What’s new in cancer: what might change in 2025
Dr Mark Baxter, Oncologist
Dr Mark Baxter is an Oncologist and Senior Lecturer at the University of Dundee who treats cancers in the upper gastrointestinal tract. Mark said: “Increasing understanding of biliary tract cancer has led to approval of the IDH1 inhibitor ivosidenib in metastatic cholangiocarcinoma (ClariDHy study). NICE approved this drug for use in January 2024.
Relevant to all tumour types, the UK TOASTIE study highlighted the prevalence of frailty in older adults with cancer receiving chemotherapy and the lack of routine frailty assessments. TOASTIE (Tolerance of Anti-Cancer Systemic Therapy in the Elderly) supports the need for oncology teams to assess for frailty and provide targeted intervention when possible”.
“Looking forward to 2025, in metastatic pancreas cancer where options are limited, there is emerging data supporting the use of KRAS inhibitors. [I’m] also hopeful that the new year will see UK approval of zolbetuximab with chemotherapy for a subtype of untreated advanced stomach cancer that is claudin 18.2-positive.”
Dr Kam Zaki, Medical Oncologist
Dr Kam Zaki is a Medical Oncologist treating lung cancer is Sussex. Kam said:
“2024 was an exciting year for oncologists who treat lung cancer. Through an NHS pilot study, patients with suspected lung cancer were able to access a liquid biopsy, a minimally invasive test to see whether their cancer was amenable to targeted therapy. The program helps clinicians choose the beat treatment for lung cancer patients. In November NICE made targeted therapy drug Alectinib available for a subset of lung cancer patients with ALK rearrangements. This is now an option instead of chemotherapy for people who have undergone surgery to remove their tumour. Clinicians are now also able to use immunotherapy drugs in selected early-stage lung cancer patients prior to curative surgery, with the drugs nivolumab, pembrolizumab and durvalumab. The number of targeted therapies is also expected to increase. For example, clinicians are hoping the drug amivantamab in combination with chemotherapy will be funded for people with lung cancer that have a rare EGFR exon 20 variant.”
Dr Apsasia Soultati, Consultant Medical Oncologist
Dr Apsasia Soultati is a Consultant Medical Oncologist working in Eastbourne and Hastings treating colorectal cancer where new drugs have also become standard:
“2024 saw approval of the trifluridine/tipiracil and bevacizumab combination in the third-line setting for people with colorectal cancer.”
Dr Soultati also reflected how her work has changed on the basis of increased use of immunotherapy: “We had to expand our acute oncology services and this year we now have weekly immunotherapy toxicity multidisciplinary meetings in order to support the patients with toxicities."
Professor Anthony Chalmers, Chair of Clinical Oncology University of Glasgow
Prof Anthony Chalmers is Chair of Clinical Oncology at the University of Glasgow and he sees people with brain tumours at the Beatson Oncology Unit.
“In low grade gliomas we now have access to a new drug called vorasidenib, which is an IDH inhibitor. People treated with this drug can successfully delay the need for radiotherapy and/or chemotherapy [following surgery, with progression-free survival of 28 months] versus 11 months for people on the placebo in trial, and the new drug only has minimal toxicities. The research was actually published in 2023 but UK patients are now getting treatment through an access program.”
You will see noted there are some themes here with new targeted drugs being made available for specific subtypes of cancer. These precision medicine approaches are giving oncologists more options in the clinic and more hope for people with cancer. However, they also bring more complexity and more cost and some colleagues have had a long wait from the data being presented at conferences until funding is agreed.
In my work as a breast cancer specialist I’ve also been able to use a new drug called elacestrant. This is active in estrogen-sensitive tumours that also have an ESR-1 mutation (a subset of a subset). These new drugs mean more work in the clinic which is challenging when we have a workforce crisis. I would reflect that perhaps the biggest change to my work in 2024 has been how we run the clinics. In 2024 I started running my clinic alongside Fiona, a specialist pharmacist. Fiona is a non-medical prescriber, not a doctor, but able to prescribe and is very expert in the area where she sees people with cancer. Fiona joins a multi-professional team, which also includes therapeutic radiographers who see people having radiotherapy. Having Fiona in the team is an important part of multidisciplinary working, which continues to be vital as our work grows.
Progress isn’t always about doing new things. Sometimes research allows us to stop. The biggest change I anticipate for my clinical work in 2025 came in on December 12th 2024 at the San Antonio Breast Conference. New results from the UK SUPREMO study showed that many people who would previously be offered radiotherapy after a mastectomy for cancer could now safely avoid that treatment. Good news for patients – and more time for me in clinic to offer new innovations!
I wonder what therapeutic changes we will reflect on in 12 months time?