Cancer Care Outlook 2024: More Treatment Advances and More Minority Involvement in Clinical Trials

While many challenges remain – particularly in overcoming long-established health disparities in cancer care – the cancer outlook for 2024 is encouraging, with continued advances in immunotherapies and more targeted drug therapies, some using so-called antibody drug conjugates (ADCs) which allow for more precise delivery of chemotherapy.

Making sure that everyone has a fair shot at both innovative treatments and standard-of-care therapies is a primary goal of Manmeet S. Ahluwalia, M.D., M.B.A, FASCO, deputy director, chief scientific officer, and chief of medical oncology at Baptist Health Miami Cancer Institute, and Fernandez Family Foundation Endowed Chair in Cancer Research.

Dr. Ahluwalia co-leads the Center for Equity in Cancer Care & Research at the Institute, founded in September 2022 by Leonard Kalman, M.D., Executive Deputy Director and Chief Medical Officer at Miami Cancer Institute. The Center’s mission is to identify and decrease disparities in cancer care and to improve minority participation in clinical trials. The Institute is involved in a rapidly growing number of initiatives.

Manmeet Ahluwalia, M.D., deputy director, chief scientific officer, and chief of medical oncology at Baptist Health Miami Cancer Institute.

 

“We have close to 200 trials which are open at Miami Cancer Institute,” said Dr. Ahluwalia. “Our particular interest is to increase minority enrollment to clinical trials. Now there's guidance from FDA (U.S. Food and Drug Administration) that if clinical trials do not have enough minority participation, it may affect post drug approval requirements. If a drug gets approved and does not have adequate minority representation, there needs to be a representation of minorities in post-approval studies..”

Overall, there is a higher incidence of cancer in Black men. And although women have a lower incidence of cancer, their mortality rates are higher. How bad are cancer care disparities among minorities? Dr. Ahluwalia points out these examples:

• Among Black men, the incidence of major cancers is higher than Whites: lung, colorectal and kidney.
• Black women have a higher incidence of cancers with low survival: stomach and pancreas.
• The uterine cancer incidence rate among Black women is 20 percent as high as in White women.
• The incidence of prostate cancer is 70 percent higher in Black men than in White men & mortality rates are twice as high.

Overall, Hispanic individuals are less likely to be diagnosed with cancer than white individuals, but have a higher incidence of specific cancer types, adds Dr. Ahluwalia. Hispanic men and women have nearly double the incidence and mortality rates for liver and stomach cancers.

The Center for Equity in Cancer Care & Research is helping get the word out among minority communities about the importance of taking part in clinical trials.

“We are working with patient navigators and community health workers to educate people about the importance of clinical trials because there's a cultural mistrust or lack of trust in minority populations,” explains Dr. Ahluwalia. “We also are now looking into providing transportation support using grants from American Cancer Society because social determinants to health adversely affect people of color. We are making sure that there's a consent form in Spanish because there are about 20 percent of patients that we see who may not read or understand English.”

Overcoming the Low Rates of Lung Cancer Screenings

The American Lung Association released its 2023 “State of Lung Cancer” report in November, finding that the rate of lung cancer screening in Florida “is far too low at 2.4 percent, compared to the national average of 4.5 percent.” Overall, lung cancer survival rates have increased over the past five years, but serious disparities remain among Black and Hispanic/Latino communities in Florida and across the nation, the report finds.

“We know that patients of minority origin also tend to have a lower screening rate. So, the rate for Hispanics is around only 2 percent. There’s a lot for us to improve the rate of lung cancer screenings --  not only in the state of Florida but nationally,” said Dr Ahluwalia.

Part of the mission of the Center for Equity in Cancer Care & Research is to ensure that the latest advances in both treatments and screenings are reaching all cancer patients.

To build awareness and encourage those at highest risk – primarily smokers and ex-smokers — to undergo lung cancer screenings, Baptist Health South Florida and the American Lung Association joined forces in 2021 as part of the “Saved By the Scan” campaign. The partnership, the first between a large healthcare organization and the American Lung Association, produced very encouraging results. The campaign resulted in a 55 percent increase in lung cancer screenings, using low-dose CT scans. Baptist Health has partnered with LUNGevity Foundation, the nation’s leading lung cancer-focused nonprofit organization, to set up a screening program targeting the Hispanic/Latino community.

Prior to these campaigns, Florida ranked as one of the lowest in the nation in the percentage of patients – primarily smokers and ex-smokers -- getting lung cancer screenings .

“When you look at the Hispanics, that number is actually 2 percent,” said Dr. Ahluwalia. “70 percent of the patients that we see in Miami-Dade County are Hispanic in origin. And that was the impetus for us to build the first lung cancer screening program for Hispanics in partnership with LUNGevity.”

Immunotherapies and Other Treatment Advances

Dr. Ahluwalia is quite optimistic about the continued advances in treatments, including the use of immunotherapies and more targeted drug therapies.

The Institute’s glioblastoma study as an example of the cutting-edge research that is underway. Glioblastomas are the most common and the most aggressive brain tumors. Because the tumor cells reproduce rapidly, glioblastomas are highly malignant, and can recur often despite surgery, radiotherapy, and chemotherapy. They can also quickly spread into other parts of the brain.

“We have a vaccine that we've been involved in leading nationally and internationally, a vaccine against glioblastoma, which had shown a lot of good results, at least in a phase two trial,” explains Dr. Ahluwalia. “The vaccine trial has shown promising results in initial trial. Average survival of glioblastoma patient is around 15 to 16 months. The initial results from the use of vaccine has resulted in a survival of around 26 months.”

The other primary area of advancements in cancer treatments centers on antibody drug conjugates, ADCs – the so-called “Trojan horses” that are released into cancer cells. Essentially, ADCs targeted toxic agents to tumor cells with minimal damage to normal cells — some refer to this as “smart chemo.”

“Initially, we gave patients chemotherapy that produces many side effects,” said Dr. Ahluwalia. “Now we have precision ‘smart oncology bombs’ or Trojan horses. We use these particular receptors to get inside the cancer cell. These receptors may not be present on a normal cell, so once it goes into the cancer cell, then it releases the payload, which only goes off in a cancer cell. This is what is making the side effects less common -- but the drugs are more effective.”