Access Health: Cancer Research's Golden Age Is On Shaky Ground

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Today is May 1, the first day of National Cancer Research Month. For this special edition of Access Health, I connected with some of the nation's leading oncology experts and asked them to take us into their world.

I found good news and bad news on this foray. I'll start with the good news.

There's an undeniable excitement in the field of cancer research right now. In some of my conversations, that excitement transcended into giddiness. Scientists who have dedicated their careers to this work are calling the current moment a "golden age," "something we've only dreamed of," "science-fiction" brought to life.

"We are at an exciting time to unveil cancer like it has never been unveiled before, down to the molecular level," said Dr. Craig Eagle, chief medical officer of the precision-oncology company Guardant Health.

Both biological and technological advancements have brought us to this period of rapid advancement and unrivaled diagnostic precision, according to Dr. Stephan Hahn, former commissioner of the FDA and current CEO of Harbinger Health, an early cancer detection company.

"When I started in oncology 40 years ago, if you had said, 'I'm going to draw a tube of blood and find circulating tumor DNA in the blood,' they would have laughed you out of the room," Hahn told me. "That just wasn't a thing."

Now, it is a thing. (Keep reading—we'll unpack some advancements in liquid biopsy and cancer screening in the next section.) By undertaking feats that were once considered impossible, like sequencing an entire human genome, cancer researchers have deepened their understanding of the disease in its many forms. And by investing in more precise testing methods to identify those many cancers, they've been able to deploy more targeted therapies.

Recent cancer research has made it easier to screen for and treat certain cancers. Scientists told me that this wouldn't be possible without advancements in machine learning and AI. We now have the capability to search for answers in a much larger pool of genetic information and treatment outcomes, but without the right tech, that would be like searching for a needle in a haystack.

This year provides unrivaled conditions for cancer research, as our deepening understanding of the disease coincides with the rising capabilities of AI. But certain headwinds are threatening that hard-earned progress, according to Dr. Karen Knudsen, CEO of the Parker Institute for Cancer Immunotherapy and former CEO of the American Cancer Society.

Knudsen called me April 7 from the Parker Institute's annual retreat, which brings together scientists and venture capitalists from around the world to analyze advancements in the field and translate them into patient testing and company formation. She, too, described a whirlwind of excitement as "brilliant discoveries" are being made.

But she also described a rising sense of urgency in the field to ensure that these discoveries aren't lost.

"The science is growing at this incredibly strong pace," Knudsen said, "but the market's not been ready to accept this number of discoveries and get them the capitalization that's needed in order to get clinical trials up on the ground."

Although the cancer mortality rate in the U.S. is improving, diagnoses are on the rise. Meanwhile, the federal government has threatened cancer research funding—a move that Knudsen called "a real concern to almost everyone in this room."

The shortage of capital for life sciences, including cancer therapeutics companies, is already a limiting factor, she told me. Without NIH funding, Knudsen fears trouble: "I don't think there's any one organization or foundation that can replace the role of the US government."

Essential Reading

Here are a few oncology research advancements that you should know about...but before we get into them, take five minutes to fill out this surveyand let me know how you're liking Access Health!

