Sep 01st 2021

Oncology Trends 2021: More Precision Therapies Than Ever

If there's one constant in medical oncology, it's that new cancer therapies are hitting the market at a dizzying pace. The U.S. Food & Drug Administration (FDA) issued a total of 59 oncology drug approvals in 2020. They included:

  • 21 new drugs
  • 2 biosimilars
  • 36 new or expanded drug indications.

2021 is on track to be another banner year for new FDA-approved oncology drugs. Keeping up with all of these advances is important. Here's what you need to know to stay up to date on the major classes of new oncology drugs.

 

Immunotherapy Drugs
Immunotherapy is a broad category of drugs that harness the immune system to fight cancer. Immunotherapy drugs come in many forms, including:

  • Checkpoint inhibitors that allow immune cells to respond more strongly.
  • T-cell transfer therapy, in which immune cells from the tumor are removed and modified in the lab before being returned to the patient's body.
  • Cancer vaccines, which protect against viruses, like the human papillomavirus and hepatitis B, that can cause cancer.
  • Cytokines, which suppress the formation of tumors by controlling infection and inflammation.
  • Adjuvants, which activate antigen-presenting cells and can enhance adaptive immune responses.

Immunotherapies that use genetic engineering to boost immune cells' anti-cancer abilities—a type of gene therapy.

Mechanism of action: These vary depending on exact drug type. Generally, cancer immunotherapy drugs either train immune cells to recognize and attack specific cancer cells, or they boost immune cells so they can eliminate cancer. Immunotherapy drugs can also enhance the body's immune response by adding cellular components.

FDA-approved drugs and immunotherapies exist for the treatment of:

  • Bladder cancer
  • Breast cancer
  • Colon-rectum cancer
  • Esophagus cancer
  • Head-neck cancer
  • Kidney cancer
  • Leukemia
  • Lymphoma
  • Liver cancer
  • Lung cancer
  • Melanoma
  • Multiple myeloma
  • Merkel cell carcinoma
  • Prostate cancer
  • Sarcoma
  • Skin cancer
  • Stomach cancer
  • Uterus cancer.

Immunotherapy drugs are being studied for cancers that affect the:

  • Brain
  • Cervix
  • Ovary
  • Pancreas.

 

Small-Molecule Targeted Therapies
Small-molecule targeted therapies prevent cancer cells from multiplying and spreading by disrupting specific molecular targets found in or on cancer cells. Each targeted therapy can only be effective if the patient's tumor contains that specific mutation or protein. Testing, such as next-generation sequencing, is necessary to identify effective therapies for each patient. Many targeted therapies are specific to a type of cancer. Other targeted therapies known as tumor-agnostic treatments focus on a specific genetic change instead of where the tumor is in the body.

Mechanisms of action: Varies depending on the exact drug. Some targeted therapies can starve the tumor by blocking the formation of new tumor-feeding blood vessels. Targeted therapies can also trigger cancer cells to self-destruct, for example.

Cancers treated by FDA-approved small-molecule targeted therapies include:

  • Bladder
  • Brain
  • Breast
  • Cervix
  • Colon-rectum
  • Endometrium
  • Esophagus
  • Head-neck
  • Kidney
  • Leukemia
  • Liver-bile duct
  • Lung
  • Lymphoma
  • Multiple myeloma
  • Ovary
  • Pancreas
  • Prostate
  • Skin
  • Stomach
  • Thyroid.

Being studied in:

  • all of the above.

 

CAR T-Cell Therapies
In this type of gene therapy, the patient's own T cells are genetically engineered to produce what's known as a chimeric antigen receptor (CAR). In CAR T-Cell therapy, the CARs then “reprogram" the T cells to recognize and kill cancer cells after being returned to the patient's body.

Mechanisms of action: The CARs allow T cells to attach to the target antigen, or protein, on tumor cells.

CAR T-Cell therapy is:
  • FDA approved for:
    • Acute lymphoblastic leukemia (ALL)
    • Multiple myeloma
    • Some lymphomas.
  • Being studied in:
    • Additional blood cancers
    • Cervix cancer
    • Head-neck cancer.

 

Bispecific T-Cell Engager (BiTE) Therapies

Bispecific T-cell engager (BiTE) therapies are a type of gene therapy where engineered proteins are used to link a patient's own T cells to the proteins their tumor expresses. This combined molecule activates the cancer-killing potential of a patient's T cells.

Mechanisms of action: Artificial bispecific monoclonal antibodies form a link between T cells and tumor cells. They direct the T cells to produce proteins that enter tumor cells and trigger their self-destruction process.

BiTE therapies are:
  • FDA approved for:
    • Acute lymphoblastic leukemia (ALL).
  • Being studied in:
    • Multiple myeloma
    • Lymphoma
    • Acute myeloid leukemia (AML)
    • Small-cell lung cancer
    • Prostate cancer
    • Gastric cancer.
 
Stay Up-To-Date on Clinical Oncology News
If you're a health plan representative and would like to learn more about precision oncology and the latest oncology trends, we encourage you to check out our Medical Oncology 101 for Health Plan Professionals webinar.

Dr. Stephen Hamilton, eviCore's Chief of Medical Oncology, will help you understand the major categories of medical oncology drugs and how they fight cancer. You'll also learn about oncology trends in 2021 and beyond.