Medical Advancements We Can Look Forward to in 2015

After looking back on 2014, pathologist Dr. Michael Misialek says there is a lot to look forward to in 2015.

As we enter the third month of the new year, it’s a perfect time to reflect back upon some of the medical breakthroughs of the previous year, and look to the future for what we can expect in 2015. Below, five things that caught my eye in 2014, and five things I’m excited about this year.

1. Immunotherapy Led the Way

This past year saw the FDA approval of several powerful new drugs for treating melanoma, as well as lung, stomach, blood, and cervical cancers. Chief among them were three new drugs to treat chronic lymphocytic leukemia (CLL), the most common leukemia found in the elderly. This will offer patients new options, especially in relapsed and resistant CLL. In a study out of Germany, researchers demonstrated combining a new antibody with standard chemotherapy improved outcomes in CLL patients with preexisting conditions.

2. We Understand Cancer Better

Last year, there were a number of important advances in our understanding of cancer. A landmark paper by scientists at the Cancer Genome Atlas Research Network found that tumors from different organs often shared the same genomic profile. What this means is that different tumors, say lung and breast tumors, for example, frequently share the same DNA mutations. This radically changes our view of cancer in that instead of treating a tumor based on its site of origin, we can now look at DNA mutations to guide therapy.

3. Advances in Cancer Prevention

In 2014, we also saw numerous advances in cancer prevention. An important international study out of the United Kingdom and Australia demonstrated that ovarian suppression plus the anti-estrogen pill anastrazole reduced the risk of breast cancer in postmenopausal women. What this means is that we may have a more effective way of preventing breast cancer. In postmenopausal women who were at an increased risk of breast cancer, this hormone drug decreased their risk of breast cancer by almost 50 percent. Additional studies will be needed to prove a sustained benefit.

4. Advances in Cancer Treatment

Researchers at the Mayo Clinic discovered that combination chemotherapy and radiation extended survival by more than 5 years in a particular kind of brain tumor (low grade glioma). Previously, it was controversial whether chemotherapy was beneficial. This study proved it to be a good combination.

5. Targeting Lung Cancer

Several studies in 2014 added additional evidence for the benefit of targeted therapy. There were breakthroughs that gave new alternatives to treatment resistant lung, stomach, and thyroid cancer. One of the most difficult challenges in using precision medicine to target mutations in lung cancer is the fact that many patients develop additional mutations, which makes the tumor resistant to treatment. In a multinational study, researchers—including those from Massachusetts General Hospital—found that an experimental drug led to shrinkage of lung cancers that had developed secondary mutations. These “next generation drugs” give promise to lung cancer patients. More studies will be needed to see if there is a sustained benefit with long term outcome differences.

What’s on the Horizon for 2015?

1. Medicine Gets Personal

I think one of the the most exciting developments in oncology and pathology is the concept of precision medicine or personalized healthcare. Simply put, this is using the genetic information of a patient’s disease to personally tailor treatment, which has dramatically impacted the approach to cancer care. Colleagues I’ve spoken to say that there will be a shift from large scale phase III trials to smaller trials where patients are segregated based on disease mutations and biomarkers. This makes patient reported outcomes more important. Greater attention will be paid to the genomic profile of a patient’s tumor or disease.

2. More immune system therapies

There may be an explosion in research and study results from novel therapies targeting the immune system. So called “immunotherapy” will make the jump from melanoma and kidney cancer to other solid organ tumors.

3. Nanomedicine: Think Small, Very Small

Nanotechnology involves the use of tiny materials, thousands of times smaller than a cell, to deliver cancer killing drugs directly to tumors. Clinical trials are underway looking at using nanoparticles for both cancer treatment and detection. In 2015, we should see the results of these studies.

4. The Emergence of the Liquid Biopsy

Traditionally, we diagnose cancer by tissue biopsy, often involving an invasive procedure. We have now discovered circulating tumor cells in the blood, which can then be extracted and the tumor DNA analyzed from a simple blood draw, called a “liquid biopsy.” This year is likely to bring these methods closer to clinical use for the detection, treatment, and monitoring of cancer.

5. An Apple A Day

Finally, there will be a focused campaign promoting a healthy lifestyle. There’s a lot of research in the works regarding low level diabetes and its relationship to cancer. Colleagues are saying that a promising area of research is the diabetes drug metformin, and its role on the insulin-like growth factor receptor. Also, there’s talk of its possible use as a new and powerful cancer drug, particularly for pancreatic cancer.

It will be interesting to see how these play out in 2015. This year promises good news as we move closer to conquering cancer. Stay tuned.