Antoni Ribas, MD, PhD: Anticipating More Progress for Patients with Cancer through Scientific and Technological Innovation
AACR President, 2020-2021
Professor of Medicine, Surgery, and Molecular and Medical Pharmacology
University of California Los Angeles
Los Angeles, California
During the 20 years that I have been a physician-scientist, I have seen unparalleled advances in cancer science and medicine, and I am excited for the future. In the next 10 years, I expect that scientific discoveries will ignite another revolution in cancer treatment and further improve outcomes for patients with cancer.
When I was completing my medical training in the late 1990s, most patients with cancer were treated with surgery, radiotherapy, and/or chemotherapy. These treatments cured some patients, but most patients with metastatic cancer did not have curative treatment options. The landscape of cancer care has been revolutionized by knowledge generated through scientific and technological innovation. Growing knowledge about genetic mutations that yield dysregulated proteins that drive cancer is being applied to the development of therapeutics that specifically target the dysregulated proteins. Deepening knowledge about interactions between cancers and the immune system has been harnessed to develop immunotherapeutics that power immune cells to attack cancers.
Since I began treating melanoma, I have seen firsthand the significant benefit that molecularly targeted therapy and immunotherapy have had for patients. Twenty years ago, only about one in 20 of the patients with advanced melanoma responded to the treatments we were using at that time—chemotherapy and cytokine therapy. Now, about half of the patients with advanced melanoma are doing well in the long term thanks to targeted therapeutics that target BRAF and MEK and immune checkpoint inhibitors that stimulate the immune response to attack the melanoma.
Molecularly targeted therapy and immunotherapy are just two examples of how the increased scientific understanding of cancer biology that has been gained in the past 5 to 10 years has led to significant advances for patients.
As we move forward, the paradigm of applying scientific and technological innovation to transform cancer prevention, detection, diagnosis, and treatment will continue apace. We are already beginning to investigate the potential of a new technology called liquid biopsy to detect cancer early in development, including those types of cancer that are currently hard to detect such as ovarian cancer. There is still a way to go, but I foresee that in a few years, this technology will allow us to draw a person’s blood, analyze it for molecular signatures of cancer, and identify who is developing a cancer before it is detectable with a CT scan. This will allow cancer to be detected at an early stage, when it is more likely that it can be treated successfully.
Another area in which scientific and technological innovation are intersecting to drive progress is in the development of the next generation of genetically modified T-cell therapies (see Increasing the Cancer-killing Capacity of the Immune System). CAR and TCR T-cell therapies involve harvesting immune cells called T cells from a patient’s blood, genetically modifying the T cells to endow them with an artificial receptor that redirects them to target and kill cancer cells, and then expanding the number of T cells before infusing them back into the patient. Researchers are now combining our knowledge of T cells and cancer biology with new technologies such as CRISPR gene editing to develop next-generation cell therapies that have longer-lasting, more robust anticancer effects.
In 2020, the cancer research community, like every other community around the world, has had to face a new challenge, the COVID-19 [Coronavirus Disease 2019] pandemic. This challenge is unlike any that we have faced before. Cancer screening and treatment have been disrupted; most cancer research projects have been halted, at least temporarily; and many cancer researchers have turned their attention to fighting COVID-19.
In addition, the COVID-19 pandemic has highlighted stark inequities in health care for racial and ethnic minorities and other underserved populations. The AACR [American Association for Cancer Research] has long been a leader in the field of cancer health disparities research, and we are extending these efforts to include all health disparities, including disparities in COVID-19.
The COVID-19 pandemic has stifled progress against cancer and is predicted to exacerbate cancer health disparities. Therefore, it is vital that Congress continue to make medical research a national priority. Federal investment is urgently needed if we are to get this pandemic under control and return to our mission of preventing and curing all types of cancer.