THE YEAR 2022 saw the return of aspects of life that had been put aside during the height of the COVID-19 pandemic. Scenes like a standing ovation at the American Society of Clinical Oncology Annual Meeting for a paradigm-shifting treatment were heartening to witness. But issues that rose to prominence during the past two years continued to capture headlines, with new research and stories highlighting racial disparities, financial toxicity and social determinants of health. Here are some of the most interesting, important and moving stories of 2022, picked by the editors of Cancer Today.
Advocating for Her Life in a Battle Against Breast Cancer
Washington Post, Feb. 22
Katrece Nolen had to fight to get the correct diagnosis and treatment for her inflammatory breast cancer, an experience that highlights the obstacles Black women like Nolen often have to overcome to get care. A report by the American Cancer Society released in early 2022 revealed racial disparities in breast cancer outcomes for Black and white women. Black women have a 4% lower incidence of breast cancer than white women, but the death rate is 41% higher. The report blamed “decades of structural racism” for the disparity. “The most important thing about self-advocacy is don’t give up,” said Nolen, who is 47 and has shown no evidence of cancer for nine years. “You have to push through the despair to get the test results, the diagnosis and the appointments you need.”
A Cancer Trial’s Unexpected Result: Remission in Every Patient
New York Times, June 5
“Unheard of.” “The first time in this has ever happened in the history of cancer.” These were some of experts’ comments after results of a small trial in patients with rectal cancer were presented at the American Society of Clinical Oncology Annual Meeting in June. At the conference, researchers noted that 18 people who had stage II and III rectal cancer that tested positive for DNA mismatch repair deficiency had their cancer disappear after being treated with the immune checkpoint inhibitor Jemperli (dostarlimab), the New York Times reported. Research published the same day in the New England Journal of Medicine noted the first 12 patients to enroll in the study who were followed for at least six months after completing treatment still had no evidence of cancer. While the study was small, Luis A. Diaz Jr., a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City and an author of the paper, said he wasn’t aware of any other studies where cancer was eliminated in every patient.
Breast Cancer Drug Trial Results in ‘Unheard-Of’ Survival
New York Times, June 7
Several treatment options exist for patients with HER2-positive breast cancer, whose tumors are almost completely populated with the protein HER2. However, these therapies have not been effective for patients who have HER2-low breast cancer, where only a few HER2 proteins are present. Enhertu (trastuzumab deruxtecan), an antibody-drug conjugate initially intended for HER2-positive patients, has changed all that. In a study of 557 patients with HER2-low metastatic breast cancer, two-thirds received Enhertu, while the remainder had standard chemotherapy. Patients receiving Enhertu went longer without cancer progressing (10 months vs. 5 months) and had longer overall survival (23.9 months vs. 16.8 months) compared with patients receiving standard chemotherapy. Based on the study’s results, the Food and Drug Administration approved Enhertu for patients with HER2-low breast cancer in August.
In America, Cancer Patients Endure Debt on Top of Disease
Kaiser Health News, July 9
The high cost of cancer care in the U.S. has left millions of Americans struggling to pay their medical bills and falling deeply into debt. According to a poll by the Kaiser Family Foundation, about two-thirds of adults with health care debt who’ve had cancer themselves or in their family have cut spending on food, clothing or other necessities. About one in four have declared bankruptcy or lost their home. “It’s crippling. Even if someone survives the cancer, they often can’t shake the debt,” said oncologist Veena Shankaran of the University of Washington Medical Center and Fred Hutchinson Cancer Center in Seattle, who has studied the financial impact of cancer.
Drugmakers Are Slow to Prove Medicines That Got a Fast Track to Market Really Work
NPR, July 22
The Food and Drug Administration (FDA) has used accelerated approval for 30 years to get new medicines out to patients who have an urgent need. Accelerated approvals are based on surrogate endpoints, indicators associated with a desired effect that can be measured more quickly than results that prove a treatment extends life or improves health. It is given with the understanding that final approval will come when the effects are confirmed, but NPR reports that confirmatory trials are often slow to come, allowing medicines to be sold for years, even decades, without solid evidence of their effectiveness. NPR found that 50 confirmatory trials—42% of the confirmatory trials currently outstanding—started more than a year after the drug was given accelerated approval or haven’t started at all. This includes 19 trials that haven’t started three years after approval and four that haven’t started a decade later. “The promise of accelerated approval is that you’re going to get access and answers,” said Gregg Gonsalves, a Yale professor and advocate who worked in the 1980s to get faster approval of medicines during the AIDS crisis. “And what happens is you got the drugs on the market, but you didn’t find out if they worked.”
After Roe, Pregnant Women With Cancer Diagnoses May Face Wrenching Choices
New York Times, July 23
Rachel Brown always said she would never have an abortion. But at age 36, news of the pregnancy she had been trying for came just a day after she was diagnosed with an aggressive form of breast cancer. Thousands of pregnant women are diagnosed with cancer each year and face wrenching decisions about pregnancy and treatment, according to the New York Times. In the wake of the U.S. Supreme Court ruling that ended the constitutional right to an abortion in June, many of those decisions are no longer just between patient and doctor, and providers say it can be hard to know what is acceptable in states that have passed new restrictions. Cancer drugs are dangerous to the fetus in the first months of pregnancy, and many newer drugs cannot be given during pregnancy at all. Brown, a mother of two, was treated last year and was able to have an abortion so she could start treatment, but she was upset by the Supreme Court decision. “I felt like the reason I did what I did didn’t matter,” Brown told the Times. “My life didn’t matter, and my children’s lives didn’t matter. … It didn’t matter if I lost my life because I was being forced to be pregnant.”
