When renowned clinician and researcher Dr. Andre Goy said he feels as though this is the most exciting time in medicine in the past century, he’s not exaggerating.
After two decades at a leading cancer care program within Hackensack Meridian Health, he’s witnessed — and been a key part of — a revolution within cancer care.
And it’s all coming together now.
Although Goy, chairman and chief physician officer for Hackensack University Medical Center‘s John Theurer Cancer Center, believes there’s a lot of work that remains when it comes to honing approaches to treating and preventing cancer … he’s more confident than ever that novel therapies, precision medicine and data analytics are leading in a transformative direction.
About 13 years ago, Goy started a program at Hackensack to genetically engineer immune cells to force them to attack cancer, referred to as CAR T-cell therapy. That approach has been a “game-changer,” he said, with cure rates of about 40% in cancer patients left with no other treatment options.
Therapeutic innovations such as those strongly factor into why Goy celebrates the current moment in cancer care. But it’s only one piece of the puzzle.
Those innovations exist within the context of actually caring for patients. Which of these new (as well as the old) therapies should be applied — and in what order — is something oncologists are looking to answer with data analytics and insights from genetic investigations.
“When someone has cancer, there’s only two questions that matter: What’s the best option for them now? And what’s the best sequence of care?” Goy said. “When a patient is on the journey of cancer, there’s so many different options today. But we don’t know yet whether A-B-C-D is going to be better than D-C-B-A. That’s going to vary with patients.”
Ideally, innovations in cancer care will also continue to improve in the area of diagnosis, Goy said.
“Cancer is increasing in incidence and is expected to increase by 60% over the next 25 years,” he said. “We have screening tools for some cancers, but, regardless, 70% of cancer deaths come from cancers with no screening tests. At the same time, early stage cancers have about 90% survival versus as low as 5 to 10% for advanced stages.”
Just as innovation is being pointed toward efforts in the early diagnosis of cancer, Goy said more is being done to determine the best path for patients who have achieved remission from cancers.
Already, there’s markers that are measurable on radiological examinations that can predict with certainty whether someone is at risk of a relapse.
“So, we need to tackle this and consolidate treatment to better prevent recurrence in patients post-cancer care,” Goy said.
One of the last pieces of cancer care innovation is connected to the work being done at a partner institution to Hackensack’s John Theurer Cancer Center, the Center for Discovery & Innovation. There, research on how genes are altered and function, known as epigenetics, is being conducted that is expected to drive clinical decisions in the near future.
Goy said one of the goals is to better grasp the cell behavior that determines whether immune cell-modifying therapies work for patients.
“When immunotherapy works, when we stop treatment, those patients don’t relapse (as often),” he explained. “So, we want to be able to understand who is responding best to immunotherapy and how we might be able to overcome (cancer cell) immunoresistance. And a big part of this will come with better understanding we can tackle the microbiome of patients.”
These innovations are all being paired with exciting advances in the technology used by cancer care teams, he added.
“(With these tech advances), we’re going to do more chemotherapy at home, more screening in the community of patients, much more supportive care along the treatment,” he said. “Generally, we’re going to move medicine toward the community and preemptive medicine.”
The hope, he adds, is that’s all going to contribute to preventing cancer and its complications, as well as improving outcomes.
He’s optimistic cancer care advancements will bear fruit in coming years, even if there are some hurdles to overcome in the meantime.
“Some of the biggest (ones) are costs, variance of care, lack of adoption of innovation early on and lack of referrals to clinical trials when someone has complicated cancer,” he said. “So, there’s many challenges that remain. But this is still a really exciting time. We’re on the cusp of a revolution in cancer care.”
