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.
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.
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.
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.
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。”
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.
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.
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.
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。
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。
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.
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.
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.
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.
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."
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