More effective cancer treatments are ongoing goals in medicine. Labs and research trials continue to identify new strategies that help treat cancer earlier and improve outcomes. So, what has sparked the most interest lately in the areas of prostate, lung, and colon cancer—the most common cancers among men?
For insight, we turned to three oncologists from the Harvard-affiliated Dana-Farber Cancer Institute to share what stands out in their respective fields. The experts are Dr. Alicia Morgans, a genitourinary oncologist; Dr. Jacob Sands, a thoracic oncologist; and Dr. Chris Manz, a gastrointestinal oncologist. Here's what they had to say.
An area that has drawn renewed interest is the use of hormonal therapies to treat cancer at both the advanced and early stages. Several ongoing trials stand out. For instance, the PROTEUS trial is using intensive hormonal therapy before and after prostate surgery for patients at high risk of cancer relapse.
"A similar strategy is to intensify hormonal treatment in high-risk patients who already have had radiation and hormonal therapy but still have measurable PSA levels," says Dr. Morgans.
Hormonal treatments are also being used in certain patients with high-risk prostate cancer after they've undergone prostate surgery. The ERADICATE study is exploring how intensive hormonal treatment may help men after prostatectomy who are identified as having a high risk of cancer recurrence through molecular testing of prostate tissue. (The results of both the PROTEUS trial and ERADICATE study are expected within a few years.)
Another area that has seen recent advancement is treating prostate cancer that has already spread. "In these cases, the common treatment approach is radiation to the prostate and intensive hormonal treatments," says Dr. Morgans. "But new targeted therapies also have been recently approved that may improve outcomes for patients with advanced cancer."
An example is lutetium PSMA-617, a type of radioligand therapy. (Radioligand therapy delivers radiation to specifically targeted prostate cancer cells.) Another is a class of cancer drugs known as PARP inhibitors that weaken cancer cells so they can't repair themselves and eventually die.
The past decade has witnessed many advances in the treatment of non–small cell lung cancer (NSCLC), which makes up 80% of lung cancers. In particular there are new drugs that target cancer cells or result in an immune response that fights the cancer, and are used either before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy).
"For neoadjuvant therapy, chemotherapy with immunotherapy — drugs that stimulate a response from the immune system — has been specifically helpful," says Dr. Sands.
As an example, he points to the combination of chemotherapy plus the drug nivolumab (Opdivo) used before surgery, which reduces the number of tumor cells still active after the tumor's removal. Similarly, giving atezolizumab (Tecentriq) — approved by the FDA in 2021 — after chemotherapy and surgery has also improved outcomes afterward.
Other targeted drugs attack cancer cells with certain genetic mutations that alter cells' DNA. "A recent example is osimertinib (Tagrisso), which treats cancer with specific EGFR mutations," says Dr. Sands. "It has demonstrated greater control of lung cancer after surgery."
The next phase of lung cancer treatment involves evaluating targeted treatment for mutations other than EGFR either before or after surgery. Ongoing trials also are exploring the expanded role of immunotherapy. For example, in the ALCHEMIST chemo-IO (ACCIO) study, which is expected to continue for a few more years, patients are treated with either chemotherapy followed by immunotherapy, or chemotherapy plus immunotherapy followed by more immunotherapy.
The news on colon cancer is not particularly uplifting. "For patients with late-stage colon cancer, there have been no major breakthroughs in treatment in recent years," says Dr. Manz. That's another reason why men should regularly get screened for polyps and early-stage colorectal cancer.
Still, there are a few bright spots. Dr. Manz notes that there have been small, incremental improvements in the standard surgery and chemotherapy treatments, so that more patients live two to three years longer than before.
While immunotherapy does not work for most patients with colon cancer, it may benefit a subgroup of 1% to 3% who have a specific genetic alteration called microsatellite instability, according to Dr. Manz. A microsatellite is a short DNA sequence repeated multiple times in a row. Instability occurs when a defect doesn't allow the DNA to get correctly copied. "In cases of instability, immunotherapy works even better than chemotherapy," says Dr. Manz.
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