In October 2015, the first oncolytic virotherapeutic,
talimogene laherparepvec (Imlygic), was approved by the
FDA for the treatment of melanoma lesions in the skin and
lymph nodes that cannot be removed completely by surgery.
The new immunotherapeutic, which was called T-Vec
during development, is a herpes simplex virus (HSV) type
1 that has been genetically modified in a number of ways
so that it is less able to cause disease, is more selective for
cancer cells, and is more likely to promote an anticancer
immune response. One of these modifications is the
addition of a gene that provides the instructions for making
an immune system–boosting factor called GM-CSF.
The exact way in which T-Vec works has not been
definitively determined by researchers and remains an
area of active investigation. However, it appears that
after injection directly into melanoma lesions, T-Vec
enters cancer cells, where it multiplies and promotes the
production of GM-CSF. As it multiplies, T-Vec causes the
cancer cells to rupture and die. Rupturing cancer cells
release GM-CSF and cell contents that together can boost
the killing power of the immune system.
T-Vec was approved after it was shown in a phase III
clinical trial to significantly increase the number of patients
who had skin and lymph node melanoma lesions shrink
or disappear compared with GM-CSF (169). Even though
T-Vec has not been shown to improve overall survival or
to have an effect on melanoma that has spread to other
parts of the body, it provides patients like Bob Ribbans
(see p. 94) with new treatment options and new hope.
Living With or Beyond Cancer
Research is powering advances in cancer detection,
diagnosis, and treatment that are helping more and more
people to survive longer and lead fuller lives after a cancer
diagnosis. According to the latest estimates, more than
15. 5 million U.S. adults and children with a history of
cancer were alive on Jan. 1, 2016, compared with just 3
million in 1971, and this number is projected to rise to
20. 3 million by Jan. 1, 2026 ( 4, 169).
Each of these people has a unique experience and outlook,
which can range from successful treatment and living cancer
free for the remainder of his or her life to living continuously
with cancer for the remainder of life. Therefore, not all
people who receive a cancer diagnosis identify with the
now commonly used term “cancer survivor.”
Cancer survivorship encompasses three distinct phases:
the time from diagnosis to the end of initial treatment,
the transition from treatment to extended survival, and
long-term survival. Recent progress in cancer treatment
was discussed in the previous three sections of the
report (see Treatment With Surgery, Radiotherapy,
and Cytotoxic Chemotherapy, p. 61, Treatment With
Molecularly Targeted Therapeutics, p. 67, and Treatment
With Immunotherapeutics, p. 81). Here, the discussion
focuses primarily on other recent advances that can help
improve outcomes and quality of life for individuals in
each distinct phase of cancer survivorship and highlights
some of the challenges they continue to face (see sidebar on
Life After a Cancer Diagnosis in the United States, p. 96).
Each phase of cancer survivorship is accompanied by a
unique set of challenges. Moreover, the issues facing each
survivor vary, depending on many factors, including
gender, age at diagnosis, type of cancer diagnosed, general
health at diagnosis, and type of treatment received.
Survivors of cancer diagnosed during childhood or
adolescence (ages 0– 19), like Jameisha (Meisha) Brown,
[who was featured in the AACR Cancer Progress Report
2014 ( 1)], are particularly at risk for critical health-related
problems because their bodies were still developing at
the time of treatment (see sidebar on Surviving a Cancer
Diagnosis as a Child or Adolescent, p. 97). In addition,
those diagnosed with cancer as adolescents (ages 15–19)
and young adults (ages 20–39) have to adapt to long-term
cancer survivorship while beginning careers and thinking
about starting families of their own.
Importantly, it is not just cancer survivors who are affected
after a cancer diagnosis, but also their caregivers, and this
population is growing proportionally with the number
of cancer survivors. Caregivers are at risk for poor health
outcomes, and this is often compounded by the fact that a
subset of caregivers are already cancer survivors themselves.
RESEARCHER ( 1).
of the U.S. population
are cancer survivors.