ASCO names molecular profiling of gastrointestinal cancer ‘Advance of the Year’
ASCO has named molecular profiling driving progress in gastrointestinal cancer as its Advance of the Year, acknowledging improvements in treatment that have resulted from molecular testing of patients’ tumors.
ASCO’s annual Clinical Cancer Advances report, released today and published simultaneously in Journal of Clinical Oncology, highlighted other major advances, including progress in targeted therapies for both earlier-stage disease and difficult-to-treat cancers; the use of biomarker-driven therapies to provide personalized treatment for lung, colorectal and gastric cancers; and the ability of combination therapies to extend survival without increasing toxicity.
“Progress in cancer treatments over the past year provide improved therapy for cancers like breast and lung,” Sonali M. Smith, MD, editor-in-chief of Clinical Cancer Advances 2021 and Elwood V. Jensen professor in medicine and chief of the section of hematology/oncology at UChicago Medicine, said in a press release. “We also saw new treatment options for patients with difficult-to-treat cancers, such as bladder and nasopharyngeal cancers.”
Progress in gastrointestinal cancer
Treatment for gastrointestinal cancer — which accounts for 26% of the global cancer incidence and 35% of all cancer-related deaths — traditionally has consisted of surgery, radiotherapy and chemotherapy. However, these treatments have had limited efficacy while negatively impacting patients’ quality of life, according to Smith and colleagues.
The ability to molecularly profile gastrointestinal cancer tumors to identify and characterize genetic mutations, amplifications or fusions, epigenetic profiles, protein expression or other molecular features has enabled treatment with targeted and personalized therapies that extend survival while minimizing toxicity.
Authors of the report specifically acknowledged that targeting HER2 has been shown to improve survival in gastric cancer, with promising research also underway for patients with HER2-positive colorectal cancer.
“Molecular profiling tools such as next-generation sequencing give us the ability to identify specific molecular and genomic-targeted treatments that are likely to benefit an individual patient. Personalized medicine is becoming a reality,” ASCO Board Chairman Howard A. "Skip" Burris III, MD, FACP, FASCO, said in the release.
Focus on equity
Although cancer mortality is decreasing in the U.S., authors of the report acknowledged that these survival gains are not evenly distributed across patient groups, with poorer outcomes persisting among Black patients, those living in rural areas, and those with lower income and education levels, among others.
The report calls for a multifactorial response to address specific interrelated barriers that preclude populations from participating in clinical trials and to address the challenges that limit research initiatives that would benefit underserved populations. A collective effort should be made by patients, caregivers, providers, policy leaders, pharmaceutical organizations and advocacy groups to develop targeted approaches that ensure all patient groups have equal opportunity to participate in and benefit from cancer research, according to the report.
“If clinical trials don’t represent the individuals we treat, including those from racial, ethnic and other minority populations, the state of science suffers, and patients with life-threatening conditions may not receive the best — perhaps only — treatment option for their condition,” ASCO President Lori J. Pierce, MD, FASTRO, FASCO, said in the release.
In the report, ASCO acknowledged other research priority areas that would help accelerate progress against cancer. These include:
- AI and deep learning;
- predicting response and resistance to immunotherapy;
- multimodality treatment for solid tumors;
- precision medicine for pediatric and rare cancers;
- care for older adults with cancer;
- reducing adverse consequences of therapy;
- obesity’s impact on cancer incidence and outcomes; and
- predicting when treatment is needed for potentially malignant lesions.
For these research goals and others, ASCO called for a sustained national commitment to fund and support cancer research, noting that this year marks the 50th anniversary of the signing of the National Cancer Act, which established the National Cancer Program and expanded the scope of NCI.
Congress approved a $2.6 billion increase in funding for NIH in fiscal year 2020, including a $300 million increase for NCI. However, the pandemic and its economic impacts threaten cancer research funding, according to the report authors, who acknowledged that even minor funding cuts can have a large impact on cancer research.
“Stable, predictable funding increases will allow our nation to continue to build on the promise of today’s research and improve outcomes for all patients with cancer,” Richard L. Schilsky, MD, FACP, FSCT, FASCO, chief medical officer and executive vice president of ASCO, said in the release.