A new wave of cancer treatments will challenge community oncologists to catch up

New treatments for cancer are being developed at a breathtaking pace. New drugs, immunotherapies that increase the body’s ability to attack tumors, and other innovations are approved three to four times a month. “Ten years ago it was a year. Today’s pace is a week,” says oncologist Tufia Haddad, a breast cancer specialist at the Mayo Clinic. These treatments are not the decisive victory in the “fight against cancer” promised by politicians since the 1970s. But they are smaller wins, including the first treatment focused on the specific biology of small cell lung cancer, metastatic melanoma, and aggressive “triple-negative” breast cancer.

Many treatments target genetic mutations or proteins and are paired with diagnostic tests that look at tumor cells or blood for these “biomarkers.” The influx of so many new tools presents both opportunities and challenges. Keeping up with breast cancer is not easy. “My heart is directed at the local oncologist who cares for all cancer patients.”

Local oncologists provide about 80% of US cancer treatments and treat a variety of malignancies, in contrast to subspecialists working in leading cancer centers. Joseph Alvarnas, a hematologist at the City of Hope Comprehensive Cancer Center in Duarte, California, said:

The flood of information is exacerbated by logistical failures. Arif Kamal, an oncologist at Duke University, states that some biomarker tests need to be processed in a specialized laboratory, which can be difficult to access. The drug itself can have stratospheric costs, and insurers may delay approval or require patients to try cheaper drugs first.Major cancer centers have the resources to avoid such barriers and provide them to patients Increased access to clinical trials, We offer the latest treatments free of charge. There is no doubt that local oncologists want to do their best to their patients, but to make the latest treatments available, especially in rural people and poorly serviced colored areas, doctors It may require strong partnerships with large cancer centers and smarter technologies.

Two important ways to disseminate knowledge National Cancer Center PDQ Website And maintained by guidelines National Cancer Network, An alliance of 31 major US cancer centers. Expertise is also expanded through partnerships between oncologists in small clinics and comprehensive cancer centers. For example, the City of Hope is working with three other centers to contract with companies to provide cancer treatment to their employees through a service called Access Hope. It pairs a distant doctor with an oncologist at a cancer center. “You can see the most complex patients at the time of initial treatment decision or recurrence, and you can keep calling even if the patient’s situation changes,” Alvarnas explains. .. A 2021 study Leaded by Alvarnas colleague Howard West, we found that in 28% of lung cancer cases, Access Hope experts recommend different treatment strategies than those offered locally.

Connections with leading cancer centers also make it easier for local oncologists to enroll patients in clinical trials. Monica Bertagnolli, a surgical oncology scientist at the Dana-Farber Cancer Institute in Boston, Alliance for clinical trials in oncologyShe chairs community practices, including a single doctor’s office. “The doctors doing the research aren’t just aware of the current situation. They are also trying to develop new treatments.”

The differences between the latest treatments vary. For patients with metastatic melanoma, the 5-year survival rate increased from 10% to 50%. Even if the new drug offers a median survival advantage of only two months, Bertagnolli says, “If it’s a new treatment route, it can be combined with something that makes a bigger difference. Maybe. “

Many experts foresee the days when artificial intelligence will help guide such clinical decisions. “Ultimately, machine learning could be applied to data in electronic health records, which should include all the patient’s biomarkers, pathology, and characteristics,” the United States said. William Cancer, Science Director of the Cancer Society, said. However, the health recording system has a long way to go, as it is optimized for billing rather than tracking results. Bertagnolli, a self-proclaimed “girl in a small town in Wyoming,” states that doctors in her research alliance area are already working to improve these systems. “These people are my heroes.”