Ian Sample speaks to the Guardian’s health editor, Andrew Gregory, and Dr Roy Herbst about the world’s biggest annual gathering of oncology professionals. Each year’s event features a mass of new research, and 2023 was no exception. What were the standout advances, and could they lead to permanent changes in the way we treat, think about and live with cancer?. Help support our independent journalism at theguardian.com/sciencepod

Cancer remains the leading cause of death worldwide, claiming the lives of roughly 10 million people each year.

But continuous advances in medical science mean we also know more than ever about its causes and how to treat it.

Earlier this month, over 40, 000 specialists gathered for the annual meeting of the American Society of Clinical Oncology to share research, discuss new treatments and ultimately save lives.

So Where are the biggest breakthroughs occurring?

And could new drugs change the way we think about cancer forever?

From The Guardian, I'm Ian Sample, and this is Science Weekly.

Andrew Gregory, you're the Guardian's health editor and you've been covering the American Society of Clinical Oncology conference in Chicago, the largest cancer research conference in the world.

Give us a sense of what that meeting's like.

Yeah, it's a huge meeting and it's the largest cancer research conference in the world because of the number of experts who attend.

So about 42, 000 oncologists, researchers and scientists arrived for this year's conference.

It takes place in a huge building called McCormick Place, which is settled on the shore of Lake Michigan and it makes for an incredible meeting place for all these people to discuss, to debate, to learn where they're making progress and also where they need to make more progress in terms of cancer research.

And what were the kinds of treatments that caught your eye this year?

There were lots of things that stuck out.

1, in breast cancer, the arrival of a new drug that basically reduces the risk of breast cancer coming back by a quarter.

We know breast cancer treatments now are very very effective so the way the research world is going is now looking at what more can be done to reduce recurrence in patients.

And then 1 in ovarian cancer, where they're looking at combinations of drugs.

So 1 of these drugs is very, very successful in ovarian cancer at the moment, but they found that adding another drug which promotes cells that effectively kill cancer can really have an impact in terms of shrinking tumours and making sure that the cancer is fully removed after surgery.

And then a very different type of study, 1 in blood cancer, and this is a new form of immunotherapy that researchers are getting very excited about.

This particular study was in multiple myeloma, which is an incurable form of blood cancer.

And what they found was that by using this form of immunotherapy, they actually found according to the results presented, that it cuts the risk of blood cancer progressing by as much as 74%.

Have there been any major developments on that front?

1 in particular that caught my attention was a blood test developed by a Californian company and that has actually started trials in the NHS in the UK and it detects fragments of a substance that effectively tells you whether or not that patient might have cancer.

Really interesting going forward, but I have to say I wasn't totally convinced by the results on this 1.

I think there's a long way to go before we'd see this kind of early detection blood cancer test used in a large population.

Andrew, this conference draws in, as you say, thousands of researchers who all have their results to share.

How do you cut through the noise and work out which, if any, are gonna be the real game changers?

Yeah, it is very difficult because there is so much research being presented.

But also I'd point out that this particular conference has a really high sort of bar when it comes to abstracts and discussions that are presented there.

So they actually turn down thousands of studies and abstracts.

And so when you actually arrive at the conference in Chicago, there is a sort of assurance that those studies that are being discussed, that are being presented are very strong.

It almost makes your job a bit harder though, because if there's research there, which is clearly bad, It's quite easy to put to 1 side, but if it's all actually good, and you've got to then find the excellent stuff, it almost makes it a bit tougher.

I wondered if there were any other treatments there that caught your eye that look particularly significant?

Richard Butler We've known for a long time that lung cancer is the world's leading cause of cancer death, it has been for decades, and so 1 study that particularly caught my eye addressed this and they actually been looking at a new drug called ozomertinib and this drug potentially miraculous results although again I caveat that there are still further research needed but this drug according to the results presented at the conference actually reduced the risk of lung cancer patients dying by half, by about 51%.

