A Year of Advancement: AACR Cancer Progress Report 2024
Screening successes, emerging technologies, precision treatments, and other steps forward from the AACR Cancer Progress Report 2024
Thanks to better prevention, detection, and treatment, cancer survivorship is increasing. According to the American Association for Cancer Research (AACR) Cancer Progress Report 2024, decreasing mortality rates for many common cancers are contributing to the growing population of cancer survivors in the US and worldwide. But the news is not all good—cancer incidence in younger adults is rising, and advances in detection and treatment options continue to spotlight the need for greater diversity in trials and more equitable access to every aspect of cancer care.
Understanding and reducing risk
New research has yielded insights into the mechanisms driving cancer and metastasis. In particular, a broader understanding of cancer genetics is improving our ability to evaluate people’s risk of cancer, take preventive measures, or select appropriate treatments after diagnosis.
A recent study of mutations in almost 8,000 lung cancer patients revealed a high rate of pathogenic germline mutations in DNA repair genes—knowledge that could eventually lead to more accurate risk stratification for patients and their families.
RNA analysis has also identified microRNAs, such as miR-15 and miR-16, whose loss contributes to cancer development, and long noncoding RNAs, such as HOTAIR that drive cancer growth, metastasis, and treatment resistance. Protein posttranslational modifications and epigenetic changes can also influence cancer onset and progression, allowing them to serve as biomarkers of disease risk and treatment response, as well as novel targets for anticancer therapeutics.
Spotting cancer sooner
Early cancer detection not only saves lives, but also reduces the burden of treatment on both patients and healthcare systems. More sensitive cancer detection, targeted screening, and increased uptake have reduced mortality rates in multiple cancers, with models projecting that a 10 percent increase in uptake could result in further gains—including a 40 percent reduction in cervical cancer deaths.
For people who already undergo recommended cervical cancer screenings, however, primary screen intervals could potentially be extended. Current guidelines recommend that people over 21 years of age undergo screening every three years via cervical cytology or every five years via human papillomavirus (HPV) testing, but a recent study showed that cervical cancer risk three years after cytology screening was comparable to the risk eight years after HPV testing—suggesting that longer intervals might preserve patient safety while lowering screening costs and barriers.
Efforts to increase cancer screening uptake have included electronic reminders, letters, telephone calls, community engagement programs, and increasing use of home sample collection where possible. Among individuals due for cervical cancer screening, those who were given educational materials and mailed self-sampling kits had approximately 15 percent higher screening rates than those only given educational materials.
Exploring emerging technologies
Emerging tools such as artificial intelligence (AI)-based diagnostic support and improved liquid biopsy and stool testing are also moving the field of cancer screening forward—although these innovations are not without their drawbacks (see Table 1).
More work is needed to fully understand and mitigate bias in AI algorithms and training data to ensure that these tools improve the overall diagnostic picture without amplifying existing inequities.
Liquid biopsy is now routinely used in many settings for cancer diagnosis, treatment selection, and monitoring; however, as the technology becomes more affordable and its detection limits improve, it may offer new options for minimally invasive early cancer detection.
“Cancer diagnostics are becoming more sophisticated,” AACR president Patricia M. LoRusso said in a recent statement. “New technologies, such as spatial transcriptomics, are helping us study tumors at a cellular level. AI-based approaches are beginning to transform cancer detection, diagnosis, clinical decision-making, and treatment response monitoring. These advances will result in improved patient care.”
Artificial Intelligence | |
---|---|
Pros | Cons |
Can increase diagnostic speed and accuracy | May perpetuate data biases |
Facilitates detection of precancerous lesions | May inherit algorithmic biases |
Reduces workload through case triage and diagnostic support | May promote cultural biases |
Integrates with LIS and EHR for provider prompts and patient reminders | May increase cancer disparities |
Liquid Biopsy | |
Pros | Cons |
Can detect multiple cancers or mutations simultaneously | May lead to higher false positive rates |
Reduces risk because it is a minimally invasive procedure | May miss precancerous or early-stage lesions |
Reduces anxiety associated with cancer testing | May not be equally effective in all populations |
Overcomes barriers such as resource or geographic limitations | May be less accessible or affordable |
Table 1. The pros and cons of emerging cancer screening technologies. Adapted from AACR Cancer Progress Report 2024. |
Promising precision medicine
Molecularly targeted therapies have moved ahead by leaps and bounds, with 8 new approvals and 11 application expansions between July 2023 and June 2024. Many of these treatments require molecular testing prior to prescription because they target particular proteins expressed in only a subset of patients or tumors.
Significant approvals and expansions include:
- Capivasertib, the first breast cancer treatment to block the function of AKT, a protein essential for cell survival and replication via the PI3K-AKT-PTEN pathway. The drug was approved alongside a companion diagnostic used to identify patients with specific mutations in AKT1, PIK3CA, or PTEN.
- Repotrectinib, a non-small cell lung cancer (NSCLC) treatment that targets tumors with gene fusions involving ROS1 or who have mutations in ROS1, NTRK1, NTRK2, or NTRK3.
- Quizartinib, a treatment for newly diagnosed acute myeloid leukemia in patients who have internal tandem duplications in the FLT3 gene. It was approved alongside a companion diagnostic that tests for the FLT3 alteration.
- Niraparib, a drug that targets tumors with BRCA gene mutations. It was previously approved for gynecological cancers but is now also approved for the treatment of prostate cancer.
- Adagrasib, which targets the KRAS G12C mutation and was previously approved for NSCLC, is now approved, in combination with EGFR inhibitor cetuximab, for colorectal cancer.
Alongside faster, more accurate, and more accessible genetic testing, molecularly targeted therapies offer new treatment options for patients with resistant disease—and bring with them reductions in off-target effects that negatively impact patients’ outcomes or quality of life.
The road ahead
Clinical laboratory professionals dealing with cancer in 2024 have a broad and varied menu of diagnostic, prognostic, and monitoring options available to them. Patients are afforded unprecedented insights into the molecular drivers of their disease, along with precisely targeted therapies for many previously untreatable forms of cancer.
Even so, challenges remain: some cancer types, such as pancreatic and uterine, are still on the rise; others, such as colorectal cancer, are being diagnosed at increasingly young ages; and health disparities are evident from the earliest screening stages to the ultimate outcomes of treatment for cancer.
More research, and more equitable application of the benefits of that research, are needed to defeat the disease—and the clinical lab plays a critical role in that work.