CANCER RESEARCH is a process of refining. Alongside, and part of, the development of new treatments are ongoing efforts to better understand the biology of cancer and how it interacts with our bodies and the medicines used to treat it. In 2024 we saw this process in many ways, with stories on giving less treatment in cases where it does not provide a benefit, finding new ways to engage the immune system so the body can stop cancer from returning or even developing in the first place, and rethinking how we name cancers to better reflect how they behave. Here are some of the stories that fascinated us and lit the way for the future of cancer treatment, selected by the editors of Cancer Today.

The Cancer That Doctors Don’t Want to Call Cancer

Wall Street Journal, Jan. 25

Some doctors are raising a surprising and challenging question: When is cancer not cancer? As improvements in screening have been able to detect even the earliest signs of cancer, doctors are finding cases where the cancer may never grow and may even recede on its own, the Wall Street Journal reported. The question is prominent in discussions about prostate cancer. A growing body of evidence shows that active surveillance—in which doctors regularly monitor for cancer growth with no immediate treatment—is a safe approach for low-risk prostate cancer and spares patients potential side effects of treatment including urinary and sexual dysfunction. But for prostate cancer cases with the lowest risk of growing or spreading outside the prostate, the term “cancer” itself can skew the discussion and make it hard for patients to consider a watch-and-wait approach. “They look at me and say, ‘I have cancer, it has to be treated,’” David Penson, a urologic surgeon at Vanderbilt University Medical Cancer in Nashville, Tennessee, told the Wall Street Journal. Not all doctors are convinced that a name change is warranted. Already 40% to 60% of men told they have a form of cancer that doesn’t cause harm have poor follow-up, and opponents of the name change worry it would further undermine the importance of surveillance.

We’re Naming Cancers All Wrong

STAT, Jan. 31

Have we been identifying cancers by the wrong names? That’s a question Fabrice André, a medical oncologist at Institut Gustave Roussy in Villejuif, France, and colleagues asked in a commentary published Jan. 31 in Nature. In a conversation with STAT, André argued that while using language based on the tissue of origin—like breast cancer or lung cancer—matters when it comes to surgery, it has little importance for other treatment decisions. Scientists now understand that the molecular characteristics of a cancer, regardless of where it originates, dictate how the cancer grows and how it should be treated. But using names that refer to the part of the body, rather than the specific mutation, can be confusing for patients when two people with the same disease receive different treatments. For example, someone with triple-negative breast cancer may receive vastly different therapies from another person whose breast cancer is HER2-positive. Additionally, André suggested current naming conventions may prevent some patients from accessing lifesaving treatments. For example, drugs targeting the immune checkpoint PD-1 were approved for people with advanced melanoma in 2014, but people with other cancer types whose tumors would also have benefited from PD-1 therapy couldn’t receive the drugs until nearly a decade later. “We see that more and more patients present with genomic alterations that would make them eligible to a therapy if the origin of cancer was different,” André told STAT. “It’s a little bit strange. So, that’s the rationale to develop a more biological-based classification.”

Cancer Therapy Approved by FDA Uses Body’s Own Cells as a ‘Living Drug’

Washington Post, Feb. 20

In February, the Food and Drug Administration (FDA) approved Amtagvi (lifileucel), a type of cell therapy that uses a person’s own tumor-infiltrating lymphocytes (TILs) to treat cancer. These TILs, extracted from a tumor sample, are grown in a lab and infused by the billions back into the body to attack cancer cells. The FDA approval marks the first time that cell therapy will be available to treat a solid cancer, a Washington Post article noted. (Another type of cellular therapy, called chimeric antigen receptor T-cell therapy, has been approved to treat certain blood cancers.) In the clinical trial leading to Amtagvi’s approval, 31.5% of 73 patients with metastatic or unresectable melanoma who were given Amtagvi experienced tumor shrinkage or disappearance of their tumor. People with these diagnoses already have newer treatment options such as targeted therapies, including BRAF inhibitors that target the tumor’s molecular features, and immune checkpoint inhibitors that harness the power of the person’s own immune system. When these treatments do not work, however, people with metastatic melanoma or unresectable melanoma have another option in TIL therapy. The development could lead to more treatment using TILs for people with other types of solid cancers. “In many ways, I feel like we’re just getting started now in the application of cellular therapy to the common cancers that result in 90% of all cancer deaths—the solid epithelial cancers,” said Steven A. Rosenberg, the senior investigator in the National Cancer Institute’s (NCI) Center for Cancer Research and chief of the NCI Surgery Branch, in a Healio article. “That’s the major challenge we now face. I think we have the tools to begin to develop substantial improvements. We have a talented team of scientists working on trying to improve it. It’s just the beginning of what I think is going to be a glorious future for cellular therapy.”

