CANCER TODAY IS DEDICATED to sharing impactful and compelling news that is important to cancer patients, survivors and their family members and friends throughout the year through four print issues and weekly online posts. As we look forward to 2024 with hope for advances in the understanding and treatment of cancer, we wanted to highlight some of the most important stories of the past year. From treatment breakthroughs to practical advice and firsthand accounts of living with cancer, these are stories that resonated with readers and informed our understanding of cancer care in 2023.
Colorectal Cancer in Young People
Researchers have noticed an alarming rise in the rates of colorectal cancer for people under 50. One projection reported colorectal cancer rates could go up 90% in people ages 20 to 34 by 2030, and it could take over as the leading cause of cancer death for those ages 20 to 50. Erin O’Donnell wrote about this trend in early-onset cancers, what it looks like for the people diagnosed at an early age and what efforts researchers are making to address the problem. “If you were born in 1990, you have an almost three times higher risk of developing colorectal cancer than if you were born in say 1955 or 1960,” said Christopher Lieu, co-director of gastrointestinal medical oncology at the University of Colorado Cancer Center in Aurora. Though Lieu told Cancer Today that colorectal cancer in young people is still “a rare event,” cases that do arise can be overlooked, leading to many being diagnosed at an advanced stage of the disease.
More Prostate Cancer Patients Choose Surveillance
People getting diagnosed with prostate cancer are often approached with a surprising suggestion: Wait to treat it until the cancer grows. And increasingly, patients are doing just that. A large and expanding body of research has found that low-risk and favorable-intermediate-risk prostate cancer often grows slowly, if at all. Waiting to treat can allow patients to spend more years without the side effects of treatment. For some, it may mean never having to go through treatment. Kyle Bagenstose reported on the increase in people choosing the wait-and-see approach and the research underpinning it. “There’s been an explosion of literature over the last eight to 10 years,” Mohamad Ezzeddine Allaf, urologist-in-chief at Johns Hopkins Hospital in Baltimore, told Bagenstose. “So that whenever you open a journal, it’s not uncommon to see studies validating the safety of active surveillance.”
Albert Khoury refused to accept that he was out of treatment options. His lung cancer had spread to the other lung, making it stage IV, and it was not responding to chemotherapy. He was offered hospice. But he continued to look for options and to press his doctors, leading to a rare double lung transplant that saved his life. “Transplant and cancer don’t go hand-in-hand by conventional teaching,” Ankit Bharat, the chief of thoracic surgery and director of the Canning Thoracic Institute at Northwestern Medicine, told Cancer Today associate editor Thomas Celona. But even though Khoury’s cancer was stage IV, it was limited to the lungs, which made surgery a possibility. “As we are learning more about cancer biology, what we’ve realized is that not all cancers are the same, and we cannot just have this kind of cookie-cutter approach and thought process for every cancer,” Bharat said.
Deconstructing Peripheral Neuropathy and Chemo Brain
Peripheral neuropathy and chemo brain, also called cancer-related cognitive impairment or CRCI, are two of the most complained about effects from cancer treatment, interfering with the daily activities of many patients across different cancer types. Cancer Today managing editor Marci A. Landsmann reported on a discussion at the American Association for Cancer Research (AACR) Annual Meeting 2023 about the most recent insights into the causes of these conditions and hopes for preventing or managing them in patients. (The AACR also publishes Cancer Today.) Despite recent attention, progress against these effects is frustratingly slow. For instance, there are multiple treatments that have been linked to thinking and memory problems that are classified under CRCI. “I think part of the problem that comes up with this is it is difficult to pin down which mechanism is taking precedent in a given patient,” said Nathan Staff, a neurologist and researcher at Mayo Clinic in Rochester, Minnesota. But speakers expressed hope that continued attention could bring new insights and methods to treat the side effects. Peripheral neuropathy, they noted, was identified as one of the 2023 Cancer Grand Challenges, a program from the NCI and Cancer Research UK, which could bring vital funding and attention across disciplines in the hope of finding a breakthrough.
