Members of the Oncology Times Editorial Board took the time to the answer the question, "What are the advances and trends in oncology to look out for in 2017?" Find out what they had to say about oncology practices and advancements in the coming year.
"Predicting the future is always problematic, yet some trends are obvious. We will continue to see the adoption of genomic analyses of patient tumors to drug discovery, with studies such as NCI-MATCH, TAPUR, and others starting to generate real data.
"We will also continue to see an expansion of immuno-oncology to broader groups of human tumors, as checkpoint inhibitors move forward across several diseases. More importantly, we should begin to see studies defining which patients are most likely to benefit from such therapies, and one trusts that biomarkers will begin to find their way into standard practice for these exciting yet challenging drugs.
"In my own favorite disease, breast cancer, we should be close to seeing the results of adjuvant therapy trials with novel HER2-targeted therapies and (perhaps) with other new agents. We will continue to wrestle with more global healthcare issues: the fallout from the 2016 election and its impact on the Affordable Care Act, and the collective burden of large numbers of high-priced new agents."
-George W. Sledge, Jr., MD, Editorial Board Chairman, and Professor of Medicine and Chief of the Division of Oncology at Stanford University
"Obviously, I'll join with probably all other members in saying that the area of most excitement now is in immuno-oncology. The new insights in this area are quite exciting and are being propelled by huge advances in our understanding of basic immunology.
"As I am also involved in HIV cure research, it's worth noting that immune checkpoint blockers are being actively explored in that work as well. We are still waiting to realize the full potential of precision oncology and better algorithms of genomic analysis continue to be needed along with more efforts to streamline the billing for and insurance coverage of this technology. It's exciting to see all this progress!"
-Paul Volberding, MD, Director, AIDS Research Institute, University of California, San Francisco; Director of Research, UCSF Global Health Sciences
"In AML, the success of targeted therapies with FLT3 and IDH1/2 inhibitors will hopefully soon result in these agents becoming part of the standards of care for AML therapy. Based on the updated randomized trials showing the benefit of gemtuzumab ozogamicin (CD33 monoclonal bound to calicheamicin), we hope the FDA would reconsider the availability of the drug in the U.S.
"Several other CD33 monoclonals are under development, as well as monoclonals targeting CD123 and bispecific antibody constructs targeting CD33, CD123, CD38, and others. Venetoclax, a BCL-2 inhibitor, is demonstrating significant activity in combination with epigenetic therapy as low-intensity therapy in older patients with AML. Finally, the checkpoint inhibitors may also provide exciting treatment possibilities in AML.
"In ALL, the novel immuno-oncology strategies are demonstrating major activities and may soon, in combined modalities, change the treatment paradigms and prognosis in adult ALL. Exciting therapies include monoclonal antibodies targeting CD22 (e.g., inozutumab ozogamicin) and CD19; bispecific antibody constructs targeting CD19 (e.g., blinatumomab), CD22, CD20, and CD38; and CAR-T cells targeting CD19 and CD22.
"In CLL, the success of the B-cell receptor (BCR) inhibitors, including BTK inhibitors (e.g., ibrutinib) and PI3K delta inhibitors (e.g., idelalisib), are already changing the treatment strategies and prognosis in CLL. Venetoclax has already received FDA approval for CLL salvage therapy, and combinations of BCR inhibitors and venetoclax may be very promising. Novel monoclonal targeting CD20 are adding therapeutic power to the therapeutic armamentarium in CLL.
"In CML, the estimated 15-year survival with Bcr-Abl selective tyrosine kinase inhibitors (TKIs) is above 80 percent, and the relative survival of optimally treated patients approaches that of a normal population. An important question is TKI treatment discontinuation and durability of treatment-free remission in these patients."
-Hagop M. Kantarjian, MD, Professor and Chairman, Department of Leukemia, and the Samsung Distinguished University Chair in Cancer Medicine, University of Texas MD Anderson Cancer Center
"In 2017, advances in oncology are likely to continue to focus on precision medicine. Genetic profiling and targeted therapies will continue to evolve along with increases in the study and use of oncoimmunology. Also, I believe the 'less is more' trend will continue to be studied in all treatment modalities."
-Carolyn Weaver, RN, MSN, AOCN, AHN-BC, Hematology Sales Specialist, Novartis Oncology
"Over the years, spirituality and religion have been recognized as a very important part of care for the person with cancer, particularly during the advanced stages of illness. Much of the literature about spirituality can be found in articles about care of the elderly and those receiving palliative or end-stage care, however, spirituality is an important part of care provision across the continuum, from diagnosis onward, not just at the end of life.
"As spiritual identity, expression, and practice are becoming more diverse in society, it is crucial to broaden our understanding and ability to recognize when a patient is experiencing spiritual needs or distress. Historically, spiritual care has been delegated only to chaplains who are the spiritual care experts. However, other members of the health care team, with adequate training, can become competent spiritual care generalists. Various disciplines in health care are coming together to better educate and promote the inclusion of spiritual screening, assessment and, when appropriate, spiritual intervention to patients with cancer in an effort to provide comprehensive care, enhance patient/family satisfaction, and improve compliance with treatment."
-Melissa Stewart, LCSW-R, Senior Clinical Social Worker, Memorial Sloan Kettering Cancer Center, New York, N.Y.