For Cancer Patients, Clinical Trials Can Come With Significant Out-of-pocket Costs

PBS, Feb. 22

Shenard Matthews makes a five-hour, 350-mile drive every three weeks from his home in Louisiana to Houston, where he receives treatment at the University of Texas MD Anderson Cancer Center. For more than a year, the 53-year-old has participated in a clinical trial testing a new therapy for his stage IV lung cancer. “It’s very stressful, and I’m not in the best shape, but it’s my only hope,” Matthews told PBS. Clinical trials can offer people with cancer access to the latest treatments, but they can come with additional costs. Many people live far away from cancer centers that conduct trials, requiring them to travel long distances for care and to incur out-of-pocket costs for things like gas, parking and hotels. Clinical trial participants pay an average of $600 in indirect costs per month, according to one report. The cost of transportation, childcare and taking time off work can prove prohibitive for some. Advocates have called on clinical trial sponsors to help low-income participants by covering some of these additional costs to ensure trials enroll enough patients. “When you are experiencing financial toxicity from a cancer diagnosis, every cent becomes a consideration for a patient, and all too often, it’s the barrier that prevents patients from being able to say, ‘Yes, I want to participate,’” said Dana Dornsife, CEO and founder of the Lazarex Cancer Foundation, a nonprofit that reimburses travel costs for clinical trial participants. “I know beyond a shadow of a doubt that it’s costing lives.”

Living Drugs That Reprogram Patients’ Immune Cells Show Early Promise Against Hard-to-treat Brain Tumors

CNN, March 13

Some types of cancer have few effective treatments and even fewer success stories. Glioblastoma, an aggressive cancer in the brain, is one such type—the average life expectancy after diagnosis is just a little over a year. In fact, only 3% to 5% of people diagnosed with this type of brain tumor will be alive three years later, a CNN article reported. However, research on chimeric antigen receptor (CAR) T-cell therapy, a type of therapy that reprograms a person’s own immune cells to attack cancer cells, is providing some promise for researchers who hope initial findings could serve as the basis for more effective treatments. CNN provided an overview of three early clinical studies, including one study of three patients published in the New England Journal of Medicine that found dramatic responses on scans within days of having CAR T-cell therapy delivered directly to the brain. In some cases, scans showed the tumors had completely vanished in just one day, CNN reported. In general, the cancer did come back, and the results did not show an overall survival benefit. Still, researchers were shocked by the dramatic initial responses for such a difficult-to-treat cancer type. “They clearly made the tumors shrink, so it’s doing something,” said Otis Brawley, a professor of oncology at Johns Hopkins University, who wasn’t involved in the study. Other research using CAR T-cell therapy to treat brain cancers has been covered this year, including an article published on Stanford Medicine’s website that describes impressive findings in 11 people with aggressive brain and spinal cord cancers that typically affect children.

Cancer Patients Often Do Better With Less Intensive Treatment, New Research Finds

AP, June 2

For many cancer types, researchers have explored whether less treatment can be just as effective, with fewer side effects, as the standard of care. Studies presented at the annual meeting of the American Society of Clinical Oncology, held this June in Chicago, showed that could be the case for ovarian and esophageal cancer and Hodgkin lymphoma. In one study, researchers compared two groups of ovarian cancer patients. One group had healthy lymph nodes removed and the other did not. After nine years, both groups had similar survival rates and the group that did not have lymph nodes removed experienced fewer complications. In another study, one group of esophageal cancer patients received chemotherapy and surgery, while another group received these treatments plus radiation. After three years, 57% of those who received surgery and chemo were still alive compared with 51% of those who received all three treatments. In a study of Hodgkin lymphoma patients, a less harsh chemotherapy treatment successfully kept the disease in check for 94% of patients after four years, with fewer side effects, higher than the 91% whose disease responded to a more intense treatment. “The good news is that cancer treatment is not only becoming more effective, it’s becoming easier to tolerate and associated with less short-term and long-term complications,” said William G. Nelson, Cancer Today editor-in-chief and director of the Johns Hopkins Kimmel Cancer Center in Baltimore, who was not involved in the research.

