People all over the world share the goal of conquering cancer—and in today’s climate of technology and innovation, advancements are being made in every imaginable corner of the field of oncology: scientific, theoretical, technological, biological, psychological, and social. Engineers are now working hand-in-hand with geneticists and physicists and internists, while computer scientists collaborate with…everyone.
In Superhuman Body, we covered one story related to cancer—the heartwarming survival of young Emily Whitehead. She was saved thanks to one of the most amazing new medical marvels, CAR T therapy, a personalized “living drug” (covered in detail in “Curing Leukemia—A Q&A with Dr. Carl June”). However, as we researched her story—and other important advancements in cancer treatments—we realized there was so much to say.
Therefore, below we’ve summarized some of the other stand-out developments is this quickly growing, dynamic field. The American Association for Cancer Research (AACR) provided a head start, because they gathered doctors and researchers to help provide an “Experts Forecast 2024,” detailing the best of the best in what lies ahead. Their job not only was to forecast some of the most promising medical advancements happening right now, but also to support both the new National Cancer Plan and President Biden’s 2016 Cancer Moonshot. Both of these initiatives seek to accelerate scientific discovery and share resources so as to reach, treat, and cure as many patients as possible.
The National Cancer Plan, which was launched in 2023 and is overseen by the National Cancer Institute at the National Institutes of Health, is a living document built on the following eight health-centric and empowerment goals.
- Preventing cancer
- Detecting cancers early
- Developing effective treatments
- Delivering optimal care
- Maximizing data utility
- Eliminating inequities
- Optimizing the workforce
- Engaging every person
As we celebrate a selection of exciting innovations in cancer care—all of which support The National Cancer Plan’s initiatives—let’s begin with perhaps our most foundational goals. Cancer is a disease that knows no boundaries, no age limits, no racial or ethnic barriers—and it cannot be bribed away with money. Our first collective priority is to ensure that everyone has equal access to quality services. Up to now, whether in cancer care or healthcare in general, sadly this has not been the case.
Equity
Airica Steed, EdD, MBA, RN, has made a unique mark in healthcare. She was not only the first Black woman to hold the post of president and CEO of MetroHealth—a public hospital system serving Cuyahoga County, Ohio—but she also served as the former president of Mount Sinai and Sinai Children’s Hospital. Airica has often said that her work is inspired by a wish to ensure that everyone has an equal chance at living a healthy life—but unlike many administrators, that drive arose from her own personal experiences.
Airica’s story started with her mother’s death at age 46. Her acute myeloid leukemia was initially misdiagnosed, and the risks of an aggressive and experimental treatment protocol were not explained—all of which prevented the patient from actively crafting the end of her life. Next, both of Airica’s grandmothers died of breast cancer. Her maternal grandmother’s cancer also was misdiagnosed—twice—so that by the time it was discovered, it had metastasized to several organs. And then, in 2022, Airica’s younger sister died, also from metastatic breast cancer. She was only 39, and she had been denied early screenings despite her family history. Airica herself was at risk of pre-eclampsia, a multi-system disorder specific to pregnancy and more common in Black women; two of her babies were premature and they struggled to survive. Pre-eclampsia is just one of the ways in which Black mothers are at a higher risk of death from pregnancy-related causes.
Airica and her family clearly had experienced first-hand how racial inequities permeate healthcare. She was attracted to Cuyahoga County because it experiences an extremely high death rate for Black babies, and Cleveland has been ranked as the worst U.S. city for Black women to live in. Airica had to put her talents where they were most needed. “We have to reverse centuries of inequity, centuries of structural injustice, centuries of poor outcomes, centuries of lack of accessibility, centuries of senseless death,” she said.[1]
Dr. Airica Steed is one just one person in the fight for equity in healthcare. Thankfully, there’s an army of healthcare workers with this priority. Another soldier is Robert A. Winn, MD, of the Virginia Commonwealth University School of Medicine. His focus is on ensuring that all populations have the most basic access to cancer prevention—through vaccines, sleep, and access to healthy food—along with access to new, more advanced technologies, screenings, or clinical trials. He notes that some patients need special help in navigating the medical system because they live in “data deserts.” These might be rural or urban areas, including underserved, at-risk communities where certain groups of people are simply not represented. This means not only that individuals have fewer ways to access the healthcare system, but also that the system itself isn’t prepared to serve them. This disparity must be addressed for future technologies—especially Artificial Intelligence (AI)—to be most effective. The wider the scope of information provided to AI, the more it can offer.[2] We’ll cover AI in more detail below.