And I think that really is significant because we're talking about 2 million deaths a year in lung cancer and so if you can reduce the risk of those patients dying, there's a huge benefit globally to lung cancer patients everywhere.

Roy Herbs, you're deputy director of the Yale Cancer Center, and were the lead author of the groundbreaking lung cancer study we've just heard about.

So to begin, tell us what makes lung cancer so hard to treat?

Lung cancer is the number 1 cause of cancer death worldwide.

But then the problem is, it's different in almost every person.

There are just so many reasons 1 gets lung cancer.

And what that does is that changes the molecular characteristics of the different cancers.

And of course, everyone has their own genetic environment.

1 size does not fit all, so it's been very hard to find a treatment to use for everyone.

The other problem is it's a very aggressive cancer.

So when we find it, it's spread outside of the lungs more than 50% of the time.

And that means it can't be cut out with a surgery, can't be treated locally just with a radiation treatment.

We know from work over the last 20 years that we can target certain vulnerabilities in a cancer.

Basically, we know 1 of the on-off switches, it's called epidermal growth factor receptor.

It's abnormality in the tumor, a change in the genetic code, that basically turns those cells, that cancer on, and causes it to grow out of control and spread.

And we know that we can give patients a pill by mouth and that that can turn off those cells.

And we've been using that for quite some time and we're now in our third generation of drug, the drug that we use in this trial called asimertinib.

This pill targets that on-off switch and turns it off.

But the idea was, what if we used it earlier in the patients who have lung cancer and are fortunate that we have found it earlier where it can be cut out?

And after we cut that out, you know, right now we've been giving some chemotherapy to certain patients and that helps a little bit, I mean like a 5% to 10% improvement, but not enough.

There's still a 40% chance that it might come back within 5 years.

However, what if that patient has this abnormality, this epidermal growth factor receptor abnormality.

Then what if we combine the new drug with that, put it all together and see if we have better results.

So this EGFR mutation helps tumors grow in some lung cancer patients, but not all of them.

And this treatment is specifically for those EGFR patients.

What benefit did those particular patients experience?

3 years ago at the ASTRO meeting, which is held in Chicago every year, we actually presented that this pill reduced the recurrence by about

But then there were still naysayers and many said, what about overall survival?

The cancer doesn't come back, but what about survival?

So now 3 years later and the results were amazing.

There was a 51% decrease in death with this pill versus the placebo.

This is the first time that 1 of these oral, what we call targeted therapies, has been used in this early setting, and it's improved survival.

Looking at these 2 survival curves, what you do is you look at percent of patients alive on the y-axis and on the x-axis you look at time.

It's quite clear that there's a separation in the 2 groups very early and it stays separated, I think it's a huge difference.

I would even go out on a limb and say as an investigator that some of these patients will be in the official term cured, meaning that they'll never have to think about lung cancer again.

My goal has always been to help patients and help them live longer with better quality of life.

And I think we made a very compelling case that that's now happening in this small piece of lung cancer.

It's about a third of the patients, and then only about 15 to 50%, depending where you live, have this abnormality.

So we're plucking off a good chunk, but there's still a lot of work to do to get the other patients.

We have a lot of breakthroughs announced at these major cancer conferences, but I'm wondering whether you think we're seeing a rise in drugs based on these cancer growth inhibitors and whether those could actually turn cancer into something more of a chronic condition when we live with in old age, rather than something that's often seen as a death sentence.

You know, the idea like you live with diabetes or you live with high blood pressure and you take your medicine every day.

I would say these EGFR inhibitors are exactly that.

Patients take these pills and there are many people that are walking the streets that are probably on these drugs and you don't know it because they're basically keeping their cancer under control.

What I'm seeing from this meeting is that there's more of these targeted therapies than ever before.

Then of course, we're seeing ways that we can target the immune system and that's just historic what's happening there.

Now we have antibodies that bring drugs to specific sites and tumors, They're called antibody drug conjugates.

That was a big deal at the meeting this year.

And then what you're seeing is informational science, artificial intelligence to figure out mechanism and find new drugs.