Small-town Patients Face Big Hurdles as Rural Hospitals Cut Cancer Care

KFF Health News, Aug. 7

The closing of rural hospitals has pushed cancer patients in many parts of the country to drive increasingly long distances to access lifesaving treatment. The years 2014 to 2022 saw 382 rural hospitals in the U.S. close, according to the health analytics firm Chartis, expanding the number and size of chemotherapy deserts in the country. The greatest impact of these closures has been in states like Texas that have not expanded Medicaid coverage under the Affordable Care Act. For patients that can mean driving an hour or more each way to get chemotherapy treatments, and the treatments themselves can last up to eight hours. “It’s pretty uncomfortable for some of these patients who may have bone metastases or have significant muscular pain and have to sit in the car that long and hit road bumps,” Shivum Agarwal, a family physician based in rural communities about an hour west of Fort Worth, Texas, told KFF Health News. The long drive can bring financial burdens too, from gasoline and car maintenance to childcare and lost income for family members or caregivers who do the driving. A federal government drug discount program allows remote hospitals to buy outpatient drugs at lower prices and has been a lifeline for places like Childress Regional Medical Center in Texas. Childress is expanding its infusion center to the relief of many people in the area. “We’ve had a handful of patients say, ‘If you can’t do it here, I’m not doing it,’” Childress CEO Holly Holcomb said.

Older Adults Do Not Benefit From Moderate Drinking, Large Study Finds

New York Times, Aug. 12

A study published in JAMA Network Open in August revealed that even light drinking was associated with more cancer deaths among older adults in Britain, a trend worsened among people with existing health problems or who lived in low-income areas. The study, which tracked more than 135,000 adults 60 or older for 12 years, defined light drinking as an average of 20 grams of alcohol daily for men and 10 grams for women. A standard drink in the U.S. has 14 grams of alcohol. “We did not find evidence of a beneficial association between low drinking and mortality,” said study lead author Rosario Ortolá of Universidad Autónoma de Madrid, adding that alcohol probably raises the risk of cancer “from the first drop.” On the other hand, the study found that drinking mostly wine and drinking only with meals lessened the risk of death from cancer among light drinkers. The study also found no reduction in heart disease deaths among light or moderate drinkers, puncturing a common belief that light alcohol drinking could benefit the heart. Current U.S. dietary guidelines say that adults 21 years old or older should limit themselves to one drink a day for women and two drinks for men. Despite that, alcohol use rose in the U.S. between 2016-2017 and 2020-2021, with deaths from excessive alcohol use spiking nearly 30% in that time.

Weight-loss Drugs Like Wegovy May Help Stave Off Some Cancers

NPR, Aug. 12

GLP-1 agonists, which were first developed decades ago to manage Type 2 diabetes, have recently been approved for weight loss. These drugs, which have brand names like Wegovy and Ozempic, mimic hormones related to hunger and slow digestion. Now, studies are starting to show the impact of these drugs on preventing cancers, including breast, colon, liver and ovarian cancer, an NPR article reported. Research presented at the American Society of Clinical Oncology (ASCO) meeting in June showed bariatric surgery and GLP-1 medications each reduced the risk of 13 obesity-related cancers compared with no treatment. The findings showed that people who had bariatric surgery had a 22% lower risk of developing cancer over 10 years compared with those who received no treatment. But among those taking GLP-1 medications, risk dropped by 39% compared with those who didn’t receive treatment for the same time period, NPR reported. The study also showed that even patients who did not lose a lot of weight on the GLP-1 agonists seemed to have lower likelihood of developing cancer. “We think the protective effects of GLP-1s are probably multifactorial,” said Cindy Lin, a resident physician at Case Western Reserve and co-author of the June ASCO study, in the NPR article. “Part of it is weight [loss], but other factors may be contributing as well—better glycemic controls, anti-inflammatory effects.”