Coffee is often seen as an example of constantly changing recommendations for cancer risk reduction, but for the last 20 years, research has been clear that coffee is not linked to higher cancer risk and actually is associated with a reduced risk for some cancers. Testing in mice during the 1970s and 1980s raised concerns about some compounds found in roasted coffee, but these tests used doses thousands of times higher than those found in the real world, and subsequent research has failed to show any risks. “Since the benefits of coffee consumption are often greatest in the highest categories of consumption, those concerns seem to be unfounded,” Nigel Brockton, vice president of research at the American Institute for Cancer Research, told writer Carisa Brewster. In fact, recent studies have added to evidence that links coffee with a lower risk for endometrial cancer and liver cancer.
Antibody-drug conjugates (ADCs) link powerful chemotherapy drugs to antibodies that direct them to cancer cells. The Food and Drug Administration first approved an ADC in 2000, but Kendall K. Morgan reported how a new generation of these drugs have been driving advances in care for several cancer types. “Not only are they [ADCs] more effective, but they have also changed the way we think about drug development,” Sara Tolaney, a breast oncologist at Dana-Farber Cancer Institute in Boston, told Morgan. Because the antibodies are tied to a chemotherapy, they are able to target features found on cancer cells even if they don’t drive cancer growth. As researchers learn more, they are finding new targets and studying the use of ADCs in early-stage cancers.
The Promise of Liquid Biopsies
Researchers have for years been interested in tests to detect cancer through an ordinary blood draw, popularly referred to as liquid biopsies. These tests are safer and less invasive than traditional biopsies, and they have become an important tool for surveillance in people who have been treated for colorectal cancer. But what a positive liquid biopsy result actually means for someone is a question doctors and researchers are still grappling with. “The questions now revolve around what to do with the results. How does it impact the treatment? Am I going to change the treatment based on somebody’s minimal residual disease assay?” said medical oncologist Pashtoon Kasi, the director for liquid biopsy research at the Englander Institute for Precision Medicine of Weill Cornell Medicine in New York City. Kasi spoke to Tara Haelle about what we know about liquid biopsies, how they affect treatment and what researchers still hope to learn.
Living With Chronic Blood Cancer
Treatment advances have transformed care for people with blood cancer. Though many are living years beyond diagnosis, most will continue to deal with the cancer for years, going through cycles of remission, relapse and treatment. Long-term survival also comes with regular blood tests and checkups and both short-term and long-term effects of anti-cancer medicines. Kendall K. Morgan reported on what it looks like for people who are living with these chronic blood cancers and how it changes their relationship to care. “The need to participate in your own treatment, in my opinion, becomes higher, and at the same time, if you end up living longer, issues come up,” said Yelak Biru of Los Angeles. Biru was diagnosed with multiple myeloma in 1995 and is now CEO of the International Myeloma Foundation.
As an oncology breast nurse navigator, Eve Spiegel was more familiar than most with cancer cases, but when she came home from a trip with a fever, nausea and abdominal pain, ovarian cancer was not the diagnosis she expected. As doctors worked to figure out what was causing the vague collection of symptoms, they asked about her family history of cancer, and she shared how, after years of believing her grandmother, Evelyn, died of lung cancer from smoking, Spiegel’s grandfather revealed she had actually died “of a female cancer.” He had kept it a secret for years, but eventually recognized the importance of this information. “In 1969 when Evelyn passed, people didn’t talk about menses, sex or any topic they considered ‘embarrassing’ or private concerns,” Spiegel wrote. In a post for the Cancer Today blog, she shared the challenges that cause ovarian cancer to be missed until it has already advanced to a later stage, how to look for signs of the disease and why it is important for families to talk about their health history.
Moving the Needle on Metastatic Breast Cancer
Metastatic breast cancer remains an incurable disease, but recent advancements in treatment and targeting are allowing more people to live longer with the cancer under control. Erin O’Donnell reported on the changes in metastatic breast cancer care and what they mean for patients. She spoke to Shanu Modi, a breast oncologist at Memorial Sloan Kettering Cancer Center in New York City, who told her that the goal is still to eradicate breast cancer. But the more attainable goal to help patients right now is to “at least keep it under control and turn it into a disease that patients can live with for a long time,” Modi said. “Having a lot of [treatment] options is important. And the fact that we’re now seeing gains in prolonging the survival of stage IV patients with the newer drugs leaves me hopeful that we are moving the needle.”
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