The time from discovery in the lab to the clinic is shorter than ever before.

So you learn from the patients who do well.

And unfortunately, for those who don't, what is it about the cancer in those patients so that we can be even smarter and more effective in future trials and in future endeavors.

It's a never ending fight, you know, to help patients.

And the 1 thing I really think, and I know, because patients came up to me at this meeting, and they've written to me, patients are happy and delighted to see that we're working to find better therapies for them, less toxic therapies to allow them to live longer.

Andy, we've been focusing on medicines for cancer, but I'm Wondering whether you came across any non-medical interventions that also showed any promise.

1 aspect that really interested me this year was on how cancer patients can potentially help themselves after diagnosis with very simple activities like walking, doing simple chores around the house and even practicing yoga after being diagnosed.

These new research studies showing that actually if you take up an active lifestyle and maintain it after being diagnosed with cancer.

You can actually reduce the chances of side effects from the treatment.

You can lower your risk of feeling fatigued all the time.

And really interestingly, there's also evidence from these studies presented at ASCO that suggests taking up exercise and practicing yoga could also reduce your risk of the cancer returning.

Some of these cancer treatments, many of them in fact, can take quite a toll on the body.

Was there any work looking at trying to improve the quality of life for patients while they're having their treatment?

There was, and this is a really fascinating area of cancer research.

We've developed 3 or 4 flagship treatments, if you like, for cancer in the last 4 to 5 decades and cancer researchers are now looking at whether actually you can get away with removing 1 or 2 of those cancer treatments to reduce the risk of side effects in patients And what we heard at the conference in Chicago was some success in this area.

In a small study, they looked at bowel cancer patients and they normally undergo surgery, radiotherapy and chemotherapy.

And what was fascinating was in a five-year follow-up study they found that some of these patients having been spared radiotherapy had no impact on their survival and so this is fascinating because it could really transform patients lives if you're able to provide the treatment without radiotherapy because of the often gruelling side effects.

And looking to the future, Andrew, and where all of this might lead, what kinds of trends are you seeing when it comes to cancer and its impact on society?

Well another trend that was discussed at the conference was because of the world's globally aging population what they're warning about is that in the next 5 to 10 years we're going to see increasingly millions of people over the age of 65 into their 70s, 80s and 90s diagnosed with cancer and that brings with it a series of complex challenges and the warning from ASCO in Chicago was that the world is not really prepared and so there's got to be a lot of effort put in in the next couple of years to sort of set up healthcare systems to prepare for this onslaught, if you like, of older cancer patients who have very, very different needs and requirements to younger patients.

There's so much information that you get exposed to when you go away to a conference like this, Andrew.

I'm just wondering, how do you feel when you come back?

Do you tend to be feeling optimistic or actually quite pessimistic given the challenges that we know lie ahead?

I mean, yes, on the 1 hand, having been exposed to some incredible developments in the cancer community, I do feel optimistic.

But I think a note of caution is that we're obviously aware of what we've been through in the last 3 years, you know, the biggest public health crisis in a century and the impact COVID-19 has had on cancer detection but also cancer treatment.

And so I am optimistic about what's been discovered and the advances that are being made potentially leading to people living longer, but at the same time, the immediate focus of cancer systems worldwide is to really get through the backlogs and provide treatment as quickly as possible to patients.

Thanks again to Andrew Gregory and Dr Roy Herbst.

You can find a link to more of Andrew's reporting from the conference on the podcast page at theguardian.com.

This episode was produced by Ned Carter-Miles and Eli Block.


Speaker 0: This is The Guardian.

Speaker 1: Cancer remains the leading cause of death worldwide, claiming the lives of roughly 10 million people each year. But continuous advances in medical science mean we also know more than ever about its causes and how to treat it. Earlier this month, over 40, 000 specialists gathered for the annual meeting of the American Society of Clinical Oncology to share research, discuss new treatments and ultimately save lives. So Where are the biggest breakthroughs occurring? And could new drugs change the way we think about cancer forever?

