From Precision Medicine to AI: The Future of Cancer Care

Cancer treatment is changing rapidly. For many patients, treatment is no longer a single course of chemotherapy or radiation, but an ongoing journey that can involve targeted therapies, immunotherapy, genomic testing and clinical trials.

Dr. Manmeet Ahluwalia, director of the Brain Tumor Program and medical oncologist at the Miami Cancer Institute, part of Baptist Health South Florida, sees these changes firsthand. He says advances in precision medicine are helping doctors better understand each patient's cancer and select treatments based on the unique characteristics of their tumor.

For World Cancer Research Day, CURE spoke with Ahluwalia about how cancer care is evolving and what patients should know about the future of treatment.

CURE: Cancer treatment can feel like an ongoing journey rather than a single chapter. What should patients know about how cancer care is changing and becoming more personalized?

Ahluwalia: According to a recent report from the American Cancer Society, cancer is increasingly becoming a chronic disease. For the first time, 70% of patients diagnosed with cancer live more than five years. That's a great win and a testament to the investment that has been made in cancer research and drug development, especially over the last two decades.

We have increasingly moved into an era of precision oncology, or personalized medicine. When a patient comes to see us, we look at their tumor and identify the genetic changes that are driving their cancer. Then we can select the best treatment for that particular patient.

Traditionally, we used chemotherapy, which could be tough on the body and cause significant side effects. These newer personalized medicines can sometimes be given for several years and have led to transformative improvements in patient outcomes.

Patients are hearing more about precision medicine, targeted therapies and immunotherapy. How are these advances changing treatment decisions?

Ahluwalia: When we see a patient with a complex cancer, one of the first things we do is take their tissue and perform robust genomic testing. We look at their DNA as well as the RNA that may be driving the cancer.

Then we ask: What is the best available drug or clinical trial for this patient?

Lung cancer is a good example. When I was in training two decades ago, we had combinations of chemotherapy that were given to almost everyone, and patients with advanced disease lived around eight months on average.

Now, we have many different drugs for lung cancer. Depending on the genetic makeup of a patient's tumor, we can select the treatment that is most appropriate for them.

Several patients with metastatic lung cancer are now living three, four or more years. Even among patients with brain metastases, there are subsets who are living five years or longer.

The power of genomic profiling and precision-based drug development has truly transformed outcomes. When you see a cancer specialist, it's important to ask whether your tumor should be profiled and whether there are targeted treatments or clinical trials that may be appropriate for you.Even when treatment is working, living with cancer can involve a lot of uncertainty. How can patients navigate the emotional side of not knowing what comes next?

Ahluwalia: I always tell my patients and their caregivers that it takes a village to take care of a cancer patient.

At our cancer institute, we have surgeons, radiation oncologists and medical oncologists working together. But we also have patient navigators who help patients through their cancer journey, as well as social workers and support groups.

I encourage patients to reach out to their tribe. Patients who have stronger support systems typically tend to have a more positive outlook and can have an easier time navigating their cancer journey.

There are also advocacy organizations and support groups, including groups that are available online, that can be valuable resources for patients and their families.

Quality of life is increasingly becoming part of the cancer conversation. How should patients advocate for their quality of life while making treatment decisions?

Ahluwalia: Patients have become increasingly informed in this era of technology. Many times, when patients come to see us, they already know their diagnosis. Sometimes they even know the treatments and potential side effects.

I always think about how much benefit we're going to get from a treatment and what the cost of that benefit is in terms of toxicity. It's about finding a balance.

Quality of life is an essential component of treatment. If patients are going to be taking a medicine for several years, it's extremely important that side effects are recognized early and managed so patients can maintain a good quality of life.

Quality of life has also become an important part of clinical trials. The goal isn't just to look at whether a treatment works, but also at its impact on patients.

I encourage patients to have that conversation proactively with their physician and talk about what matters most to them.

There is a lot of excitement around new technologies and treatments in oncology. What developments are you most optimistic about for the future of cancer care?

Ahluwalia: If you look at drug development over the last 25 to 30 years, we've made tremendous progress.

I'm particularly excited about continued advances in immunotherapy. We're also very excited about antibody-drug conjugates, which use an antibody to deliver a chemotherapy payload directly into cancer cells. This approach can potentially make treatment more effective while limiting some of the side effects associated with traditional chemotherapy.

We're also excited about increasingly personalized targeted therapies and CAR T-cell therapies, in which a patient's own immune cells are modified to help fight cancer.

And then there's artificial intelligence. AI has the potential to help us make sense of the enormous amount of genomic and clinical data we're collecting. That could help accelerate drug development and improve how we understand cancer.

Ultimately, I'm excited because these advances may give us new opportunities to treat cancers that have historically been difficult to treat.

If you could change one thing about the way we think about or talk about living with cancer, what would it be?

Ahluwalia: Cancer is a diagnosis not only for the patient but for the entire family because it affects everyone.

I tell people it's important to seek treatment at a major cancer center with experts who treat their particular type of cancer regularly. It's also important to seek care at a center that has access to clinical trials because some of the greatest innovations of tomorrow are available through clinical trials today.

I also encourage patients to be positive and to be an active stakeholder in their own treatment. Having a strong family and support system is very important because, as I said earlier, it truly takes a village to take care of a cancer patient.

When patients are treated at a center with access to genomic profiling, the latest surgical and radiation technologies and clinical trials, they are giving themselves access to a broad range of treatment options.

Our goal should be to simplify what is an incredibly complex disease for patients and their families.

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