Refinement of Surgical Treatment of Cancer Named Advance of the Year

ASCO named the Refinement of Surgical Treatment of Cancer as the Advance of the Year for 2020 in their annual report, Clinical Cancer Advances: ASCO’s Annual Report on Progress Against Cancer.¹

The report also highlighted advances in cancer prevention, molecular diagnostics, and cancer treatment, including surgery, radiotherapy, combination therapy, immunotherapy, and other therapy types.

“Advances in systemic therapies have helped refine our approach to surgery in patients with cancer, even changing who needs to undergo surgery,” ASCO Immediate Past President and Chair of the Board Monica M. Bertagnolli, MD, FACS, FASCO, who is also a Co-Executive Editor of Clinical Cancer Advances 2020, said in a press release.² “Neoadjuvant therapies can, in some cases, dramatically reduce the amount of surgery a patient needs. Not only can these approaches lead to longer survival, they can mean shorter recovery for patients and, ultimately, better quality of life.” 

Specifically, advances in systemic therapies for melanoma, kidney, and pancreatic cancers were emphasized as some of this year’s most impressive research successes.

Neoadjuvant combinations of immunotherapies paved the way for more successful, less-invasive surgery for patients with advanced melanoma. The featured NeoCombi trial and the OpACIN-neo trial looked at the efficacy and safety of these pre-surgery combination immunotherapies and have already changed the general practice, helping patients with this cancer type to avoid surgery in many cases. 

Moreover, in treating patients with kidney cancer, surgical resection has generally been the primary treatment of many solid tumor cancers, including renal cell carcinoma. However, targeted therapy has been able to provide an alternative to immediate surgery. Results from the CARMENA trial and the SURTIME trial, both discussed in the report, provided evidence of this, suggesting that targeted therapy may eliminate the need for surgery in this type of cancer. 

Furthermore, while surgical resection affords the best chance of survival with pancreatic cancer, many patients either have tumors that are difficult to surgically remove entirely or cannot be removed at all. Upfront systemic treatments though, discussed in two single-arm phase II studies highlighted in the report, make surgery possible for more patients with pancreatic cancer.

Additional major advances featured included:

• Long-term data show that vaccines against HPV are reducing the risk of cervical cancer in real-world settings.

• Biomarker-driven treatment approaches are opening the door to personalized care for metastatic pancreatic cancer.

• Combinations of different therapy types indicate that survival can be extended without increasing toxicity.

• An expanding number of targeted therapies are offering new optimism for patients with difficult-to-treat cancers. 

Notably, the authors also drew attention to the necessity for federal research investments. According to a survey conducted by ASCO, 67% of Americans say the US government should spend more money on finding treatments and cures for cancer, even if it entails higher taxes or adding to the deficit.  

“Many research advances are made possible by federal funding,” 2019-2020 ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO, said in the report. “With the number of new US cancer cases set to rise by roughly a third over the next decade, continued investment in research at the national level is crucial to continuing critical progress in the prevention, screening, diagnosis, and treatment of cancer.”

Additionally, starting last year, ASCO has begun including a list of “Research Priorities to Accelerate Progress Against Cancer” in order to establish future research efforts they believe should be focused on. The list this year includes:

• Identify strategies that predict response and resistance to immunotherapies.

• Limit extent of surgery by optimizing systemic therapy.

• Increase precision medicine research and treatment approaches in pediatric and other rare cancers.

• Optimize care for older adults with cancer.

• Increase equitable access to cancer clinical trials.

• Reduce the adverse consequences of cancer treatment.

• Reduce obesity’s impact on cancer incidence and outcomes.

• Better identify premalignant lesions and predict when treatment is needed.

However, Burris addressed the idea that without access to care this research does not matter, highlighting the need to make high quality cancer care, including clinical trials, available to more patients.

“Creating an infrastructure to support patients is a critical part of the equation, as is creating connections between clinical practices and research programs,” Burris wrote. “We have much work to do before everyone with cancer has equal access to the best treatments and the opportunity to participate in research. I know that ASCO and the cancer community are up for this challenge.” 

References:

1. Markham MJ, Wachter K, Agarwal N, et al. Clinical Cancer Advances 2020: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. Journal of Clinical Oncology. doi:10.1200/JCO.19.03141.

2. Clinical Cancer Advances 2020: ASCO Names Advance of the Year, Issues Research Priorities for Cancer Community [news release]. ASCO. Published February 4, 2020. ascopost.com/news/february-2020/clinical-cancer-advances-2020/. Accessed February 5, 2020.