From The Guardian, I'm Ian Sample, and this is Science Weekly. Andrew Gregory, you're the Guardian's health editor and you've been covering the American Society of Clinical Oncology conference in Chicago, the largest cancer research conference in the world. Give us a sense of what that meeting's like.

Speaker 0: Yeah, it's a huge meeting and it's the largest cancer research conference in the world because of the number of experts who attend. So about 42, 000 oncologists, researchers and scientists arrived for this year's conference. It takes place in a huge building called McCormick Place, which is settled on the shore of Lake Michigan and it makes for an incredible meeting place for all these people to discuss, to debate, to learn where they're making progress and also where they need to make more progress in terms of cancer research.

Speaker 1: And what were the kinds of treatments that caught your eye this year?

Speaker 0: There were lots of things that stuck out. 1, in breast cancer, the arrival of a new drug that basically reduces the risk of breast cancer coming back by a quarter. We know breast cancer treatments now are very very effective so the way the research world is going is now looking at what more can be done to reduce recurrence in patients. And then 1 in ovarian cancer, where they're looking at combinations of drugs. So 1 of these drugs is very, very successful in ovarian cancer at the moment, but they found that adding another drug which promotes cells that effectively kill cancer can really have an impact in terms of shrinking tumours and making sure that the cancer is fully removed after surgery.

And then a very different type of study, 1 in blood cancer, and this is a new form of immunotherapy that researchers are getting very excited about. This particular study was in multiple myeloma, which is an incurable form of blood cancer. And what they found was that by using this form of immunotherapy, they actually found according to the results presented, that it cuts the risk of blood cancer progressing by as much as 74%.

Speaker 1: And what about early cancer detection? Have there been any major developments on that front?

Speaker 0: 1 in particular that caught my attention was a blood test developed by a Californian company and that has actually started trials in the NHS in the UK and it detects fragments of a substance that effectively tells you whether or not that patient might have cancer. Really interesting going forward, but I have to say I wasn't totally convinced by the results on this 1. I think there's a long way to go before we'd see this kind of early detection blood cancer test used in a large population.

Speaker 1: Andrew, this conference draws in, as you say, thousands of researchers who all have their results to share. How do you cut through the noise and work out which, if any, are gonna be the real game changers?

Speaker 0: Yeah, it is very difficult because there is so much research being presented. But also I'd point out that this particular conference has a really high sort of bar when it comes to abstracts and discussions that are presented there. So they actually turn down thousands of studies and abstracts. And so when you actually arrive at the conference in Chicago, there is a sort of assurance that those studies that are being discussed, that are being presented are very strong.

Speaker 1: It almost makes your job a bit harder though, because if there's research there, which is clearly bad, It's quite easy to put to 1 side, but if it's all actually good, and you've got to then find the excellent stuff, it almost makes it a bit tougher. I wondered if there were any other treatments there that caught your eye that look particularly significant? Dr.

Speaker 0: Richard Butler We've known for a long time that lung cancer is the world's leading cause of cancer death, it has been for decades, and so 1 study that particularly caught my eye addressed this and they actually been looking at a new drug called ozomertinib and this drug potentially miraculous results although again I caveat that there are still further research needed but this drug according to the results presented at the conference actually reduced the risk of lung cancer patients dying by half, by about 51%. And I think that really is significant because we're talking about 2 million deaths a year in lung cancer and so if you can reduce the risk of those patients dying, there's a huge benefit globally to lung cancer patients everywhere.

Speaker 1: Dr. Roy Herbs, you're deputy director of the Yale Cancer Center, and were the lead author of the groundbreaking lung cancer study we've just heard about. So to begin, tell us what makes lung cancer so hard to treat?

Speaker 2: Lung cancer is the number 1 cause of cancer death worldwide. But then the problem is, it's different in almost every person. It's very heterogeneous. There are just so many reasons 1 gets lung cancer. And what that does is that changes the molecular characteristics of the different cancers.

