January 21, 2022 by John Fernandez
Cancer Projections 2022: Higher Late-Stage Diagnoses, But More Treatment Advances and Pivotal Clinical Trials
Looking ahead to a new year of advances in treating and diagnosing many types of cancers, the specter of the COVID-19 pandemic still looms large, with an anticipated increase in late-stage diagnoses because of delayed screenings, explains Michael Zinner, M.D., CEO and executive medical director of Miami Cancer Institute.
“We’re still feeling the impact of delayed cancer screenings because of COVID,” said Dr. Zinner. “I was on the phone with a 70-year-old woman who had skipped her mammogram during COVID only to discover that she now has a positive biopsy two years later. Now, would she had found that two years ago? Don’t know, but the likelihood is that it’s more advanced now than it was two years ago.”
There are many unexplained and concerning cancer trends that are expected to continue in 2022, including rising colorectal cancer cases in younger adults and a rise in breast cancer diagnoses — but with an ongoing decline in deaths from breast cancer.
Immunotherapies and Clinical Trials
There are also many positive trends in cancer treatments that continue to evolve — “game changers” as Dr. Zinner describes them. Immunotherapies involve cancer treatments that help your immune system fight cancer. Your body’s immune system already helps fight infections, such as the common cold and COVID-19, but there are drug therapies that can weaponize the immune system to target cancer cells.
“Most of the cellular immunotherapies are against leukemia, or the liquid tumors or blood cancers,” said Dr. Zinner. “They’re not very effective against the solid tumors, like tumors of the pancreas or breast. But we also see those being developed in the laboratory. And I actually think we’re going to see clinical trials for those within the next year.”
Miami Cancer Institute will be increasing clinical trials involving immunotherapies and other treatments. “Those discussions are underway now because we have built a unique facility at the Institute for clinical trials,” said Dr. Zinner.
There will be much progress in the area of immunotherapy, both at the chemical and cellular levels. “And so, by that, I mean at the chemical pharmaceutical level — drugs that will turn the immune system on or off,” he adds. “There’s a lot of drug development that’s being done to combine therapies. Now they’re making antibodies that not only attach to a cell, but are also linked to a therapeutic. Those are all drugs in development that fall under the category of immunotherapy.”
Potential Game Changers: mRNA Tech and Blood Tests
Many people don’t realize that the mRNA technology behind the Pfizer-BioNTech and Moderna vaccines against COVID has been used in developing vaccines that target cancer cells for many years — but challenges remain in targeting specific cancers. “Yes, the mRNA technology that Pfizer and Moderna were working on was, in fact, being built in the laboratory for specific cancer treatment,” he said. “But we’re not there yet.”
The biggest challenge in developing mRNA vaccines for cancer patients is pinpointing treatment for an individual because everyone’s neoantigens generated by mutations in tumor cells are specific to them.
The same applies to what will one day be a revolutionary turn in diagnoses: Blood tests — also known as blood biopsies — that can detect early-stage cancer?
“That actually is also another game changer,” said Dr. Zinner. “We’re still in the early stages of blood biopsies, in terms of its efficacy and its sensitivity and specificity. We’re not sure who should get it and who should not get it. It’s still an expensive test. But I think as the cost comes down, its availability improves, and its sensitivity goes up — it has the potential to be a very important tool in early detection.”
Here are more detailed cancer insights from Dr. Zinner for 2022 and beyond:
What are the dominant trends you are seeing in cancer rates and cancer mortality?
“Certainly, breast cancer is one where the incidents will go up, but the mortality will go down. The rise in pancreatic cancer is unclear. but definitely there’s a rise in pancreatic cancer and we don’t have many good treatments for it. So, deaths from pancreatic cancer will remain high. Colorectal cancer in the under age 50 population — now the under 40 population — is rising rapidly. And we have no idea why. So, we will see that and we will have to change our paradigm for screenings. Right now, you don’t get your first colonoscopy until you’re 50 or 45 within the last year, but we clearly are going to have to drop that back down lower and lower as years go on.”
How will healthcare barriers be minimized or eliminated for minorities or underserved populations?
“I hope we’ll have more public-private partnerships that reach into the underserved communities to improve access to screenings — for example, mammogram vans, or testing for prostate cancer in the African American male population. I hope that we will see more of those kinds of reaches into the community.
“And hopefully we’ll see them brought into more clinical trials. What you have heard me talk about in the past is our diversity, in terms of population, compared to many other cancer centers around the country that do clinical trials. We have much more diversity than most of the centers on the East Coast, the West Coast or even in the Midwest. And that’s a very positive aspect for us.”
Can you explain the biggest challenges of developing blood biopsies to detect early-stage cancers?
“It’s a screening tool with the premise that if you have an early tumor, from which you have no symptoms, that its DNA or elements of it are circulating in your blood. And a sample is pulled out and goes through a very specific test looking for that DNA. That can tell us whether or not it’s cancer. But that’s not good enough. Just knowing that you have a cancer somewhere is not good enough. It has to be specific and say, for example, this kind of DNA looks like it comes from a pancreas cancer.”
Can you elaborate on some cancer trends which are inexplicable and remain a challenge to reverse?
“It’s so hard to understand why some of these things are happening. Why is colon cancer now a disease of people in their 30s and 40s? Whereas when I was in medical school, that was extremely rare, except for a certain genetic in hereditary cancers. Why is pancreatic cancer rising at the rate it’s going? For those of us in the medical field, we’re watching it, but we’re not understanding why. Is it environment? Is it in the food? Is it lack of physical activities? Is it medication?
“One of the cancers that’s almost going away is stomach cancer. And part of the reason we think stomach cancer is going away is because we discovered that there’s bacteria that may be causing some of the stomach cancers. And we’re treating everybody with antibiotics since after World War II and the rate of stomach cancer’s gone down like that. Is that why? Because we did away with that bacteria? Is there something in our gut that’s making the colon cancer and pancreas cancer worse? So, I really posed a lot of questions without a lot of answers. That’s the problem.”
Can you explain how the new surge in COVID cases from the Omicron variant will likely continue to delay cancer diagnoses?
“We’re beginning to see diseases at a later stage now that should have been caught earlier. I think that will probably be worse in 2022. And it will continue to be worse over the next several years. The problem with COVID is that this new wave is beginning to hit and that means we’re may stop the screenings again. We may stop colonoscopies. We may stop mammograms.
“Look at the lines that are forming outside the COVID testing centers here in Miami-Dade. My colleagues in Massachusetts are telling me that they can’t do anything except deal with COVID right now. There were a lot of things we were talking about doing together. They can’t. So, it is going to have an impact again this winter. I think the delays in screenings are going to add to the complexity of the disease we see going forward.”