First, a Few Building Blocks
Dr. Winn is one of the experts chosen by the American Association for Cancer Research (AACR) to forecast some of the most promising medical advancements in the field. While the more technical innovations we’ll highlight might seem quite “sciency,” a handful of cancer basics and vocabulary can provide context—and allow us to understand at least a little bit about how researchers think.
- In very basic terms, cancer is an accumulation of cells that have altered from normal tissue. As cancer develops in a person, it can continue to change, and some of these “molecular alterations” become especially difficult to treat. New technologies are targeting these alterations.
- Cancer alterations can be unique to a specific patient or similar among many patients who suffer from a particular kind of cancer. These “shared” characteristics are called “driver mutations,” or “drivers,” and they provide both clues and targets for new treatments.
- When cancer cells develop, they produce identifiable molecules—proteins called “antigens”—that treatments can target. These tumor-associated antigens can be found at low levels throughout the body.
- “Neoantigens” are even more promising. When certain alterations occur in a tumor’s DNA, they release a new protein that forms on cancer cells. These neoantigens are completely unique to those specific cancer cells, so targeting them comes with a lower risk of accidentally harming healthy cells during treatment.[3] Importantly, sometimes neoantigens are individualized (“personal”), and others can be “shared”—meaning patients with the same cancer type can be helped with the same therapy.
Precision Medicine
In recent decades, almost half of all newly approved cancer therapies have been in “precision medicine”—therapies designed to “home in” on tumors by targeting their molecular alterations.[4] According to one of AACR’s Expert Forecast physicians, Patricia LoRusso from Yale Cancer Center, there are several precision medicine initiatives that are inspiring researchers today, including:
- Creating new drug combinations that are effective with so-called “undruggable” tumors—tumors that are hard to “latch onto” and kill.
- Tethering a toxic drug to a “monoclonal antibody” that kills cancer cells. Monoclonal antibodies are produced in laboratories, and act like natural antibodies in our immune systems.
- Using precision medicine earlier in a patient’s treatment program, before a tumor has metastasized and become harder to treat. Precision medicine could even be used before “primary treatment,” such as surgery, to shrink a tumor ahead of time.
- Using precision medicine as part therapies personalized to specific patients. These might include combining them with radiation and chemotherapy, as well as immunotherapy, CAR T, and vaccines, among others.
“If we can define appropriate tumor drivers and target them as early as possible, we might be able to think about curing cancer rather than simply controlling it,” LoRusso said.
Advancements in Oncology Drug Development and Delivery
Chemotherapy is one of the primary pillars of cancer treatment; it’s been used for more than seventy years, and it’s come a long, long way. However, in today’s world of technology and innovation, oncology medications are changing every day—from how they’re formulated, to how they interact with cancer cells, to how they’re infused.
Oncology drug development relies on understanding basic cellular processes—and how they are disrupted in cancer. But even knowing these processes doesn’t guarantee that every drug works as imagined. AACR’s drug expert, Paul Workman, PhD, at The Institute of Cancer Research in London, reports that in 2023, seventeen new cancer drugs were approved by the FDA—but 95 percent of cancer drugs tested in clinical trials never get approved. “This is because they end up being too toxic, ineffective, or no better than existing therapies once they are evaluated in patients, despite promising preclinical data,” he says.
So far, a limited number of “drivers” has responded to chemotherapy, which means that only 14 percent of US cancer patients are treated with precision medicine. “The main reason for the low application of precision medicine is that most cancers are driven by genetic alterations for which we currently have no drugs,” Workman says. “So, number one, we need to increase the clinical success rate of the drugs we are developing, and number two, we need to find ways to discover drugs against the so-called ‘undruggable’ targets,” he said. “In addition, we need to use intelligent combinations of new and old drugs to overcome drug resistance.”
