A Look at Progress and Future Directions

Manmeet Ahluwalia, MD, MBA, FASCO

With May being National Cancer Research Awareness Month, Manmeet Ahluwalia, MD, MBA, FASCO, emphasized the month’s significance in recognizing past achievements, current progress, and future potential in improving patient lives.

“To me, the most exhilarating part of being a cancer researcher is bringing the best cutting-edge treatment options for our patients here at Miami Cancer Institute, but then working collaboratively with our network across the globe to do that for the entire universe,” explained Ahluwalia, chief scientific officer, chief of medical oncology, deputy director, and Fernandez Family endowed chair in cancer research at the Baptist Health Miami Cancer Institute, in an interview with Targeted Oncology^TM.

In the interview, Manmeet Ahluwalia, MD, MBA, FASCO, discussed the significance of National Cancer Research Month and highlighted how ongoing cancer research has directly impacted patient care.

Targeted Oncology^TM: What significance does National Cancer Research Month hold for you and your work as an oncologist?

Ahluwalia: As a cancer researcher, I could not be [more] thrilled about May being the National Cancer Research Month. This month was designated in 2008 by Congress to recognize the importance of research, but also the continued importance of research into finding new treatments for our patients so that we can improve both the life of our patient, but also their quality of life. This takes us back to 1971 when President Nixon declared the war on cancer by passing the Cancer Act. To me, National Cancer Awareness Month is about the past, the current, and the future.

For the past, it is acknowledging the impact of research. This year, we had a report from the American Cancer Society, basically showcasing that in the last 3 decades, from 1992 to 2021 or so, we have decreased cancer mortality by 34%.¹ That means we have decreased one-third of cancer deaths, and this basically translates to 4.5 million cancer deaths in this country. We have averted that as a result of this investment in cancer research that the United States government and Congress supported. It emphasizes that it is also a month where we honor our patients and their stories, because we learn from every patient that we treat, whether it is standard of care, whether it is on clinical research. It is not only that we are helping our patients get the best outcome, but we also understand why sometimes treatments do not work, and as a result, we devise your treatment options for our patients. It is an important present situation because it provides continued hope for our patients that we have learned from our past, and we’re going to do our best for you.

It is also an inspiration and a call for collaboration. As a cancer researcher, I do not work alone. I depend on so many colleagues who work tirelessly in labs every day finding new treatments that I am very excited to translate in clinics for my patients, in terms of clinical research. It always takes a village to take care of a cancer patient. We do that here at Miami Cancer Institute, where surgeons are working very closely with radiation oncologist medical neuro-oncologists to give the best care to our patients. We are joined in that journey by our research nurses, our regular nurses, pharmacists. So, it is a whole group of patient caregivers who are coming together with family members to ensure that we have a best outcome for our patients.

But also, to me, it’s about the future. It is an ongoing commitment, and I could not be more excited that we are living in the best era of humankind, where we have new discoveries coming down every day. Today, we have better drugs which are targeting these genomic drivers of cancer in patients, and as a result, new targeted therapies, or immunotherapies, are delivering better outcomes compared with the chemotherapies of cytotoxic agents which had been used in the past. Not only are our patients living longer, they are [also] living longer with a better quality of life. To me, the most exhilarating part of being a cancer researcher is bringing the best cutting-edge treatment options for our patients here at Miami Cancer Institute, but then working collaboratively with our network across the globe to do that for the entire universe.

Cancer Cells – stock.adobe.com

How does ongoing cancer research directly impact the care you can provide to your patients in our community?

I work at Miami Cancer Institute. We are a large cancer center, part of Baptist Health South Florida. We see around 1400 patients that walk through our doors every day. As a cancer researcher and an executive, these people who are putting their trust in us, so we have to make sure that we are providing them the best standard of care, but also, most importantly, the most cutting-edge clinical trials. That is an avenue of not only getting a drug of today, but it is getting a drug or a treatment of tomorrow. What we have found out is that it provides people hope, but to us, trust is sacred. We have over 2000 employees here [at the] Miami Cancer Institute. We work hand in hand to provide the best treatment options for our patients, and I am very excited that we work with these amazing cancer researchers and investigators around the country, where we are working collaboratively to design the best trials for our patients today and for tomorrow.

What are some of the most exciting or impactful areas of cancer research currently underway, in your opinion?

Every few decades, we have themes. Say 25 years back, if you remember, the cover of The Times magazine had this drug called imatinib [Gleevec], which was a drug that was being used to treat patients with chronic myeloid leukemia, and typically patients with chronic myeloid leukemia at that time point, 25 years back on an average lived 2 and a half to 3 years. Now, most of these patients are surviving decades. It has been so exhilarating to see the era of targeted medicines.

A decade back or so was this decade of immunotherapies. We had drugs like pembrolizumab [Keytruda], which were coming and really transforming outcomes of our patients. The last 4 or 5 years has been this era of antibody-drug conjugates, which are these Trojan horses using these alterations which are present on the cell in a way to get into the cell, like a cancer cell, and then we release a cytotoxic payload inside the cancer cell. This is getting very specific, because when we use chemotherapies, we give it to the patients, and not only did that result in killing of the cancer cell, but it would also result in killing of the normal cells. That is why our patients had lost blood counts, because these are also the blood cells dividing at a very rapid rate. Our chemotherapies were not able to distinguish between cancer cells and other cells, so there was a lot of collateral damage, but antibody-drug conjugates are like smart chemotherapies, where we are decreasing the collateral damage.

