This year marked a major advance with a molecular test that can help many women with early-stage breast cancer safely forgo chemotherapy. There were also advances in the use of liquid biopsies for refining treatment in several major cancers.
Investigational Blood Test Detects Common Cancers
Early detection of cancers by a simple blood test, often called a liquid biopsy, is another facet of diagnostics that has been gaining traction. Some recent studies have shown that a blood test that assesses multiple potential markers, including both genes and proteins, may be sensitive enough to potentially diagnose cancer. One such test, CancerSEEK, was able to detect eight common types of cancer by assessing eight protein biomarkers and tumor-specific mutations in circulating DNA found in blood samples.
The federally funded study analyzed the blood of approximately 1,000 patients previously diagnosed with cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung, or breast and compared those results to blood sample analyses from 850 healthy people. CancerSEEK was able to detect evidence of cancer with a sensitivity (the positive results were accurate) of 69% to 98% and a specificity (the negative results were accurate) of greater than 99% (this study was funded, in part, by NCI and the National Institute of General Medical Sciences). The authors suggest that CancerSEEK may be able to be developed as a universal blood test for the early diagnosis of cancer.
Voices for Cancer Research: Gina Hollenbeck
“Because of cancer research and the people who have participated in clinical trials, I have a good quality of life. I can do the things I want to do.”
Gina is a mother of two, an active runner and tennis player, and a non-smoker. Despite living a healthy lifestyle, a persistent cough brought her to the doctor where they revealed that she had a collapsed left lung with multiple tumors. At 38 years old, Gina was diagnosed with adenocarcinoma – the most common type of lung cancer seen in non-smokers.
Gina was then introduced to her oncologist, Dr. Osarogiagbon, and additional scans showed that the cancer had spread to her brain and lymph nodes. She underwent several surgeries and is being treated with therapies that specifically target a genetic mutation in the cancer.
A nurse and an avid researcher, Gina was determined to maintain an integral role in her own care with Dr. Osarogiagbon. “Dr. O has been an answer to prayer. He has let me be an active participant in my care, and we make informed decisions together. I think that has helped a lot in my care – to feel like I have a voice.”
Gina credits her quality of life to clinical trials and federally funded research. “I’m grateful for clinical trials -- I think they are the way we make progress in medicine. Even five years ago, stage IV lung cancer would have been a death sentence. Now, thanks to cancer research, people have a range of personalized therapies available to them with minimal side effects.”
Gina Hollenbeck is the President of ALK Positive Outreach, a Facebook support group for patients with ALK-positive non-small-cell lung cancer and their caregivers.
Major Trial Identifies Women Who Can Safely Skip Adjuvant Chemotherapy for Breast Cancer
An international, federally funded clinical trial of more than 10,000 women with hormone receptor–positive, HER2-negative, lymph node–negative breast cancer delivered practice-changing findings. The results of the trial showed that women older than age 50 years with low and intermediate recurrence risk scores (0 to 10 and 11 to 25, respectively), as determined by a 21-gene expression assay, did not benefit from adding adjuvant chemotherapy to standard adjuvant endocrine therapy (this study was funded, in part, by NCI).
The results from TAILORx also showed that women age 50 years and younger, especially those with recurrence scores of 21 to 25, could accrue some benefit from adjuvant chemotherapy. This clinical trial is a significant advance in precision medicine. Up until now, women older than age 50 years with scores between 11 and 25 on the Oncotype DX gene expression assay were usually recommended to receive adjuvant chemotherapy. These women can now safely receive just endocrine therapy, which both reduces the cost of care and spares them the short- and long-term adverse effects of chemotherapy.
Voices for Cancer Research: Raymond U. Osarogiagbon, MD, FACP
“We are at a point in the evolution of medical science where a lot of investments in cancer biology and care delivery are now coming together to bear fruit. Applying this knowledge to the people who will benefit most is part of the reason why we need ongoing–greater even–funding for cancer research.”
Dr. Osarogiagbon always knew that he wanted to work on a disease where the outlook was poor and the opportunity to make a difference was great. After attending medical school in Nigeria, he came to the United States to focus on sickle-cell disease research. Later, however, he developed an interest in lung cancer.
“The development of a lung cancer is not just a personal tragedy, it affects families, communities, and populations. There is a tremendous loss of life, productivity, and happiness,” said Dr. Osarogiagbon.
Findings from Dr. Osarogiagbon’s early research using Veteran’s Affairs (VA) electronic health records, led to the development of multidisciplinary care clinics within the VA health system. Dr. Osarogiagbon wanted to expand this multidisciplinary approach to community settings where the majority of lung cancer care is delivered. In 2005, he relocated to Memphis, Tennessee, to address what he calls the “triple whammy” – that the poorest states with the least well-developed healthcare infrastructure have the highest burden of disease.
“In an age of rapid discovery, these advances are not being applied fast enough to the places where people really need them – we have to bridge that gap. This is what drives me every day,” said Dr. Osarogiagbon.
With the help of NIH funding, Dr. Osarogiagbon and his colleagues have developed a simple, color-coded kit to help surgical teams efficiently collect the full scope of information needed to recommend the best care for each patient with lung cancer. Dr. Osarogiagbon notes that within five years, the kit has helped improve the quality of lung cancer surgery by increasing the proportion of cases that meet the National Comprehensive Cancer Network’s quality standard from 4% to over 80%, and significant improvements are already being seen in patient survival. He stresses the importance of federally funded studies and that now is the time to invest even more.
Dr. Osarogiagbon is the director of the Multidisciplinary Thoracic Oncology Program at the Baptist Cancer Center, in Memphis, Tennessee. Disclosures include stock and other ownership interests with Lilly, and Pfizer; consulting or advisory roles with Genentech/Roche and Lilly; paid research consultant for the Association of Community Cancer Centers; speakers’ bureau with Genentech/Roche; and a patent for a Lung Cancer Specimen Kit.
To learn more about why Dr. Osarogiagbon lives to conquer cancer, visit asco.org/live-to-conquer-cancer.