Cancer is more than just a single disease—it’s a complex collection of conditions that demand personalized approaches to treatment. While navigating a diagnosis can be overwhelming, there’s hope on the horizon thanks to advancements in cancer care such as targeted therapies, immunotherapy and more personalized treatments. We spoke with Dr. Shridar Ganesan, MD, Ph.D., director of the new Center for Molecular Oncology at NYU Langone Health’s Perlmutter Cancer Center, about how these advancements are improving survival rates, enhancing the quality of life for patients and may result in a future where some cancers will be well-managed conditions.
NJF: How have cancer treatments changed over the years and what are the most significant advancements?
Dr. Shridar Ganesan: The greatest advancements in cancer treatment now are targeted therapeutics and more personalized treatments. In the old days, we had one treatment; we thought one cancer is one disease. Now we realize that there’s lots of different kinds of cancers driven by different molecular changes. Those impact the kinds of treatments.
For example, for lung cancer, we have treatments ranging from targeted therapy to immunotherapy based on exactly what kind of lung cancer you have. It can improve the efficacy and reduce the toxicity of our treatments. For breast cancer, we now have molecular tests that are used routinely to customize treatment plans for individual patients. The development of targeted therapies in lung cancer and breast cancer have significantly improved outcomes in these diseases
Immunotherapy has also really changed the way we manage some, but not all, cancers. For example, in melanoma, which was notoriously chemo-resistant, immunotherapy is often part of our current standard approach. Some immunotherapy approaches, like antibodies to PD-1, basically wake up the immune system to allow your body’s immune system to reject certain cancers. There is also cellular immunotherapy, like CAR-T therapy, in which your own immune cells are modified to target cancers and this has been used to great effect in certain leukemias and lymphomas. Not every cancer is amenable to immunotherapy; many breast cancers do not respond to this approach, even though some triple negative breast cancers do benefit, whereas many melanomas and lung cancers can benefit from this. The use of molecular testing to guide treatment has really changed the landscape of our treatment approach to multiple cancer types.
Continuing advances in our understanding of cancer biology, and development of novel treatment approaches are causing rapid changes in how we approach the treatment of many cancers.
NJF: Would these advanced methods be considered a first line of treatment or more of an alternative therapy?
Dr. Ganesan: It depends on the kind of cancer you have, what stage, where it is, etc. Chemotherapy and radiation still form the backbone of many treatments. However, immunotherapy, targeted therapy and other forms of treatment are starting to play a role, even up front, in certain kinds of cancer.
ScreenNJ is a statewide service that provides education about cancer prevention and detection to the community and professionals. ScreenNJ supports NJ residents to obtain cancer screening through navigation and mobile health services regardless of their ability to pay. For more information about ScreenNJ visit screennj.org.
NJF: How are technologies like AI, telehealth and robotic surgeries contributing to advancements in cancer treatment?
Dr. Ganesan: Telehealth has really taken off since the pandemic. It’s become useful when you’re unable to have a real physical interaction. But we can’t make diagnoses over telehealth. But it is useful in certain circumstances
In terms of robotic surgery, it has streamlined a lot of our approaches to surgery. I’ll leave that to my surgical colleagues. I think it will, hopefully, reduce complications associated with certain surgical procedures.
AI is just evolving and has lots of promise. Certain things are already being used, like AI-assisted interpretation of radiographic studies. I look forward to seeing how those are implemented and validated.
NJF: How do you think these advancements might impact the overall quality of life for cancer patients?
Dr. Ganesan: In the future, I hope we look back in shock and appreciation of how far we’ve come as our treatment options get better and better. We’re going to better classify our diseases, get treatments that target the root cause of the individual cancer that people have, and have personalized prevention, screening and treatment. Ultimately, the aim is to have appropriate interventions and convert this into a well-managed set of illnesses. We hope to be able to convert some cancers to a chronic illness.
