拉里·诺顿

MSK的拉里·诺顿博士讨论了在癌症治疗在过去十年中取得的最大成就,他希望看到未来的东西。

In January, the American Cancer Society reported that the rate of cancer deaths in the United States had fallen 2.2% from 2016 to 2017. This was the largest single-year decline in cancer mortality ever reported.

Many factors have contributed to the continuing decline in cancer deaths. The reduction in the number of people who smoke is chief among them. But advances in diagnosis and treatment, especially those made during the past ten years, have also played a significant role. Experts anticipate that, with further advances in research, cancer survival will continue to improve over the next decade and beyond.

这里,拉里·诺顿,MD,医疗肿瘤学家和高级副总裁纪念斯隆 - 凯特琳癌症中心(MSK),关于一些癌症治疗的最大成就会谈2010至2019年间完成的,他希望看到未来的东西。

Immunotherapy

By any estimate,immunotherapyhas been the past decade's most noteworthy advance in cancer medicine. It was one of the earliest attempts regarding the nonsurgical treatment of cancer. Making it effective, though, has taken more than 100 years, coming into its own only in the 2010s.

The field dramatically accelerated in 2011 with the US Food and Drug Administration'sapproval of ipilimumab(Yervoy®)为黑色素瘤。This drug, in a class called immune checkpoint inhibitors, was based on research conducted by immunologist James Allison, PhD, and developed in clinical trials with the help of MSK physician-scientists. Dr. Allison, who led the Sloan Kettering Institute's Immunology Program from 2002 to 2012,won a Nobel Prizein 2018 for this pioneering work. Several other checkpoint inhibitor drugs followed. What these therapies have in common is that they take the brakes off the immune system, enabling it to destroy cancer.

WHITE BLOOD CELL

“除了黑色素瘤,这些都是一些第一新药真的产生影响lung cancer“诺顿博士说,”他们也已经成为非常重要的治疗膀胱癌and other cancers."

嵌合抗原受体(CAR)的T细胞疗法was another big leap forward in immunotherapy. In this approach, pioneered byMichel Sadelain, MD, PhDat MSK, scientists genetically engineer a patient's own immune cells to make a new protein that can latch on to cancer. This turns those altered cells into powerful cancer fighters.

下一步是什么

祖母儿童

研究人员正在寻找办法,使免疫治疗药物有效地更多的人,更多类型的癌症。一种方法是的IS使用癌症疫苗和病毒激活肿瘤细胞,使它们的免疫系统更加明显看好。这些治疗可能与关卡药物和CAR T.结合

靶向治疗

Targeted therapies走进自己在90年代末和21世纪初,随着药物如批准曲妥珠单抗(赫赛汀®) and伊马替尼(Gleevec®)。但在2010年代,他们成为更多的癌症的标准治疗的一部分。新药几十个被批准为实体瘤和血液癌症。这些疗法的目的是利用主要发现癌细胞而不伤害健康组织的弱点。

Researcher Looking Through Microscope

由于所谓的研究basket trials,研究人员了解到,同样的药物可能不利于许多类型的癌症,如果肿瘤具有相同的遗传变化。其中的这个泛癌症方法的最显着的例子是larotrectinib(Vitrakvi®), which theFDA approved in 2018

Advances in targeted therapy for blood cancers, especially慢性淋巴细胞白血病acute myeloid leukemia,andacute lymphocytic leukemia,导致了许多药物的批准。这些博士ugs have fewer side effects than traditional chemotherapy. Because of that, they can be given to people who are unable to tolerate more intense treatment because of their age or other health problems.

下一步是什么

Researchers are learning more about how tumors develop resistance to targeted drugs. In addition, they're studying the role oftumor heterogeneity,which allows some tumor cells to escape the effect of these drugs.

According to Dr. Norton, another exciting area of research is tackling the noncancerous cells that surround tumors, called the肿瘤微环境。“其中一些细胞的刺激癌细胞生长,同时我们也可以去他们后用药物,”他说。“套用禅宗公案:仅靶向肿瘤就像是试图拍单手就可以有过程的两面夹击,真正有所作为。”

分子诊断

With the development of tests likeMSK-IMPACT™, launched in 2014, andMSK-ACCESS,launched in 2019, doctors now have the ability to look for hundreds of cancer-causing mutations across a range of tumor types with a single test. As of the end of January 2020, more than 50,000 tumors from more than 43,000 patients have been analyzed with MSK-IMPACT. More recently, MSK-ACCESS has enabled doctors to study tumors using a blood test called a liquid biopsy rather than having to do a more complicated tissue biopsy.

下一步是什么

医生/科学家寻找一个DNA屏

分子诊断,寻找一系列细胞的变化。这些措施可能包括染色体得失,基因拷贝数,结构重组的变化,以及更广泛的突变签名。信使RNA(携带从DNA信息给细胞的蛋白质生产机器的遗传物质)的分析正在成为一种重要的诊断工具,也是。

Unlike other genetic tests, MSK-IMPACT and MSK-ACCESS look for mutations in a person's normal tissue for comparison. This bonus analysis is revealing new clues about which cancers are inherited.

