Oncology is gaining ground on several fronts, thanks in large part to increased sophistication in the technology of cancer therapeutics, but also in how those technologies are applied.
Research is transforming oncology from a "one-size-fits-all" branch of medicine, as a better understanding of the cancer biology is leading to precisely targeted drugs and personalized treatment regimens. New standards of care being tested in multiple clinical trials are gaining ground against biliary, lung, and prostate cancers. Research is defining and refining methods for cancer prevention and screening, just as large research studies settle debates regarding the treatment of colon and breast cancer.
ASCO is directing attention to progress in these areas in its 2009 CCA Report. Released Nov. 9, the report, formally known as "Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention and Screening," is ASCO's annual assessment of the most significant clinical cancer research of the past year.
As an example of personalized medicine and targeted therapies, for the first time in 30 years, a randomized trial identified a regimen, initial chemotherapy combined with the epidermal growth factor receptor (EGFR)-targeted drug cetuximab(Drug information on cetuximab) (Erbitux), that increases survival for people with metastatic head and neck cancer.
- Among new standards of care comes the first for advanced biliary cancer: results from the largest clinical trial for this disease showed that combining gemcitabine(Drug information on gemcitabine) (Gemzar) and cisplatin treatment increases survival and slows cancer progression, compared with gemcitabine treatment alone.
- In debates regarding colon and breast cancers, the first trial to examine bevacizumab(Drug information on bevacizumab) (Avastin) in the adjuvant setting demonstrated that adjuvant treatment with the drug does not prevent colon cancer recurrence in patients who have undergone surgery for their disease. Also, standard three-drug chemotherapy has been found more effective and less toxic than single-drug treatment with capecitabine(Drug information on capecitabine) (Xeloda) in women age 65 and older undergoing adjuvant treatment for early-stage breast cancer.
- On the cancer prevention and screening front, research suggests that more women may benefit from HPV vaccination than previously thought, based on findings showing that Gardasil reduces the risk of HPV infection, cervical cancer, and other HPV-related disease in women aged 25 to 45.
Dr. Douglas W. Blayney, ASCO president, cast the report as encouragement for "people with cancer and those who care for them," noting that cancer death rates have declined 15% since 1990. Today, two-thirds of patients survive at least five years after diagnosis, he said. Forty years ago, only half survived this long. "And today they have a dramatically higher quality of life," he said.
But the report is as much a call to action as a celebration of progress. ASCO wants to use the 2009 CCA Report as fodder for its efforts to encourage policy makers to accelerate research aimed at improving the quality of patient care. "To achieve new breakthroughs, the scale of our nation's response must match the scale of the problem," Blayney said.
Channeling President Obama's goal of finding "a cure for cancer in our time," the ASCO president called for long-term federal investment in the nation's clinical research infrastructure. He then put in a political plug for healthcare reform, framing access to high-quality care as an important first step toward that goal.
