Cancer. The word alone can evoke fear and despair. However, advancements in cancer care have significantly altered the landscape, providing new hope for those diagnosed with a disease that once offered little reason for optimism.
Erev Tubb, MD, FACP
In the last decade, breakthroughs in understanding cancer biology – including gene mutations and immune system interactions – have led to newer, more targeted treatments for cancer patients. This progress has shifted the focus from dying of cancer to living with an incurable condition.
The impact extends beyond the explosion of new life-extending medical treatments. It influences how doctors talk to patients about diagnoses and prognoses, and how patients navigate their daily lives during and in between treatments. As Erev Tubb, MD, FACP, explains, discussing cancer with new patients is largely about managing their expectations, which takes great delicacy.
“I tell my patients, ‘I’m not here to make something sound better or worse than it is,’” says Tubb, an internal medicine physician, medical oncologist and hematology specialist with Inspira Medical Center Mullica Hill. “I’m here to explain what we know and what we still need to find out.”
“Many cancers previously treated with systemic chemotherapy just a decade ago are now managed with more personalized approaches.”
Personalized treatment approaches
The major shift in treatment: Many cancers previously treated with systemic chemotherapy just a decade ago are now managed with more personalized approaches, says Rachel Levenbach, MD, a specialist in medical oncology and hematology with Regional Cancer Care Associates. Traditional chemotherapy kills off cancer cells but often affects healthy cells as well, leading to significant side effects. In contrast, newer treatments are more targeted, more effective and less damaging to the body.
Two major categories of these newer treatments are targeted genetic therapies and immunotherapy. Targeted genetic therapies hone in on specific genetic mutations within cancer cells. These treatments can inhibit cancer growth or kill cancer cells while causing minimal damage to normal cells, Levenbach says.
Immunotherapy, on the other hand, harnesses the body’s immune system to fight cancer. It either enhances the immune cells’ ability to recognize and attack cancer cells or modifies the patient’s immune cells to improve their ability to fight such dangerous invaders.
“In the past decade, immunotherapy has become a game-changer for many advanced cancers previously considered incurable, such as stage IV lung cancer, advanced lymphoma and melanoma,” says Tubb. “These therapies often replace or complement chemotherapy, providing a gentler treatment that helps maintain quality of life.”
Both immunotherapy and targeted medicine are advancing thanks to genomic analysis. Unlike genetics, which studies inherited traits, genomics focuses on mutations that occur in cancer cells over time, explains Tubb. By identifying these mutations, genomic analysis enables a more personalized treatment approach.
Through genomic analysis, lab panels that identified 45 gene mutations even 5 years ago can now list 100 different ones, says Levenbach. “We get lab reports back, and it includes all these mutations. In the past, we thought there wouldn’t be any agents for these, but new therapies are coming out all the time.”
Overcoming resistance to therapies
Cancer has historically eluded treatment because it can mutate, rendering previously effective therapies ineffective. A significant recent advancement is the ability to anticipate and manage this resistance, says Tubb, noting that these insights have led to the development of response-adaptive treatments, which involve ongoing assessments and adjustments to the treatment plan based on how the cancer responds.
“If you see that you can control a cancer with immunotherapy but one area of the cancer escapes immune response, you don’t have to throw the whole treatment out the window and switch to a different one,” Tubb says.
This adaptive approach allows doctors to modify treatments in real-time, addressing cancer’s evolving resistance mechanisms and improving the chances of successful management, he adds, noting that in some cases he will collaborate with other experts, including radiation colleagues, to devise a comprehensive plan of attack.
Quality of life improvements
Many targeted therapies and immunotherapies are now available in oral form or otherwise require less time than traditional chemotherapy, which typically involves long infusion sessions. “Many of my patients only need to visit the office once a month or once every other month,” says Levenbach. “And they’re able to live much longer and more normalized lives, able to work, spend time with family and friends, and travel more than in the past. Even patients in their eighties and nineties are responding well because the therapies are less aggressive and don’t cause a lot of side effects.”
Rachel Levenbach, MD
However, a patient’s overall health can significantly affect their response to therapy, she stresses. “The healthier you are going into treatment, the better you can handle the drugs, whether it’s chemotherapy or targeted therapies, and at the necessary doses,” Levenbach says. “Being healthy also helps with managing side effects and doing activities that will improve your well-being, like being able to exercise, eat well and sleep properly. These factors all contribute to a better response to treatment.”
Still another positive outcome of newer, gentler treatments has been the reduction in visible side effects. “Not losing their hair is a big game changer for many patients. It helps them feel less self-conscious and able to maintain a sense of normalcy,” says
Levenbach.
This improvement in quality of life is not just cosmetic, it has profound psychological and social impacts. “Patients will tell me their job won’t give them time off because they look too well. People don’t realize that behind the scenes, these patients are fighting cancer every day,” she says. “It sounds vain, but losing hair is probably the most important concern for a lot of patients. They don’t want to feel like everyone can see they are a cancer patient.”
Balancing hope with reality
While many cancers once considered a death sentence can now be treated effectively, this isn’t the case for every patient. This bittersweet reality is part of the challenge faced by oncologists, says Tubb.
“It is our job not only to treat but also to educate a patient on their disease and what to expect,” he says.
While Tubb says he can predict end-of-life stages with some accuracy, determining how long someone will live with a chronic condition is much harder. The balance is delicate, requiring ongoing communication and adjustments as new treatments become available and patients’ conditions evolve, with the goal being not just to extend life but to enhance its quality.
“I like nothing more,” Tubb adds, “than to be wrong about somebody’s limited lifespan.”
