The year 2023 marked a significant era in the journey of oncology. With the blend of advancements in technology, dedicated research, and an unwavering commitment from the scientific community, we gained new insights and made remarkable progress in understanding and combating cancer. Here we share the key developments in cancer research in 2023, starting from the latest statistics, delving into treatment innovations, and concluding with other groundbreaking discoveries.
Currently, worldwide, cancer is the leading cause of death.
Interestingly, the most diagnosed cancer is female breast cancer, with an estimated 11.7% of all countries, or approximately 2.3 million new cases diagnosed. Lung cancer, which had previously been the most diagnosed, is now in second place, with an estimated 11.4%.1
A September 2023 Lancet article 2, looked at preventable and treatable cancer deaths worldwide and then proceeded to rank the cancers for premature years of life lost (YLLs) worldwide. Lung cancer has the highest YLLs, followed by liver cancer. Breast cancer ranks third for premature YLLs -this for both men and women, worldwide.
In 2024, the United States is predicted to witness 2,001,140 new cancer cases and 611,720 cancer deaths, marking the first-time new cancer cases have surpassed two million annually. This stark increase in cancer cases, juxtaposed with the continuing decline in cancer mortality since 2021, highlights the dual nature of our fight against cancer – successful advancements in treatment and early detection, yet an upward trend in cancer incidence.
In particular, the incidence of lung cancer is expected to rise through 2035. This expectation goes beyond the U.S. and includes most countries worldwide. Among women in European, Eastern Asian, and Oceanian countries, the projected lung cancer age-standardized incidence rates (ASRs) – measured as 100,000 person years, for women is expected to increase dramatically through 2035. Additionally, the number of new lung cancer cases in 40 countries is expected to increase by 65.32%, with China witnessing the largest number of new cases.3
Causes and Burden -The Persistence of Cancer Disparities
Despite advancements, disparities in cancer care remain a critical challenge. For instance, Black patients experience twice the death rates from prostate, stomach, and uterine cancers compared to White patients. American Indian and Alaska Native patients also face higher mortality rates for liver, stomach, and kidney cancers.6
In another recent article published in JAMA Oncology 2023, researchers examined data from 2.4 million women in 81 countries, all diagnosed with breast cancer. Variations in the stage at which breast cancer is diagnosed were noted among different regions and countries. In low- and middle-income countries, as well as in lower socioeconomic status and older age groups, there were higher percentages of metastatic breast cancer and cases where the stage was unknown. This systematic review and meta-analysis offer supporting evidence for strategic cancer control planning aimed at enhancing early diagnosis accessibility. A key focus in cancer surveillance should be prioritizing the improvement of both quality and coverage of cancer registries, incorporating standardized staging conventions.4
It is important to note that for women, across all Human development index (HDI) levels, breast cancer stands out as a significant contributor to treatable causes of premature YLLs from cancer. Furthermore, across all HDI levels women had a higher proportion of treatable premature YLLs than men. It is conceivable that this disparity between men and women is due to the high rate of breast cancer. 2
Additionally, according to the latest WHO fact sheets, “Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity.’’
While these numbers display a rather disheartening fact, it is also a fact that brings with it some amount of hope. If we know the cause –and the cause is something we have control over, we can initiate change, reduce the number of deaths and use what we know to combat cancer with preventative measures. For example, we know that between 30% and 50% of cancers can be prevented. Prevention involves avoiding risk factors. This requires education that focuses on the risk factors and how they can be avoided, as well as putting ‘evidence-based’ preventative measures in place.
In this, the second decade of 2000, we have the means to detect cancer earlier than in the past. Early detection of cancer, followed by the best available medical treatment of the specific cancer does affect the overall outcome. Today, more cancers do have a greater likelihood of being cured, if diagnosed in the early stages and treated accordingly. It is an established fact that cancer mortality is significantly lessened when cancer is detected in the early stages; treatment is more effective, the cancer responds better – the outcome is better, more positive.
Recent years have brought a range of new cancer treatment methods. One such treatment recently introduced, antibody-drug conjugates (ADC). ADCs are biopharmaceutical products made up of monoclonal antibodies stably linked to a small molecule drug, that can be targeted to destroy specific cancer antigens, without harming healthy cells. These ADCs, when used to fight cancer, are referred to as oncology antibody conjugates. While this is not a new concept – Nobel Prize Laureate, Paul Ehrlich came up with this hypothesis in 1913 (!), in recent years ADCs have become a game-changer in the fight against cancer.5
The year 2023 was a tremendous year for FDA, with a total of 45 new oncology drugs approved. Seventeen of these are specifically for the treatment of cancerous tumors and belong to 2 of the newer categories of treatment, immunotherapy, or receptor tyrosine kinases (RTKs) inhibitors.