• Immunotherapy could help cancer patients with the MMRd gene to avoid surgery, radiation or chemotherapy, according to the results of a clinical trial led by Memorial Sloan Kettering Cancer Center. The trial included 103 patients with several types of stage 1-3 cancer, treating them with Jemperli, a checkpoint inhibitor made by GSK. Eighty percent of patients did not require more aggressive treatments—previously standard for their types of cancer—after six months on the drug.This new finding, presented at AACR and published in NEJM on Sunday, builds upon a previous study that used the same drug to treat 100 percent of rectal cancer patients in their trial—in other words, each and every patient's tumor vanished.By extending the study, researchers have proven that the drug can kill other types of cancers as well.Between 5-10 percent of rectal tumors and 2-10 percent of other solid tumor cancers in the sample (including esophageal, colon and prostate cancers) are believed to be related to the MMRd gene. "These results could change how we treat some cancers," said Dr. Luis Diaz Jr., head of the division of solid tumor oncology at MSK. "Current treatments like surgery, radiation, and chemotherapy can seriously affect quality of life."
• Harbinger Health unveiled new data at AACR showing promising results for its blood-based multi-cancer early detection (MCED) platform.Using a novel approach that combines AI with individualized DNA methylation analysis, the test achieved 98.6 percent specificity. The platform also showed strong performance in detecting cancers that currently lack routine screening programs, such as pancreaticobiliary and hepatobiliary cancers.I spoke with Dr. Stephan Hahn, Harbinger's CEO (and the former FDA commissioner) and Dr. Hutan Ashrafian about these results, and how liquid biopsies—blood tests that can identify diseases like cancer—could shape the future of cancer detection. Here's how they described their visions:Ashrafian: "I think these tests should ultimately become part of a [routine] check-up so that people can be certain that they are well, and if they are unwell, things can be done sooner rather than later. The nature of our test is that it is not purely for specialists, but can also be used in the community, so primary care docs can use it to support their patients."Hahn: "100 percent, that's the vision. No one bats an eye at getting cholesterol checked every three months as you intervene to make sure it's getting better. No one even thinks about it—and that's the way this should become."
• The precision-oncology company Guardant Health is also making strides in blood-based cancer screening. At this week's conference, the company presented 18 abstracts highlighting its Guardant Infinity platform, which integrates blood and tissue testing to provide a comprehensive view of a patient's cancer. This approach captures changes in gene expression, DNA structure and methylation—allowing clinicians to track how cancer develops and responds to treatment over time.Dr. Craig Eagle, Guardant Health's chief medical officer, summarized the most relevant findings for me. Here's one that stood out: Guardant's platform has been able to identify cancer signals of origin, which show clinicians where to look for trouble after patients receive a positive test. New data presented at AACR revealed a more than 90 percent ability to identify the first two cancer "hot spots" in a patient.
• This at-home breath-collection kit from SpotItEarly is improving access to pre-screenings for multiple types of cancer by using a unique combination of dogs and AI. Canines sniff the patients' breath samples while the company's AI platform monitors their behaviors and physical signals, like hesitation, sniff intensity and subtle body movements beyond the standard sit/no-sit cue. The technology collects thousands of data points per second, then analyzes them to assign each sample a cancer prediction score.The test has a 93.9 percent sensitivity and 94.3 percent specificity rate across four cancers: breast, lung, prostate and colorectal, according to a recent Nature study involving 1,386 participants. It also identified 14 other cancer types that it wasn't specifically trained to detect with 81.8 percent sensitivity—suggesting broader potential for this screening method.

Pulse Check

Dr. Boris Pasche is the president and CEO of the Barbara Ann Karmanos Cancer Institute and chair of the department of oncology at Wayne State University, both based in Detroit.

Before joining Karmanos, Pasche led Wake Forest Baptist's cancer center and chaired its cancer biology department. A pioneer in cancer genetics, he discovered a gene variation linked to cancer risk and co-invented an FDA-approved device for the treatment of patients with advanced hepatocellular carcinoma who fail first- and second-line therapies.

As both an executive and a cancer researcher, Pasche is tuned into the science and logistics behind oncology research. I was excited to connect with him this week for a pulse check.

Is there a breakthrough or innovation in oncology research that you wish was getting more attention? Fill us in!

In the past decade, there has been an impressive number of lifesaving innovations in cancer research and treatment. Some examples include CAR T-cell therapy, which uses a patient's own T-cells to seek out and destroy cancer cells, and the development of theranostics, which combines diagnosis and treatment using radioactive pharmaceuticals to both identify and precisely target cancer cells.

More recently, I am personally very excited about what could be a revolutionary technology that will allow people to undergo cancer treatment in their homes with few side effects. Over more than two decades, my colleagues and I developed a treatment modality using radiofrequency electromagnetic fields to specifically target tumor cells without affecting normal cells. It is the first such treatment FDA-approved for cancer therapy, and because the treatment can be effectively delivered through a handheld device, it can be given at home. Right now, the Therabionic P-1 is only FDA-approved for certain liver cancer patients who have failed more traditional treatments, but we have several ongoing clinical trials that are researching its ability to treat other tumor types, which is very exciting.