The chemical aspects of drugs also can contribute to new medications. For example, libraries of DNA-encoded chemical compounds—which reveal how they bind to tumors—allow researchers to test millions of compounds at one time, instead of tens or hundreds of thousands. But even more exciting is something called “targeted protein degrader drugs.” When these medications bind to a tumor, they break down the unwanted proteins on its surface. “Being able to design protein degraders that effectively and selectively remove a protein of interest is probably the biggest chemistry breakthrough we’ve seen in oncology drug discovery in recent years,” Workman said.[5]
Once the medications have been formulated, there’s also the matter of delivering them into patients’ bodies. An example of improving this part of the treatment process—during hours-long infusions—comes from the Massachusetts Institute of Technology (MIT). Since 1916, dosage throughout the medical field has been calculated based on each patient’s body surface area. Now, MIT engineers are overhauling traditional dosing, to compensate for differences in body composition, genetics, drug toxicity, drug interactions, circadian fluctuations, or other factors that can lead to patients’ receiving too much or too little of their prescriptions. Their new system, named CLAUDIA (Closed-Loop AUtomated Drug Infusion regulAtor), rapidly prepares blood samples every five minutes to consistently monitor the drug’s concentration. If necessary, CLAUDIA’s algorithm adjusts the infusion rate to keep the medication at the optimal range, so it is both effective and nontoxic.[6]
Cancer Vaccines
The world’s experience with COVID has taught everyone a lot about vaccines—especially mRNA vaccines. Because mRNA was so successful, researchers have renewed focus on vaccines formulated to treat cancer. AACR’s vaccine expert, Catherine Wu, MD, of Harvard Medical School, sees several promising avenues.
Especially exciting is the promise of “shared neoantigens,” because a vaccine could be developed that would readily treat a large number of patients. But Wu also anticipates larger, more comprehensive vaccine trials, as well as more research—for both personalized and shared vaccines—that focuses on expanding the types of cancer that vaccines could help.[7] For more on our coverage of vaccines related to cancer, see our story, “Teaching the Body to Fight Cancer: Immunotherapy in Action.” [hyperlink title]
Artificial Intelligence
It goes without saying that Artificial Intelligence (AI) is changing the way humans interact with computers—and the world of medicine is taking full advantage of AI’s potential. The average person might not know what Large Language Models (LLM), machine learning, or advanced quantum computing are, but we can imagine that harnessing the seemingly limitless data on the Internet can speed up and enhance…well…everything. Medical research, educational content development, pharmaceutical practices, patient care.[8] New AI tools allow researchers, scientists, doctors, and writers to streamline and improve computer-based work at all levels—from automating writing and proofreading tasks to supporting large-scale research.[9]
Let’s start with a relatively “simple” AI example. In a small percentage of patients, their metastases make primary, or “origin,” cancers hard to identify; this makes treatment difficult, because many cancer drugs—including precision medicines—are developed for specific types of tumors. That’s why researchers at MIT and Dana-Farber Cancer Institute have developed the OncoNPC model. It uses machine learning—where statistical algorithms learn and generalize from data about tumor types, and then the model performs tasks without explicit instructions. The model has been accurately classifying tumors, which has allowed a significant increase in patients to receive the targeted medications they need, instead of more general chemotherapy drugs.[10]
Another way in which AI can help with oncology medication development is an AI algorithm called AlphaFold—which can accurately predict the structures of more than 90 percent of cancer proteins. Knowing a protein’s structure is key when researchers develop drugs to fight it—because sometimes the medication attaches to pockets or grooves in the tumor. AlphaFold applies decades of data from known structures, which can shave years off the initial phase of the development of a new drug. Plus, AI could even develop the ideal structure of a small molecule to fit within the contours of the cancer’s protein. Unsurprisingly, however, the success of future AI models will depend on shared accessibility of data developed by pharmaceutical companies—but these companies usually guard their data.[11]
Another cool AI application would be the creation of “digital twins.” These would be sophisticated computer simulations of real patients—which would allow the computer to “test” how a particular drug might impact a particular cancer in a specific patient. This process also would make drug development faster, less expensive, and more successful.[12]
Beyond cancer identification and drug development, AI promises several other exciting possibilities in the field—and will answer some of our most pressing medical questions. For example, by computing vast quantities of data—and using LLM’s ability to generate information in readable, accessible sentences—workers can instantly link and analyze research documents, design more efficient clinical trials, improve vaccine discovery, and streamline medical diagnoses.[13] It’s as if everything we collectively know can be funneled into medical solutions that people can actually understand.
