the past, more than one-third of the first- and second-stage breast cancer women will receive chemotherapy, but now it has dropped to just one-fifth. With the increasing discussion and awareness of over-treatment in the public, the use and acceptance of genetic testing methods such as OncotypeDx and MammaPrint to predict breast cancer recurrence are increasing. The authors of the study did not find the association), reducing chemotherapy has become a significant and inevitable trend.
The changes in breast cancer are obvious. However, I am not sure whether this situation will expand to other rare malignant tumors, which may vary depending on the type of tumor. In the future, this difference may even become more apparent.
2. Increased new anticancer drugs
For those tumors with specific molecular mutations, doctors are offering more and more targeted drugs, for example, a series of hormone antagonists for breast cancer and prostate cancer, and some amplification or modified protein inhibition for lung cancer. Agents (such as EGFR, ALK), have been approved for ovarian cancer and will be used for PARP drugs of certain types of breast cancer.
At the same time, tumor immunopharmaceuticals, mainly PD-1/PDL-1 inhibitors, are used to treat a variety of tumors. There are also some monoclonal antibodies, such as rituximab and trastuzumab (Herceptin), which have been well documented in standard treatments. There are also new drugs such as Darzalex (CD38 mAb for multiple myeloma), and antibody conjugates such as Kadcyla, Inotuzumab (recently approved Besponsa), which have been used in cancer therapy. At the same time, a recent paper on Adcetris (CD30 monoclonal antibody Brentuximab Vedotin) replacing bleomycin for the treatment of Hodgkin's lymphoma ("B" in ABVD) also reflects reduced use of chemotherapeutic drugs and use of immunologic drugs. Increased trend.
3, pay attention to the cost of cancer drugs
The problem of high cost of anticancer drugs has always existed. With the emergence of more and more drugs and clinical applications, the economic burden of anticancer drugs on individuals and society has also risen.
Some people think that anticancer drugs should not be reimbursed by private insurance companies or public insurance companies ( medical insurance medicare, Medicaid medicaid) unless cancer treatment is proven to have a definite effect on patients.
However, oncologists, patients, economists, and insurance managers are still controversial about how to define “benefit†or “valueâ€.
The cost of anticancer drugs is a social issue. The discussion about it reflects the individual's value in the responsibility for cancer treatment, and whether all cancer patients should have equal opportunities to receive treatment that they and their doctors think is most appropriate.
4, pay attention to cancer genetic diagnosis and its quality, payment problems
Cancer genetic diagnosis is an important issue for patients who want to try new anticancer drugs. They need to know if the molecular characteristics of their tumors match these new drugs. The US Centers for Medicare and Medicaid Services is currently weighing whether it is necessary to include second-generation sequencing (NGS) for advanced cancer patients in Medicare and Medicaid payment programs. To date, the FDA has approved a cancer genetic test, the FoundationOne CDx, which costs about $5,800.
The focus of the debate is primarily on the quality and cost of diagnostic testing. As you may have heard, cancer biopsy results from different companies may vary, and doctors and patients need to repeat tests to get reliable results. With the increasing dependence of cancer treatment drugs and doctors' clinical decision-making on genetic testing, the qualification of genetic testing laboratories is particularly necessary.
The current situation is that the payment restrictions on cancer genetic testing have limited the application of some very useful detection methods. I will write another article to explain this.
5, accurate treatment of cancer
It is based on the molecular mutation of the tumor rather than the specific body parts of the tumor (such as the breast, colon), which is the basis for accurate treatment of cancer. This advanced treatment replaces traditional treatments and is a major trend. I think this will be the future of oncology.
Last May, the FDA first approved the immunotherapeutic drug Keytruda for the treatment of patients with microsatellite instability. A month later, at the 2017 American Cancer Congress (ASCO), doctors reported the results of an experimental drug, larotrectinib, which benefited most cancer patients with TRK gene fusion in early clinical studies, including those in the past. Refractory cases. The drug is under FDA approval and is expected to have more performance in the future.
However, not all oncologists recognize the value or feasibility of this cancer treatment. According to preliminary research, it seems that the response of such drugs may depend on the location of the cancer. For example, at the AACR meeting last spring, Dr. David Hyman and colleagues reported the SUMMIT basket trial for patients with HER2 and HER3 mutations. Clearly, Neratinib exhibits some activity in advanced breast cancer, salivary gland cancer, cholangiocarcinoma, and other cancer patients with HER2 mutations, but has limited efficacy in colon cancer. This trial has a limited scope and involves only a relatively small number of patients carrying HER2 and HER3 mutations. Therefore, careful data collection (including post-marketing data), including the relationship to the location of the tumor, and details of the mutations associated with the anticancer drug based on its molecular characteristics are also required.
6, the improvement of patient report feedback mechanism
The feeling of cancer patients is very important. But doctors and policy makers are not too concerned about their subjective description of pain, nausea, fatigue and other symptoms. As more and more anticancer drugs emerge, patient report results (PROs) will enable doctors to discover subtle differences in drug response in some patients, while also helping to weigh the risks and benefits of treatment.
Some people insist that extending the overall survival is the main goal of anticancer treatment. However, as patients and physicians increasingly value quality of life (and not just prolong survival), the impact of patient reporting results is even more pronounced.
How do you collect these results? Especially after the drug is on the market, how to collect more feedback data? Generally through unblinded clinical trials - patients know that their treatment may have a placebo effect or an anti-placebo effect. If doctors and decision makers are willing to trust these patient reports, it is like opening a Pandora's box, and cancer treatment will be full. And I also look forward to reading, hearing and learning more about this kind of good news.
7, artificial intelligence (AI)
Few doctors, even oncologists in the field of subspecialty, can keep up with the pace of development in the field of artificial intelligence. Whether it is IBM's Watson (I am optimistic about it), or the advice given by other brands of artificial intelligence, rely on big data-driven algorithms to guide doctors. As an emerging field, computational biology can apply big data to individualized case analysis and make rational recommendations based on the latest knowledge and treatment of cancer science. This will be the direction of future development.
Oncology needs to be driven by artificial intelligence, at least in terms of adjuvant treatment decisions. It is estimated that there will be 15 million new cancer cases in the world in 2018. Doctors and patients need to have too much information, and it is easy to miss useful information that can improve the treatment results.
Conclusion:
Is there something missing? Yes, I did not mention CAR-T therapy for almost cancer screening in 2017. Obviously, these biotherapies involve genetic editing, collecting and returning white blood cells from each patient. Although it can achieve relief and cure for cancers that are ineffective against most anticancer drugs, I am still skeptical that it can help tens of thousands of safe and effective drugs compared to simple anticancer drugs. A large patient population.
In addition, I did not mention prevention. Cancer prevention remains the primary concern of everyone and the best way to reduce cancer deaths, drug toxicity and treatment costs. Quitting smoking is a commonplace topic, but it has not yet become a trend in some parts of the world; vaccination to prevent high-risk HPV and hepatitis B virus infection, and to remind obese people to control diet, but progress in this area is also too limited.
Since the current environmental protection bill in the United States needs to be improved, few doctors are willing to join the slow-moving field of environmental oncology, and it is likely to unravel the causal link between carcinogens and cancer. It may take a long time for us to see significant progress in order to understand the pathogenesis of many cancers and how to avoid them. The slow development of environmental oncology lies in insufficient incentives. Perhaps in the list of 2019 next year, the situation will change.
(Author: Friends of good health)
Anesthesia Medical Co., Ltd. , https://www.trustfulmedical.com