And of course, everyone has their own genetic environment. 1 size does not fit all, so it's been very hard to find a treatment to use for everyone. The other problem is it's a very aggressive cancer. So when we find it, it's spread outside of the lungs more than 50% of the time. And that means it can't be cut out with a surgery, can't be treated locally just with a radiation treatment.

It's a very, very difficult foe.

Speaker 1: Tell us about this particular study. What were you looking at?

Speaker 2: We know from work over the last 20 years that we can target certain vulnerabilities in a cancer. Basically, we know 1 of the on-off switches, it's called epidermal growth factor receptor. It's abnormality in the tumor, a change in the genetic code, that basically turns those cells, that cancer on, and causes it to grow out of control and spread. And we know that we can give patients a pill by mouth and that that can turn off those cells. And we've been using that for quite some time and we're now in our third generation of drug, the drug that we use in this trial called asimertinib.

This pill targets that on-off switch and turns it off. But the idea was, what if we used it earlier in the patients who have lung cancer and are fortunate that we have found it earlier where it can be cut out? And after we cut that out, you know, right now we've been giving some chemotherapy to certain patients and that helps a little bit, I mean like a 5% to 10% improvement, but not enough. There's still a 40% chance that it might come back within 5 years. However, what if that patient has this abnormality, this epidermal growth factor receptor abnormality.

Then what if we combine the new drug with that, put it all together and see if we have better results. So that's really what we did here.

Speaker 1: So this EGFR mutation helps tumors grow in some lung cancer patients, but not all of them. And this treatment is specifically for those EGFR patients. So what were the results with this? What benefit did those particular patients experience?

Speaker 2: 3 years ago at the ASTRO meeting, which is held in Chicago every year, we actually presented that this pill reduced the recurrence by about

Speaker 0: 83%.

Speaker 2: But then there were still naysayers and many said, what about overall survival? The cancer doesn't come back, but what about survival? Do people live longer? So now 3 years later and the results were amazing. There was a 51% decrease in death with this pill versus the placebo.

This is the first time that 1 of these oral, what we call targeted therapies, has been used in this early setting, and it's improved survival. Looking at these 2 survival curves, what you do is you look at percent of patients alive on the y-axis and on the x-axis you look at time. It's quite clear that there's a separation in the 2 groups very early and it stays separated, I think it's a huge difference. I would even go out on a limb and say as an investigator that some of these patients will be in the official term cured, meaning that they'll never have to think about lung cancer again. My goal has always been to help patients and help them live longer with better quality of life.

And I think we made a very compelling case that that's now happening in this small piece of lung cancer. It's about a third of the patients, and then only about 15 to 50%, depending where you live, have this abnormality. So we're plucking off a good chunk, but there's still a lot of work to do to get the other patients.

Speaker 1: We have a lot of breakthroughs announced at these major cancer conferences, but I'm wondering whether you think we're seeing a rise in drugs based on these cancer growth inhibitors and whether those could actually turn cancer into something more of a chronic condition when we live with in old age, rather than something that's often seen as a death sentence.

Speaker 2: Yeah, great question. It's already happening. You know, the idea like you live with diabetes or you live with high blood pressure and you take your medicine every day. I would say these EGFR inhibitors are exactly that. Patients take these pills and there are many people that are walking the streets that are probably on these drugs and you don't know it because they're basically keeping their cancer under control.

What I'm seeing from this meeting is that there's more of these targeted therapies than ever before. Then of course, we're seeing ways that we can target the immune system and that's just historic what's happening there. Now we have antibodies that bring drugs to specific sites and tumors, They're called antibody drug conjugates. That was a big deal at the meeting this year. And then what you're seeing is informational science, artificial intelligence to figure out mechanism and find new drugs.

And it's a very exciting time. The time from discovery in the lab to the clinic is shorter than ever before. So you learn from the patients who do well. And unfortunately, for those who don't, what is it about the cancer in those patients so that we can be even smarter and more effective in future trials and in future endeavors.

