Innovation

Forbes Health Summit 2014: Cancer Patients Will See These 6 Treatment Breakthroughs And Innovations In The Coming Years

smart data
Among the innovations in cancer care will be an increasing impact of smart technologies and big data, a "molecular stethoscope," and greater patient participation. Photo courtesy of Shutterstock.

Because the industry is in a “very turbulent period,” the host of the Forbes Healthcare Summit 2014 jokingly warned his audience Thursday morning “don’t get sick for the next three or four years!” Steve Forbes, Chairman & Editor-in-Chief, Forbes Media forecast the coming years will include more patient involvement and more beneficial breakthroughs, however beyond that he dared not venture a guess as to what exactly healthcare will look like. “What is going to emerge is not what we had before the Affordable Care Act and it’s not going to be what some of the designers of the Affordable Care Act envisioned,” said Forbes, “It’s going to be something new and no one can say with certainty how all the forces that have been unleashed by technology, unsustainable costs, and by the government’s increased involvement in this area in recent years how all this will shake out.”

While Forbes chose not to imagine the future, we at Medical Daily are intrepid enough (or foolhardy, depending on your view) to attempt just that. These six innovations in the area of cancer care, we predict, will transform patient treatment in the coming years.

BIG DATA

Key to your battle against cancer will be data, highly personal and technologically-derived data. Whatever type of cancer you have, your doctor will not only genetically test the tumor but also sequence some portion or even all of your genome. This means you will soon be seeing (and possessing) secure, high tech devices to accommodate this explosion of necessary data.

“We’re dealing with three billion bits of data, and you need to have this information before you start treatment but now it takes weeks months before you can access this data,” said Patrick Soon-Shiong, chairman and chief executive officer of NantHealth. “What we’re building is a next generation micro device.” The exact size of a passport, his forthcoming device is the equivalent of possessing the “cloud in your pocket.” Its most important feature is the ability to capture your medical records, including your genome, in one succinct place and also analyze and move all that data at a previously unheard of speed: 6,000 megabits per second. Forget your cell phone, medical technology will be your go-to device.

Molecular Stethoscope

Another aspect of big data working in your favor will be the molecular stethoscope, described by Richard Klausner, chief medical officer of Illumina (and former director of National Cancer Institute) and used by your doctors to screen you for cancer. “Tumors put out — at very early stages — their DNA into the circulation,” said Klausner. “We can now measure that with incredible precision, with incredible specificity.” This means there could be, in Klausner’s words, “a blood test or urine test that detects very early stage cancer.” So not only might there be population wide screening for early cancer, using such detection tests, your doctors will be able to understand whether they got all the cancer out after you have undergone a particular treatment. In other words, patients will likely avoid unnecessary chemotherapy or other possibly painful treatments and their side effects. “You know, 70 to 80 percent of current cancer therapy doesn’t do the patient much good," Klausner observed. In the future, costly ineffective overtreatment will be easily avoided.

Not One but Hundreds of Diseases

In the coming years, your cancer will not be identified and treated as a part of your anatomy but by its genetic subtype. In other words, gone are the days where a cancer patient will be classified as suffering from breast cancer, say, or lung cancer. Instead each patient’s cancer will be categorized and more importantly treated as part of a small group of other people, most likely around the world, all suffering from different types of cancer though with a similar genetic disease profile. “In my mind we’re going to break cancer into so many hundreds of diseases and patient types and be able to find individual appropriate therapies — if not a cure — to make it more of a chronic disease,” said Bob Hugin, Chairman & CEO of Celgene. Naturally, this means treatment will transform.

Drugs

Going forward your immune system, fortified by highly specialized drugs, will help fight the cancer, and, instead of taking one, two, or even three approved chemotherapy drugs, you will treat your illness with a succession of different drugs given in low doses through stages of treatment. How does that differ from today?

Generally, all current cancer treatments are intended to attack the genetic mutation. “The [incorrect] assumption we made is that cancer was a form of a single mutation, a single gene, or single clone,” explained Soon-Shiong. “And some of these genes are asleep, some are awake.” But as a patient takes a particular drug, “those genes that are asleep waken,” said Soon-Shiong. One drug may beat one type of mutation, but not the others which pop up as the treatment (and disease) progresses. Meanwhile unavoidable resistance develops among the thousands of mutated genes and their expressed proteins. Each individual cancer, then, is essentially its own separate rare disease and must be treated as such through a series of precision attacks. Metaphorically, cancer will be attacked by a series of small drones, instead of dropping a single bomb.

Patient Participation

You will become an active participant in your own treatment. There will be a panoply of new, highly targeted drugs created. Necessarily, then, the way drugs are developed by pharmaceutical and biotechnology companies and the way they are approved by the Food and Drug Administration — along with the profit structure surrounding them — must transform. “We’re totally changing the paradigm of clinical trials,” said Klausner. “It’s very different now and we need to get away from what we’ve done in the past.”

In fact, according to Hugin, “drug approvals may come from data that comes from post-approval settings.” In other words, each subset of patients being treat for a particular genetic subtype of cancer will be part of the data flow determining whether an approved drug works and whether it is effective. With new technological devices, patients may be remotely monitored while taking a particular drug, in addition, they may be noting their own side effects into an electronic medical record. Essentially, then, your personal physiological experience will be directly entered into and a key part of the architecture of information available to doctors, drug companies, and the FDA.

Greater Hope

In dare we say the overwhelming majority of cases, patients will not think of cancer as a death sentence (or potential death sentence) but simply a chronic, manageable disease — even when it is detected at a late-stage. Fortunately, this is already true for many people suffering from cancer today, yet it will be even more so in the future. “There’s much more hope today and the patients understand that,” said Sandra Swain, Medical Director Washington Cancer Institute at MedStar Washington Hospital Center; first hand she has seen how her patients learn and understand more about cancer and their own possibility of long survival. Additionally, she has observed how the changes in treatment, including genetic testing, has prevented over-treating patients while alleviatiating fear. “Now with the current oncotype tests… we have been able to decrease the number of women who get chemotherapy. This is huge," Swain said. "This is one of the biggest advances I’ve seen in my career.”

According to Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, doctors and patients alike have adopted a “false construct”  that “there are two populations of humans, sick ones and healthy ones. We need to think in this new age that we’re all sort of pre-affected and affected,” he stated. In short, since we all will sometimes make a trip to the land of the sick, wouldn't it be best if we are carrying the appropriate passport and understand the cultural norms?

Increasingly, cancer is a treatable condition of aging. Going forward, doctors, scientists and professionals working in high technology and pharmacology will be creating new and more effective treatments. Meanwhile our healthcare system has already begun to transform to accommodate these innovations and their attendant costs. Just as the Internet, in the words of Forbes “blasted away the traditional boundaries for all media companies,” high tech and smart data will do the same within the Healthcare sector. More and more of the decision-making will be shifted to consumers — you, the patient. Are you up for your part in the healthcare revolution?

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