Oh, how far we’ve come!
When we take a holistic look at the major milestones and obstacles in cancer care over the last half century, we get a great sense of where we are headed. In a way, our past is informing our future, and we see how this narrative will evolve in the coming decades to help cancer care become more personalized, patient-centered, and accessible.
Looking back, for years, if you were diagnosed with cancer, there would likely be a standard treatment plan that was simply based on what kind of cancer you had, how aggressive it was, and if it had spread. The treatment could often feel as debilitating as the cancer itself. In the early ‘70s, the world was abuzz over sensationalized news around the idea of a magic bullet that would cure cancer. Reckoning with reality, we quickly learned that there was no magic, one-size-fits all approach to curing cancer. It was a humbling realization that led to the growing understanding that curing cancer would not be that simple. Instead, it would require profound analysis of each type of cancer, and then the evaluation of that against the individual patient’s genetics, environment, and lifestyle, so that treatment was highly personalized. This led to the precision medicine mindset we embrace today. Our expanding comprehension of cancer has led to significant headway in detection, prevention, and treatment. In fact, we have gained more knowledge about cancer in the last two decades than had been learned in all the centuries prior, opening us up to a myriad of advancements.
Still, this year, more than 1.7 million Americans will learn they have cancer. It’s a devastating statistic, one that is predicted to grow as the population expands and ages. These figures highlight the crucial need to find better treatments – we all know this. There’s encouraging work being done to march towards the creation of an environment that supports and incentivizes value-based oncology, so that patients can benefit equitably from innovations in care.
One form of radiation treatment for cancer that is showing promise is adaptive therapy. Dubbed the “holy grail” of radiation therapy, long-term clinical adaptive therapy follow-up has shown significant improvement in terms of tumor control and low toxicity profile cancers below the respiratory system, including prostate cancer. Additionally, adaptive therapy has proven to offer dosimetric benefits, especially with head and neck cancers. Adaptive therapy is a personalized radiation treatment approach in which clinicians continuously adapt their strategy to changes in the patient’s anatomy and physiology. By adjusting treatment based on daily imaging information, they can account for variations in tumor shape, size and location, and changes in surrounding organs.
But adaptive therapy is not there yet. In its current state, it is a slow, expensive process requiring significant capital equipment, hours of training, and the need for extensive involvement from a highly skilled clinician, making it unattainable for many (clinicians and patients alike). It may be nearly impossible to deliver the transformational level of care that adaptive therapy offers while being scalable, efficient, and effective, unless we can evolve the treatment to remove these barriers and make this form of highly personalized treatment accessible to all.
An intelligent, accessible adaptive therapy approach has the potential to improve outcomes that can result in a longer disease-free life expectancy for patients. Additionally, it may help open the door for more opportunities, research, and advancements in cancer treatment. Today’s barriers to widespread personalized care through adaptive therapy include:
- Limited Expertise and Extensive Training: The process involves highly skilled clinicians and extensive involvement, most often requiring MR linac systems for “on-couch” or online treatment.Currently, these systems require significant capital equipment, hours of training, and highly-skilled clinicians to support the end-to-end process. Clinical staff that historically has been trained to operate in environments with radiographic imaging now have to learn how to work with the presence of a magnetic field and new accessories.
- Slow: Currently, adaptive therapy takes significant time and hinders the speed at which clinics can adopt and utilize these systems to treat patients. From a patient perspective, adaptive therapy can be slow and uncomfortable, as the patient must lay completely still on a treatment couch for about 45 minutes.
- Uneconomical: We need to shift away from the current model, where your zip code is a far better indicator of your survival rate than your genetics, when it comes to cancer. Adaptive therapy today requires expensive capital equipment and extensive clinician hours, making it cost-prohibitive for the majority of patients.
- Restrictive Patient Selection Criteria: The MR linac physically may make patients feel confined, so claustrophobic patients have great difficulty receiving treatment. Furthermore, patients with certain metals in their body cannot be treated with a MR linac, which restricts treatment further.
- Technological Infancy: Adaptive therapy tools and solutions to date have been in their infancy. They enable the process, but do not make it practical or efficient. The burden is placed on the clinician, with limited AI utilization available to help streamline large groups of data and help with decision making.
Adaptive therapy in its current state may not be perfect, but it represents the next stage of a personalized healthcare transformation, and sheds a bright light on the potential there is to dramatically change the practice of intelligent medicine in coming years. We can move that process forward by innovating ways to improve the infrastructure and introduce artificial intelligence to increase the efficiency, flexibility and affordability of adaptive therapy, to expand the availability of this advanced high-quality treatment to cancer patients of all kinds.
We need to continue tireless efforts to adapt and advance treatment. To build an ecosystem where adaptive can truly adapt and help cancer patients across the world, we need to bring together leaders in cancer care development to innovate; health legislators to advance value-based care models; oncology researchers to illustrate improved outcomes and help shape future advancements; and cancer patients/doctors for their first-hand perspectives. This equation will bring together a strong network that, united, can carve out a road toward sustainable, patient-centered oncology care. Adaptive therapy currently may be the road less traveled, but it has the potential to offer personalized, effective treatment to an expansive number of cancer patients, and that will make all the difference.