New targeted therapy or immunotherapy has a very different side effect profile than chemotherapy and radiation. But some people can tolerate it and some people cannot. There are a lot of things we don’t know, like why the same person with the same disease has different reactions to the drug. There are a lot of individual features in how we metabolize drugs and how our bodies respond.
My aim is that hopefully in the future, we change the way people think of cancer where patients are struggling with the side effects of treatment, sickly and without hair; we want to be able to treat it like other common diseases people have, living their lives without undue toxicity. We’re starting to achieve that in some sense.
ScreenNJ is a statewide service that provides education about cancer prevention and detection to the community and professionals. ScreenNJ supports NJ residents to obtain cancer screening through navigation and mobile health services regardless of their ability to pay. For more information about ScreenNJ visit screennj.org.
NJF: Are there specific types of cancer where screening accuracy has significantly improved?
Dr. Ganesan: There are some cancers where we didn’t have screening at all before, like lung cancer. People who are at a greater risk of lung cancer can undergo low-dose CT scans to detect these cancers early and improve outcomes. That wasn’t standard practice a while back.
There are more kinds of screenings available for colon cancer, even though colonoscopy remains the gold standard of care. There are now things like stool-based DNA testing and even blood-based testing that are starting to come into play.
There is a lot of interest in blood-based multi-cancer screenings, but these require careful validation.
Cancer vaccines are in their early days, but there’s a lot of hope. The HPV vaccine will prevent the majority of cervical cancers, and a subset of head and neck and penile cancers. Vaccines and treatments for certain forms of viral hepatitis can also prevent a significant subset of liver cancer.
NJF: What are the current statistics on survival rates due to improved cancer screenings and early detection?
Dr. Ganesan: Survival from cancer, overall, is going up. Both screening and improvements in treatment have contributed to that decline. Since the incidence rate of some cancers is flat, but mortality is going down, it suggests that we’re identifying cancers at earlier stages and our treatments are also improving.
There was a recent set of papers that were done by the National Cancer Institute and groups in Boston that showed that if we increase screening rates, we can further increase cancer survival. Clearly, it’s having an impact – but we can do more because still not enough people are being screened.
NJF: Are there any risks associated with cancer screening, such as radiation exposure? If so, do the benefits generally outweigh the risks?
Dr. Ganesan: The benefits certainly outweigh the risks. The risk is not so much from radiation exposure, but rather from identifying a benign lesion for which you’ll get a biopsy. This is known as a false positive and can cause anxiety and invasive procedures. Overall, we know that some cancer screenings ultimately improve your chances of survival in many settings, and are really beneficial to the population in a positive way.
ScreenNJ is a statewide service that provides education about cancer prevention and detection to the community and professionals. ScreenNJ supports NJ residents to obtain cancer screening through navigation and mobile health services regardless of their ability to pay. For more information about ScreenNJ visit screennj.org.
NJF: What is the best way for patients to learn about the latest screenings and treatments?
Dr. Ganesan: The National Cancer Institute has a lot of screening recommendations. There are also guidelines from the American Cancer Society. Having a good primary care doctor that you visit regularly can also help people stay on top of screenings.
NJF: What advice would you give to patients and families navigating a cancer diagnosis and treatment with these new advancements in mind?
Dr. Ganesan: The key thing is people of appropriate age should know their family history of cancer and speak to their primary care doctor about cancer screening. It’s never too early to figure out what you’re going to do so you know in advance when you should start screening.
Cancer screening is really important, and is still underutilized, even with the resources the United States has. There are studies that show that if we increase doing what we already know works to motivate people to get screened, we’d have a major impact. Another thing we can do is find opportunities and new approaches to get people to screen and that’s exciting. We need to find new things we can implement and deliver widely in order to have an effect on people.
Shridar Ganesan, MD, Ph.D., is the director of the Center for Molecular Oncology at NYU Langone Health’s Perlmutter Cancer Center.
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