As a result, we have seen tremendous improvement in outcomes of our patients. One of the antibody-drug conjugates that we have seen tremendous impact of is a drug called trastuzumab deruxtecan [T-DXd; Enhertu]. That has helped transform the outcomes of patients with HER2-positive breast cancer, both metastatic disease but also with patients with brain metastases, and these patients are living much longer now. As a result, I could not be more excited about the next several years and the continued impact of antibody-drug conjugates, bispecifics, and a number of other drugs which are coming through the pipe.

What role do clinical trials play in advancing cancer treatment within a community oncology setting?

We all know 75% to 80% of cancer care is given in the community. It is not at large academic medical centers, so it is critical that the community oncologists are aware of the clinical trials that are ongoing for our patients, especially in complex cancers. We believe that patients with complex cancer should be at clinical trials, but what we have also been very excited about is that in the last decade or two, a lot of clinical research has moved to community practices too. Because a lot of research is being driven in a manner that these clinical trials are not only available at the National Cancer Institute-designated cancer centers or the academic cancer centers, but these clinical trials are now available at large community practices.

As a community oncologist, it is important to be aware of research not only going on [in] your program, but it is also important to know of the research that is going on at nearby, larger centers, so that at least for patients with complex cancers that may not have very good standard-of-care treatment options, that you are able to refer these patients to the right place. I always believe clinical research is the heart and soul of advancing cancer care, because we have great cancer care today, because we had great clinical research in the preceding decades, and to make sure that we are improving the standard of care for our patients tomorrow, we [need to] invest into clinical research and clinical trials today. For that, we have to all work together to make sure that we have the best treatment options for our patients, both today and in the future.

Are there any particular research advancements that have recently changed or are poised to change how you approach cancer care?

Previously, the medical treatment for patients with cancer was chemotherapies, but in the last 3 decades, we have seen that change [with], for example, targeted drugs. I gave the example of [imatinib] in chronic myeloid leukemia, and we have seen that in a number of other cancers. One more example is in solid cancers. I would take the example of lung cancer, which has really become the poster child for drug development in the last 25 years. In targeted therapies, we have had drugs which target the EGFR pathway. So, patients with EGFR[-mutant] lung cancer, [25 years] back with stage IV disease, on average died in 12 months. Now, these patients are living, on average, 4 years. Some of the latest trials have shown overall survival of 4 years or more, which could not be more exhilarating. Within the last 2 decades, we have seen the outcomes of lung cancer increase by 4-fold, which is tremendous, and I think that will continue. But a number of [patients with] lung cancer may not have these oncogenic drivers and so or what we call wild type, but that is where immunotherapies have really transformed the outcomes of these patients. Drugs like pembrolizumab, nivolumab [Opdivo], either given alone or in combination with chemotherapies have been really great. Again, outcomes of these patients have improved from 9 to 12 months to now 3 years or so. It is great to see the progress there.

The next few years are going to be exciting because we now have antibody-drug conjugates, which are these smart bombs, or smart chemotherapies, which we are using the Trojan horse approach to go and deliver payload in these cancer cells, whereas we if we can spare the normal cells. And also, there has been a lot of interest in other immunotherapies, like [chimeric antigen receptor (CAR)] T-cell therapies and bispecifics, which are really transforming the outcomes of patients with hematologic malignancies.

We have a great story of this girl called Emily, who, close to a decade back, had a form of leukemia, and everyone had given up hope on her. Basically, they told the parents that she probably would only survive for several weeks to months. But Carl June[, MD,] who has been an exemplary figure in CAR T-cell therapies, was working on something which was given to her, and she is now 10 years out and has been cured using the CAR T-cell therapies. What we do matters, research matters, and hence I would love to advocate for continued research funding so we can create more success stories like Emily, because that is what makes it worthwhile for me and my colleagues to come to work every day where we can make a difference in the lives of our patients.

What message of hope or progress in cancer research would you like to share with our audience during this month?

I would reiterate this message of hope for our patients. We are doing much better with our cancer care today compared with 3 decades back. As I had outlined, the American Cancer Society report basically states that we have decreased the mortality from cancer by 34% in the last 3 decades. I think the next 3 decades are going to be even better, because nowadays we are working on tests which will help us detect cancer earlier. The newer tests are better than the existing tests, and I think they will get even better. We are using artificial intelligence [AI] to help us distinguish imaging characteristics for our patients so we can pick up the minimum changes. And also, we are using AI to devise better drugs for our patients. We are also increasing the speed at which we can test drugs in the clinic and get drug approvals for our patients. I would deliver this message of hope for our patients, people who work in the cancer field, and for community in large that we are, we could not be more excited about what the future holds for our patients.

REFERENCE:

Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin. 2025; 75(1):10-45. doi:10.3322/caac.21871