Richard Simcock: Reflecting on a year of clinical cancer innovations

Richard Simcock, Chief Medical Officer at Macmillan Cancer Support, recently posted on LinkedIn:

“It’s well described that as you age the years go by more quickly. As World Cancer Day promptly arrived earlier this month, I was reminded to take a moment and reflect on the previous year and acknowledge just some of the many advances we have seen in the last 12 months and recognize the efforts of so many fellow healthcare professionals pioneering and shaping important work in the field of oncology.

2023 saw more than 25 NICE appraisals for new cancer treatments, while in breast cancer we saw Olaparib made available for people affected by breast cancer who have inherited the BRCA gene. There were headline-grabbing announcements around the personalized immunotherapy drugs (CAR-T) available for blood cancers. These therapies represented new frontiers in scientific discovery, but also in price level for NHS-funded treatments. Meanwhile NICE also approved the first immunotherapy drug for advanced cervical cancer. These approvals mean that people with cancer today are receiving these drugs and have another treatment option, while new data published at conferences and in journals continues to offer new hope. Most notably in the new data category was the session from Tom Powles from Barts at the ESMO Conference in Madrid, where his presentation on a combination of new antibody-dependent conjugates and immunotherapy appeared to move the dial on advanced bladder cancer for the first time in over a decade.

It wasn’t just new drugs that made the news, but also old drugs with new purpose. The NHS ‘repurposing medicines’ program launched which introduced the use of decades-old anastrozole as a therapy that may reduce the risk of breast cancer. The news was welcome but the NHS launch needed more guidance and support for primary and secondary care. It left many hopeful people struggling to get answers. A reminder that the introduction of change, old or new, needs infrastructure.

There were important shifts elsewhere. 2023 was the year that most of us first heard of ChatGPT. Meanwhile, NICE introduced guidelines on the use of artificial intelligence in radiotherapy workflows and in chest x-ray analysis which I believe marks a significant shift towards more adoption of AI to support cancer care as an everyday tool.
I suspect the most (over)used the word recently in relation to cancer advances has been ‘precision’, meaning specific molecular and genomic changes in a person’s cancer. Understanding those changes took a step forward with a detailed publication from the 100,000 Genomes Cancer Programme just last month that highlighted genomic changes that may help us to inform prediction and prognosis for future patients. All of this advance needs to prove itself, and the news last year that in England one-year survival rates for (most) cancer have improved is a welcome testament to these advances and all the ones that preceded it. While these are promising steps forward, this specific data only measures up to 2020 and we know that the pandemic, cost-of-living, and other external challenges may well play a role in stalling further improvements. There is still much work to be done.

Looking back can be helpful, but looking forward is essential. We demonstrated our commitment to be future-focused at Macmillan with the publication of our work on influencing the future of cancer care. I expect the themes from the work will be relevant in the year ahead. Specifically, NHS and social care will be challenged to introduce innovation when a workforce and funding crisis, caused by years of Government underinvestment, threatens the service’s ability to do the fundamentals well. We need services that can offer the latest genomic insight, but they also need to have acceptable waiting times and access to services. Attention to building back the basics seems to me to be of greater importance than the shiny and optimistic distractions of the best of science. The ‘sweet spot’ where innovation helps us to do the ordinary and important things well and quickly is one we should be aiming for over the next year.

My final observation of the many wonderful advances of the last year is that none of them replace the need for person-centered care and the requirement for a good conversation with a person affected by cancer about what matters most to them. Personalized care should always be at the heart of treating and caring for people with cancer.”

Source: Richard Simcock/LinkedIn