Rural Americans Have Difficulty Accessing a Promising Cancer Treatment
Kaiser Health News, Aug. 25
In CAR T-cell therapy, a patient’s T cells in their blood are removed and then genetically engineered to target their cancer before being reintroduced to the bloodstream. Due to its potentially life-threatening side effects that require special care, however, only 150 centers in the U.S. offer CAR T-cell therapy, making it inaccessible to many in rural areas. Some patients upend their lives to get access to this treatment. One such patient was Suzanne BeHanna, who traveled 750 miles from her home in New Mexico to Houston, where she received treatment for her stage IV lymphoma while living in a trailer park. After undergoing unsuccessful chemotherapy, BeHanna wanted to move back home, but her husband convinced her to give CAR T-cell therapy a try. She received the treatment in October 2019, and the next month, her cancer was gone. “I had no tumors,” she told Kaiser Health News. “It was surreal.”
The Toll of Heroism: Increased Cancer Incidence Among 9/11 Responders
Cancer Research Catalyst, Sept. 9
Social media posts circulate every year on Sept. 11 and reverberate with sentiments of “never forget.” But 21 years after the attack on the World Trade Center towers in New York City, researchers are still sorting out increases in cancer risk for first responders who came to aid victims. A blog post in Cancer Research Catalyst used the start of September, a month designated to promote awareness of prostate cancer, thyroid cancer, and leukemia and lymphoma, to review studies that attempted to assess risk for these cancers among first responders. The blog post included data from epidemiological studies, research on precancerous changes in prostate cancer cells seen in mouse models exposed to similar toxic matter as 9/11 responders, and controversies around how watching this group so closely could affect the data. (Cancer Research Catalyst is published by the American Association for Cancer Research, which publishes Cancer Today.)
Colonoscopies Save Lives. Doctors Push Back Against European Study That Casts Doubt
NPR’s All Things Considered, Oct. 13
Studies on cancer screening in adults have established that colonoscopy can reduce the incidence of colorectal cancer and deaths from the disease. However, coverage of a European study in popular media earlier in 2022 raised doubts about the value of colonoscopy screening—and garnered outrage from many physicians who routinely recommend colonoscopy. The study, published in the New England Journal of Medicine, showed a lower-than-expected 18% reduction in colorectal cancer in people who were invited to screening compared with those who received usual care and no statistically significant reduction in colorectal cancer deaths. In a report on the NPR radio program All Things Considered, physicians noted flaws in the study and picked away at headlines that claimed the study showed colonoscopy does little to save lives. Of note, more than half of the study participants invited to get a colonoscopy didn’t get one, experts said. However, for those who did get the screening, the risk of developing colorectal cancer decreased by 31%. Colonoscopy, an evidence-based tool used to screen for colorectal cancer, is recommended for most adults between ages 45 and 75 in the U.S. The screening tool can also detect and remove polyps before they become cancerous.
A Global Epidemic of Cancer Among People Younger Than 50 Could Be Emerging
CNN, Oct. 17
Cancer is a disease associated with aging, but more people are being diagnosed with cancer before the age of 50. A review of cancer registry records from 44 countries found that these “early-onset” cases are rising in 14 types of cancer, many of which affect the digestive tract. “I recall it being a point of discussion in both hospitals that people getting colon cancer were getting younger and younger, more and more, and they couldn’t explain it,” said Brendan Higgins, who accompanied his wife, Iana dos Reis Nunes, to Memorial Sloan Kettering and Mount Sinai cancer centers in New York after she was diagnosed with colon cancer at age 43. Cancers diagnosed at younger ages tend to be more aggressive than those found at later ages and can go undetected for longer, since many screening recommendations don’t start until age 50. Karen Knudsen, CEO of the American Cancer Society, called the review “a call to arms,” and suggested the need for more research into the specific trends driving the rise and more awareness of behaviors linked to a higher risk of cancer.
Lung Cancer Screening Saves Lives. So Why Do So Few of Those at Risk Get One?
USA Today, Nov. 15
Only 5.8% of those eligible for a free, low-dose CT scan to screen for lung cancer actually get the scan, far fewer than those who get screened for colorectal, breast and cervical cancer. Yet studies show that screening leads to at least a 20% reduction in death from lung cancer. Experts cite a variety of reasons for the low rate, including complicated rules around who is eligible for screening, lack of awareness about the screening, and an attitude of blaming lung cancer patients for their illness. Another factor that can influence whether a person is likely to be screened is where that person gets their health care. A recent study by the Veterans Health Administration found that the facility where a person receives health care accounted for 36% of the screening variation, and the person’s doctor accounted for 19%.
How a Biomarker Test Saved This Lung Cancer Survivor’s Life
Healthline, Nov. 30
In June 2021, Brittany Hawkins was diagnosed with stage IV lung cancer, and doctors told her she had just three months left to live. With the 36-year-old mother’s prognosis seeming grim, her doctor recommended biomarker testing to look at genes, proteins and other molecules in the tumor to predict how a cancer may react to different treatments. The tests showed that a tumor in her lung had the RET + KIF5B mutation, which is found in less than 2% of non-small cell lung cancers. She started taking Gavreto (pralsetinib), one of two drugs approved by the Food and Drug Administration to target that mutation. The treatment dramatically reduced the size of her tumor and eliminated all the cancer that had spread to other parts of her body. “Biomarker testing offers the opportunity to personalize treatment based on the cancer’s inherent vulnerabilities,” Vamsi Velcheti, medical director of the thoracic oncology program at the NYU Langone Health Perlmutter Cancer Center in New York City, who was not involved in Hawkins’ care, told Healthline.
Cancer Today magazine is free to cancer patients, survivors and caregivers who live in the U.S. Subscribe here to receive four issues per year.