However, the Internet is not only a panacea of excellent information; it’s also full of errors. That’s why the medical community has to be particularly careful—because cancer research is a life-and-death matter. Some of the current challenges in dealing with AI include identifying the best methods to initiate searches, such as learning optimal keywords or coding, or, even better, “question-answering systems,” which allow researchers to use more natural language in their online searches. All of these efforts are targeted toward producing content that avoids ambiguity and improves both accuracy and “truthfulness”— top priorities in coming years.[14] The Web is not going anywhere; computer scientists and medical researchers around the world are sculpting it into a valuable partner in healthcare.
It doesn’t take a rocket scientist to realize that medicine—and particularly, the field of oncology research—is wide open for students interested in changing the world. STEM students in almost any discipline can find a place to use their skills and make a real, lasting difference. And if you ever need inspiration, just check any of the survivor stories in cancer support websites. We’ve compiled several within our list of resources in our story, “What to do after a cancer diagnosis.”
Resources
National Cancer Plan, National Cancer Institute: https://nationalcancerplan.cancer.gov
Cancer Moonshot℠, National Cancer Institute: https://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative
American Association for Cancer Research (AACR), https://www.aacr.org
[1] MetroHealth, “Dr. Steed’s Story: Personal Experience Fuels a Commitment to Equity, Health and Innovation,” MetroHealth (website), published online 4 January, 2023, https://news.metrohealth.org/dr-steeds-story-personal-experience-fuels-a-commitment-to-equity-health-and-innovation/.
[2] Neha J. Pancholi, PhD, “Experts Forecast 2024, Part 2: Achieving Cancer Health Equity,” AACR (website), Cancer Research Catalyst, published 12 January, 2024, https://www.aacr.org/blog/2024/01/12/experts-forecast-2024-part-2-achieving-cancer-health-equity/.
[3] Understanding Cancer Immunotherapy Research (UCIR), “Neoantigen-Based Therapy,” UCIR (website), Types of Immunotherapy, accessed online 8 May, 2024, https://www.ucir.org/therapies/neoantigen-based-therapy#:~:text=Further%2C%20while%20tumor%2Dassociated%20antigens,healthy%20cells%20along%20the%20way.
[4] Neha J. Pancholi, PhD, “Experts Forecast 2024, Part 3: Precision Medicine for Cancer Treatment,” AACR (website), Cancer Research Catalyst, published online 30 January, 2024, https://www.aacr.org/blog/2024/01/30/experts-forecast-2024-part-3-precision-medicine-for-cancer-treatment/.
[5] Neha J. Pancholi, PhD, “Experts Forecast 2024, Part 4: Cutting-edge Tech for Oncology Drug Discovery,” AACR (website), Cancer Research Catalyst, published online 31 January, 2024, https://www.aacr.org/blog/2024/01/31/experts-forecast-2024-part-4-cutting-edge-tech-for-oncology-drug-discovery/#:~:text=“Being%20able%20to%20design%20protein,drug%20cancer%20targets%20in%202024.
[6] Ann Trafton, “A closed-loop drug-delivery system could improve chemotherapy,” MIT News (website), published online 24 April, 2024, https://news.mit.edu/2024/closed-loop-drug-delivery-system-could-improve-chemotherapy-0424.
[7] Neha J. Pancholi, PhD, “Experts Forecast 2024, Part 1: Advances in Cancer Vaccines,” AACR (website), Cancer Research Catalyst, published online 8 January, 2024, https://www.aacr.org/blog/2024/01/08/experts-forecast-cancer-research-and-treatment-advances-in-2024-part-1/#:~:text=Wu%20predicts%20that%202024%20will,sponsored%20phase%20II%20clinical%20trials.
[8] MIT Solve researchers, “Cure Xchange Challenge: Health AI for Good,” Solve (website), an initiative of the Massachusetts Institute of Technology, accessed 7 May, 2024, https://solve.mit.edu/challenges/cure-challenge#.
[9] Jose J. Martinez, “Applications of LLMs in Healthcare Research,” MantisNLP (website), published online on Medium.com 5 March, 2024, https://medium.com/mantisnlp/applications-of-llms-in-healthcare-research-9ffde7f3b4cf#:~:text=LLMs%20play%20a%20crucial%20role,of%20content%20creation%20and%20documentation.
[10] Anne Trafton, “AI model can help determine where a patient’s cancer arose,” MIT news (website), published online 7 August, 2023, https://news.mit.edu/2023/ai-model-can-help-determine-where-patients-cancer-arose-0807.
[11] Pancholi, Part 4.
[12] Pancholi, Part 4.
[13] MIT and Martinez.
[14] Martinez.