Can We Prevent Cancer With a Shot?

Wall Street Journal, Oct. 10

Promising results marked progress in the development of vaccines to lower the risk of cancer developing or returning. Most people are familiar with vaccines that prevent infectious diseases, and some cancer vaccines do just that. The human papillomavirus (HPV) vaccine targets infections that can lead to cervical and other cancers, and the hepatitis B vaccine protects against an infection that can result in liver cancer. Most cancers are not caused by infections, however, leading researchers to investigate vaccines that can prevent cancer by training the immune system to eliminate signs of cancer before they develop. Among vaccine targets are inherited genetic mutations that put people at greater cancer risk. Examples include vaccines for people with Lynch syndrome, a genetic condition that greatly increases colorectal cancer risk, and those with BRCA gene mutations that increase the risk for breast, ovarian and other cancers. Other vaccines seek to stop precancerous lesions from developing into cancer. One study compared two groups of patients with precancerous polyps in their colorectal systems. After the polyps were removed, one group received a vaccine and the other received a placebo. A quarter of the people who got the vaccine had an immune response, and after two years, that group had a 38% reduction in polyp recurrence. “Cancer cells and even pre-cancer cells know how to hide from the immune system,” said medical oncologist Neeha Zaidi of the Johns Hopkins Kimmel Cancer Center in Baltimore, who is developing a vaccine that targets a mutation on the KRAS gene that can promote the growth of lung, pancreatic and other cancers. “It needs that help from a vaccine.”

More Young People Are Surviving Cancer. Then They Face a Life Altered by It.

NPR, Nov. 11

Four years ago, Lourdes Monje was diagnosed with stage IV breast cancer at age 25. In decades past, that diagnosis would have had a grim outlook, but Monje is alive today and her cancer is contained thanks to advanced immunotherapy drugs. While the typical cancer patient used to be around retirement age, NPR writes Monje represents “the new generation of cancer survivor”: a younger person who still has decades of life ahead of them and must navigate educational, financial and social concerns, such as dating or dealing with infertility, in the years after treatment. People under 50 are being diagnosed with cancer in rising numbers, and these survivors face unique challenges. “When we think about all the things that are happening in your life at that time—you’re graduating from high school, going to college or starting a career or starting a family—having a cancer diagnosis has such a significant impact,” Alison Silberman, CEO of the young adult cancer support group Stupid Cancer, told NPR. These survivors can face choices about preserving their fertility, affording out-of-pocket costs for long-term care and broaching the topic of cancer with new romantic partners. Experts worry not enough research focuses on quality of life for these survivors and that young survivors don’t receive adequate support. “Those conversations need to happen earlier, and they need to happen more often,” Silberman said.

Undiagnosed Depression in Cancer Patients Is One of the Biggest Gaps in Treatment.

NBC News, Nov. 29

About one-third of cancer patients deal with depression, anxiety or another mental health issue, but awareness and services are lacking for many patients. NBC News reported that more than half of the country lives in areas with a shortage of mental health providers, and only 20% to 40% of those providers take insurance. The toll on cancer patients is considerable, both in suffering and in cancer outcomes. People dealing with mental illness can struggle to adopt healthy practices like getting exercise and avoiding alcohol, and they may lack the willingness to follow through with treatment. Cancer patients who have depression can have mortality rates up to 39% higher than other patients who don’t have depression. But there are things patients can do. Integrative therapies, such as yoga, music therapy and mindfulness-based interventions, have been found to reduce anxiety and depression symptoms. Taking the initiative to tell your doctor that you think you could benefit from mental health services can be an important step. “Your oncologist is not going to identify your mood swings for you,” Simone Webster, of Washington, D.C., who was diagnosed with breast cancer at age 31, told NBC News. “They don’t know if you’re having suicidal ideation or depressed unless you tell them.”