包括正常组织的诊断测试也揭示更多细节clonal hematopoiesis(CH)。这个年龄段的相关情况导致白血细胞数量的增加携带致癌突变。CH是不是癌症,但谁拥有它的人,患癌症的风险增加。“我们正在学习更多有关role that CH cells play in relation to many kinds of cancer,not just blood cancers," Dr. Norton says.

Screening and Early Detection

Researcher Looking At Scan

In the 2010s, large studies confirmed the benefits of many screening tests, such ascolonoscopiesforcolonandrectal cancerandlow-dose CT scansfor people at an increased risk of lung cancer because of their smoking history. There have been a number of advances in乳房X光检查and other types of breast screening as well. For example, MRIs can be used to classify a woman's risk of developing breast cancer.

此外,MSK正在领导一个国家试验,以评估对比增强数字化乳腺摄影(CEDM)作为替代在适当的妇女的标准数字化乳腺摄影和MRI。CEDM might be a more sensitive test than digital mammography and more practical than MRI.

下一步是什么

Middle Age Woman Being Active

Dr. Norton says that the personalization of cancer screening will play a big role over the next decade. "Not everyone needs to have the same level of monitoring," he notes.

MSK'sPrecision Interception and Prevention program结合精密医学的原则,对预防和早期发现的研究。这种做法的目的是预防癌症的发生或在最初阶段阻止它,当它更容易治疗。

Surgery

PATIENT PREPPING FOR SURGERY

在过去的十年中,微创和机器人surgerieshave become standard for more and more cancers. For many cancer types, studies have confirmed that these surgeries are just as effective as open surgeries at controlling disease but with less pain and quicker recovery.

"Many of these surgical techniques have been advanced at MSK'sJosie Robertson Surgery Center," Dr. Norton says. The center, whichopened in 2016,使得外科医生在国家的最先进的设置执行门诊手术。一半以上,每年在MSK完成20000次手术现在都在门诊的基础上完成的。

下一步是什么

尽管手术将继续成为癌症治疗的一个重要组成部分,诺顿博士说,在其他治疗方法的不断进步将使得一些人为了避免手术完全。“对于有些人用breast cancer,药物疗法和放射变得非常有效,我们可能会做研究看他们是否可能不需要手术或仅需要微创手术,”他说。

Radiation Therapy

Inradiation therapy,在过去十年中的重要原则之一是“少即是多”。像进展intensity-modulated radiation therapyandimage-guided radiation therapyuse computer programs and advanced imaging to deliver stronger doses of radiation while sparing healthy tissue. Oftentimes, fewer radiation treatments are needed to achieve the same benefits. There have also been advances in identifying which tumors can be effectively controlled with less radiation overall, which reduces side effects.

下一步是什么

In 2019, the纽约质子中心opened in East Harlem. The center aims to provide treatment and to conduct clinical trials comparing proton therapy to other types of radiation. Proton therapy is already in use, especially for head and neck cancers and pediatric tumors. Experts expect it to become more widely used in the 2020s.

Pediatric Cancer

CHILD AND PARENT WITH DOCTOR

Survivorship rates for pediatric cancers continued to improve in the 2010s. About 80% of children with cancer can now be cured with available treatments. For the remaining 20%, there has been an increased focus on personalized medicine.

All children treated atMSK Kids收到MSK冲击测试。和临床试验通过MSK的开发早期药物开发服务can now include children as young as 12. For children with very rare mutations, protocols for single-patient use (SPU) can provide lifesaving treatment.

下一步是什么

类似的举措MSK的Pediatric Translational Medicine ProgramExpanded Genomics Program旨在使个性化医疗的选项更多的孩子患有癌症。而当研究人员进行的SPU,他们收集数据,了解某些药物如何以及为什么工作还是没有。这些发现可能会导致未来的审判。

支持护理和患者体验

Research reported in 2017 confirmed that systematic monitoring ofpatient-reported symptoms在化疗改善生存的结果。巴勒斯坦权力机构tient input and the patient experience are now incorporated into the design of clinical trials. These measures empower patients to actively report their symptoms. Doctors and nurses are then able to intervene early, ultimately improving patients' quality of life as well as survival rates.

下一步是什么

Grandparent with Child

Investigators at MSK are continuing to focus on the influence ofnutrition中西医结合,andexercisein improving patients' well-being during and after treatment — as well as their cancer outcomes. Digital health andtelemedicineare another exciting frontier in cancer management and research, Dr. Norton says. Clinical trials already underway aim to look for measurable benefits from these interventions.

Many of the advances in cancer treatment and diagnosis seen over the past ten years are possible thanks to funding from donors, Dr. Norton explains. "You can make progress with philanthropic support that you can't accomplish any other way," he says. "It gives researchers freedom to be creative in a way that no other type of funding makes possible."

了解更多https://www.mskcc.org/

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