Speaker 1: You sound optimistic.

Speaker 2: Very much so. We're making progress. We can't stop working. We can't stop doing trials. It's a never ending fight, you know, to help patients.

And the 1 thing I really think, and I know, because patients came up to me at this meeting, and they've written to me, patients are happy and delighted to see that we're working to find better therapies for them, less toxic therapies to allow them to live longer.

Speaker 1: Andy, we've been focusing on medicines for cancer, but I'm Wondering whether you came across any non-medical interventions that also showed any promise.

Speaker 0: 1 aspect that really interested me this year was on how cancer patients can potentially help themselves after diagnosis with very simple activities like walking, doing simple chores around the house and even practicing yoga after being diagnosed. These new research studies showing that actually if you take up an active lifestyle and maintain it after being diagnosed with cancer. You can actually reduce the chances of side effects from the treatment. You can lower your risk of feeling fatigued all the time. And really interestingly, there's also evidence from these studies presented at ASCO that suggests taking up exercise and practicing yoga could also reduce your risk of the cancer returning.

Speaker 1: Some of these cancer treatments, many of them in fact, can take quite a toll on the body. Was there any work looking at trying to improve the quality of life for patients while they're having their treatment?

Speaker 0: There was, and this is a really fascinating area of cancer research. We've developed 3 or 4 flagship treatments, if you like, for cancer in the last 4 to 5 decades and cancer researchers are now looking at whether actually you can get away with removing 1 or 2 of those cancer treatments to reduce the risk of side effects in patients And what we heard at the conference in Chicago was some success in this area. In a small study, they looked at bowel cancer patients and they normally undergo surgery, radiotherapy and chemotherapy. And what was fascinating was in a five-year follow-up study they found that some of these patients having been spared radiotherapy had no impact on their survival and so this is fascinating because it could really transform patients lives if you're able to provide the treatment without radiotherapy because of the often gruelling side effects.

Speaker 1: And looking to the future, Andrew, and where all of this might lead, what kinds of trends are you seeing when it comes to cancer and its impact on society?

Speaker 0: Well another trend that was discussed at the conference was because of the world's globally aging population what they're warning about is that in the next 5 to 10 years we're going to see increasingly millions of people over the age of 65 into their 70s, 80s and 90s diagnosed with cancer and that brings with it a series of complex challenges and the warning from ASCO in Chicago was that the world is not really prepared and so there's got to be a lot of effort put in in the next couple of years to sort of set up healthcare systems to prepare for this onslaught, if you like, of older cancer patients who have very, very different needs and requirements to younger patients. Jason Vale

Speaker 1: There's so much information that you get exposed to when you go away to a conference like this, Andrew. I'm just wondering, how do you feel when you come back? Do you tend to be feeling optimistic or actually quite pessimistic given the challenges that we know lie ahead?

Speaker 0: It's probably a mix of the 2 Ian. I mean, yes, on the 1 hand, having been exposed to some incredible developments in the cancer community, I do feel optimistic. But I think a note of caution is that we're obviously aware of what we've been through in the last 3 years, you know, the biggest public health crisis in a century and the impact COVID-19 has had on cancer detection but also cancer treatment. And so I am optimistic about what's been discovered and the advances that are being made potentially leading to people living longer, but at the same time, the immediate focus of cancer systems worldwide is to really get through the backlogs and provide treatment as quickly as possible to patients.

Speaker 1: Andrew, thanks for coming on. Really good to speak to you.

Speaker 0: Thanks, Ian.

Speaker 1: Thanks again to Andrew Gregory and Dr Roy Herbst. You can find a link to more of Andrew's reporting from the conference on the podcast page at theguardian.com. This episode was produced by Ned Carter-Miles and Eli Block. The sound design was by Tony Onuchukwu. The executive producer was Eli Buri.

We'll be back on Tuesday. See you then.

Speaker 0: He's the Guardian.

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Will new treatments change the way we view cancer for good?