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New advances in cancer treatment are transforming the treatment landscape. Dr Richard Quek, Senior Consultant, Medical Oncology explains 5 of these innovative treatments.

Over the last decade, we have seen cancer treatment options extend to a wide arsenal of treatment modalities, from surgery to chemotherapy, radiation therapy, targeted therapy, and immunotherapy, among many others.

Conventional treatment such as surgery, chemotherapy and radiation therapy remain the standard of treatment for many cancers. However, the emergence of new cancer drugs and advances in cancer treatment techniques are transforming the treatment landscape and improving patient outcomes.

Here are 5 of these new cancer treatment advances that we are seeing in 2023:

1. Antibody-drug conjugate (ADC)

What it is:

ADCs are a new class of drugs that are designed to target and destroy cancer cells. They combine monoclonal antibodies specific to proteins expressed on t he cancer cells surface (cancer antigens), with highly potent chemotherapy or radiation particles. The potent chemotherapy/radiation payload is released onto cancer cells, when the ‘homing’ antibodies have attached to cancer antigens. The proximity of the chemotherapy or radiation payload to the cancer cells allows for significantly smaller doses of payload to be used, which in turn reduces side effects from the treatment.

How it is transforming the treatment landscape:

Conventional chemotherapy is designed to eliminate fast-growing cancer cells. It can, however, also harm surrounding healthy cells.

By linking chemotherapy drugs with a cancer-seeking molecular using ADCs, we are able to optimise the features of both components through (1) differentiation between healthy and malignant cells using monoclonal antibodies, and (2) the cancer cell-killing ability of chemotherapy drugs.

ADCs have shown promising results and are approved in the treatment of certain cancers. For example, the clinical application of Enhertu — a specifically engineered HER2-directed ADC — has seen significantly improved survival for women with previously treated HER2-positive metastatic breast cancer¹, as well as others with HER-amplified cancers e.g. lung/ stomach cancers.

2. Neoadjuvant immunotherapy

What it is:

Immunotherapy has rapidly become the cornerstone of treatment for many cancers over the years. The use of immunotherapy in the neoadjuvant setting (i.e. administering immunotherapy prior to surgery) is an emerging option that allows us to shrink a tumour or stop the spread of cancer prior to surgery, making the surgical procedure less invasive and more effective.

How it is transforming the treatment landscape:

Generally, cancer burden is highest prior to surgery. It is thus the best time to prime the immune system to attack the cancer.

Initial studies on neoadjuvant therapy in the treatment of melanoma and lung cancer have been very encouraging. One study showed that melanoma patients who received neoadjuvant immunotherapy had a significantly lower risk of cancer recurrence compared to patients who received the drug only after surgery².

Another study on patients with resectable non-small cell lung cancer (NSCLC) showed that neoadjuvant immunotherapy plus chemotherapy resulted in significantly longer event-free survival than chemotherapy alone³.

3. Personalised cancer vaccines

What it is:

Cancer vaccines help ‘educate’ the immune system to recognise specific mutations on cancer cells and eliminate them. Recently, two pioneering pharmaceutical companies, Moderna and Merck, collaborated to develop personalised messenger RNA (mRNA) cancer vaccines that are custom-built based on an analysis of patients’ tumours after surgical removal.

How it is transforming the treatment landscape:

Re sults from Merck – Moderna’s study⁴ on the use of mRNA vaccine in combination with immunotherapy, showed a reduced risk of recurrence or death by 44% compared to immunotherapy alone in Stage 3 and 4 melanoma patients with high risk of recurrence following complete resection.

These results suggest that this combination may be a new treatment option that can potentially extend the lives of patients with high-risk melanoma.

4. CAR T-cell Therapy

What it is:

Chimeric Antigen Receptor (CAR) T-cell Therapy is a type of immunotherapy where a patient’s T-cells (a type of white blood cells) are extracted and genetically engineered to form CARs, which bind to cancer-related proteins. The modified T-cells are then reinfused into the patient to detect the cancer cells and initiate a series of immune responses against them.

Singapore is the first country in Southeast Asia to offer the treatment⁵.

How it is transforming the treatment landscape:

CAR T-cell Therapy has shown very promising outcomes for the treatment of blood cancers. Selected groups of patients are eligible for CAR T-cell Therapy, including:

• Children and young adult patients from 2 – 25 years old with B-cell Acute Lymphoblastic Leukemia (ALL) that is resistant, and where a relapse has occurred subsequently or post-transplant
• Adults with relapsed or refractory Diffuse Large B-cell Lymphoma (DLBCL) who have not benefited from at least two types of standard treatment
• Adults with relapsed or refractory Follicular Lymphoma (FL) who have not benefited from at least two types of standard treatment.

The overall success rate in achieving remission with CAR T-cell Therapy is 60 – 80% for lymphomas, and 70 – 80% for leukemias⁶. Many patients with previously relapsed blood cancers have also shown promising results with no evidence of cancer after receiving treatment.

5. Proton Therapy

What it is:

The use of protons in radiation therapy (RT) has emerged in the recent decade thanks to advances in technology, computing power and imaging. Compared to traditional RT, where radiation is delivered to cancer cells using photons (X-rays, gamma rays) or particles, proton therapy uses protons (positively charged particles extracted from hydrogen atoms). These protons are injected into a cyclotron or synchrotron particle accelerator to deliver the protons to a tumour at any depth in a patient’s body.


How it is transforming the treatment landscape:

Proton therapy can benefit both adult and paediatric patients in a wide range of cancers. Compared to traditional RT, proton therapy can deliver an extremely high dose of radiation to a very localised site, resulting in the following benefits:

• Minimal radiation to healthy tissue
• Reduced risk of secondary cancers
• Safe dose escalation associated with higher overall survival
• Reduced risk of radiation-induced malignancy in young patients
• Reduced side effects and toxicities in critical locations such as the base of the skull and the prostate

What it means for cancer patients

These advances have so far shown promising results in the treatment of many cancers. Eligible patients can benefit from more precise treatments that are lower in toxicity and less invasive, leading to better survival rates, reduced side effects, and overall treatment outcomes.

As many of these treatment advances are relatively new, there remain some challenges and research gaps to consider. Firstly, cancer cells may bypass treatment mechanisms and become resistant to treatment. Secondly, not enough research is going into rare cancers, which often fall under the radar of pharmaceuticals due to low returns on investment.

Nevertheless, these revolutionary advances offer cancer patients new, personalised treatment options that they can benefit from presently and in the future