A promising attribute of this therapy is that patients who have used it have experienced practically no side effects, and it is the first systemic therapy using radiofrequency electromagnetic fields to target cancer at the cellular level, targeting tumor cells while leaving other cells intact. If it proves effective in other tumor types, I expect it to be an effective and side-effect-free weapon against many types of cancer.

Which industry trends are you keeping an eye on, and how might they alter cancer researchers' strategies in the future?

I am most interested in understanding how to incorporate AI into cancer research and treatment. We don't know for sure what changes it will yield, but it already has a direct application in radiology. For example, it's been shown to recognize specific tumor patterns potentially more quickly and more thoroughly than a human can. A human still needs to verify and certify those results, but we might get an additional level of security and accuracy by using AI to diagnose cancers more completely and accurately.

AI is also poised to affect pathology. Pathology is a very complex field, but in cancer, physicians look at patterns of certain cells to try to define precisely where cancer tumors originated. AI is already recognizing patterns typical of certain types of tumors versus others, which is proving beneficial. One great hope is that pathology will get better and better in terms of providing a more exact diagnosis. Many patients diagnosed elsewhere seek second opinions at Karmanos. We know pathologists providing second opinions change the initial diagnosis received elsewhere 1-35 percent of the time. That is a good reason to pursue a second opinion, but it is also a large error rate, so we are eager to learn how AI might be harnessed to improve initial diagnosis.

C-Suite Shuffles

• UnitedHealth Group made two changes to its leadership team on Tuesday. The company promoted Dr. Patrick Conway, who currently helms Optum Rx, to CEO of the entire Optum enterprise. Heather Cianfrocco—Optum's current CEO—was named executive vice president of governance, compliance and information security for UnitedHealth Group.
• Encompass HealthtappedPatrick Tuer to serve as its first COO. He has held various leadership positions, including group president and regional president, since joining the company in 2018. Encompass is the largest owner and operator of inpatient rehabilitation hospitals in the U.S.
  
  
• Neil Cowles is the new chief information and technology officer at Kaiser Permanente, based in Oakland, California. He has been working as the health system's chief technology officer since last summer and will lead its IT organization in his new role.

Executive Edge

My running routine has fallen to the wayside recently, but after speaking with Dr. Christopher Flowers on Tuesday, I was itching to lace up my shoes and hit the trails!

Flowers is the division head of cancer medicine at MD Anderson Cancer Center, overseeing 16 medical oncology departments, composed of roughly 450 faculty members and 3,000 employees. When we connected, he was here in Chicago for the AACR conference—and started his busy day with a six-mile run along the Lakefront Trail.

As a lifelong runner and a health care professional, Flowers prioritizes physical activity, even on busy workdays. Here's a snippet of our conversation, where we discussed how he does it:

• "As you gain increasing responsibility as a health care executive, it becomes more and more challenging to fit [running] into your daily schedule. I don't have knees that are as good as they were 20 years ago or a schedule that is as permissive as it was 20 years ago...so sometimes that 17-mile run turns into a six-mile run, like it did this morning. But it's still great to get out and be able to enjoy the outdoors and to be able to build exercise into your daily habits. That's been one of the key components [of my routine], is that whenever I am traveling, I try to build exercise into the beginning of the day or the end of the day.
  
  
• "The other component is trying to build exercise into daily life at work. When I first moved to MD Anderson, I lived a little bit more than a mile away from work, so I walked to work every day and walked home. Now I live about two miles away from work, so I walk to work about once or twice a week and then walk home. But building that exercise into the everyday component of life has really been a critical way to be able to maintain those healthy habits.There's almost nothing that can happen in a busy day, as a health care executive, that isn't gone or released after walking a mile or two home. [Then, you are] actually ready to be present at home with your family with all the stresses of the workday left behind you. I find that many of the challenges and problems that may not have been completely solved during the day, oftentimes get solved on that walk home or walk to work in terms of planning for the day.
• "Exercise plays a role in essentially every study that we do in cancer care: in helping people to respond better to cancer therapies and preventing people from getting cancer."

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