The American Association for Cancer Research’s blog, Broadening The Reach Of Cancer Vaccines In 2024, talks about the advances expected for vaccines used to treat cancer. While this is a promising avenue, the costs of research and the unknowns about the biologic stimuli that would be needed, make this a more complex solution than it seems, especially when talking about personalized vaccines. These would target patient-specific neoantigens.
Another form of cancer treatment that is currently being tried and tested is medical nanorobot technology. Nanorobots can be used to interact directly with the cells to deliver drugs or genes. Nanorobots distinguish themselves from nanocarriers or nanomedicines in that they have an active power source.8
Immunotherapy is another aspect of cancer treatment that has come into the forefront. Immunotherapy can be active, or inactive. Active immunotherapy uses the immune system itself to ‘activate’ immune responses and inactive immunotherapy uses immune cell-based products made of monoclonal antibodies. In both cases, immunotherapy has demonstrated most useful for treating cancer when used as part of a combination therapy.6
An example of cryoimmunology can be found in The Piezo1 study. This study involved performing cryoablation with ProSense® on tumor volumes of approximately 100 mm3 (diameter ~6 mm) using a mouse model. The cryoprobe was placed percutaneously directly on the tumor mass. The data demonstrates that cryoablation induces immune rejection by enhancing CD8+ T cell activation, a process dependent on T cell expression of Piezo1. Increased activation and responsiveness, potentially leading to a more robust immune response against abnormal cells, was detected up to 2 weeks after cryoablation, displayed as an increase in CD25 and interferon gamma (IFNγ) expression on CD8+ T cells.
In the field of cryoimmunology, cryoablation is known to induce potent T cell-dependent tumor rejection. Prior independent research using ProSense® to explore cryoablation’s antitumor activity includes a study titled “Functional tumor cell-intrinsic STING, not host STING, drives local and systemic antitumor immunity and therapy efficacy following cryoablation” by Alshebremi et al published in August 2023 in the Journal of ImmunoTherapy of Cancer. The study demonstrated the unequivocal role of an ongoing and functional STING pathway as a major driver of local control and the systemic abscopal effects on advanced tumors following cryoablation.
An independent study published in Annals of Surgical Oncology concludes cryoablation is an oncologically safe and feasible minimally invasive procedure option in lieu of surgery for patients with early-stage, low-risk breast cancer. The study’s authors suggest the widespread use of screening mammography allows for earlier detection – and therefore increased customization of treatment, less aggressive management, reduced treatment burden, improved quality of life – and examines cryoablation as the “next step in the surgical de-escalation of breast cancer.” The article goes on to state, “Clinical trials have determined not only that cryoablation is just as effective as surgical resection for early-stage, low-risk tumors, but that cryoablation also provides a superior alternative when it comes to financial implications.”9
The ICE3 study, which is expected to be finalized in the first quarter of 2024, is the largest U.S.-controlled multicenter clinical trial ever performed for liquid nitrogen-based cryoablation of early-stage breast cancer. Interim results show a 96.91% recurrence free rate, 100% safety, and 100% doctor and patient satisfaction with cosmetic results.
A recently published independent study conducted using ProSense® in Europe to treat early-stage breast cancer produced very similar results, reporting a 96.8% success rate in women with early-stage breast cancer who declined surgery. Another independent study in Europe demonstrated a 93.4% to 96.8% tumor reduction rate in women diagnosed with molecular subtype Luminal-A and Luminal-B tumors who were deemed inoperable for breast cancer.
In yet another independent study published in November 2023, it was demonstrated that IceCure system offers significant advantage in ability to re-treat tumors that are initially resistant, achieving a subsequent local control rate of 100%. The technology’s ability to preserve renal function post-treatment is paramount for patients’ quality of life; 92.4% of patients (N= 24) were discharged the day after cryoablation. These findings serve as a guide for medical professionals in choosing efficient, cost-effective, and patient-friendly treatment options, thereby benefiting society at large by optimizing kidney tumor management.10
ProSense enhances patient and provider value by accelerating recovery, reducing pain, surgical risks, and complications. With its easy, transportable design and liquid nitrogen utilization, ProSense opens the door to fast and convenient office-based procedures for breast tumors. Success across multiple indications supports ProSense®’s commercialization, particularly in facilities that can use one device across multiple specialties.
Looking forward to 2024
As world cancer day approaches, we hope this blog has shown that while cancer is an ever-growing burden, with increasing patient numbers, there is hope and there is choice thanks to new innovation and the tireless work of oncology researchers.
- Yiallourou, Anneza I. “Hereditary Breast Cancer. Risk-Assessment, Screening and Risk-Reduction Strategies.” Breast Cancer Management for Surgeons: An Examination Guide. Cham: Springer International Publishing, 2023. 79-110.
- Frick, Clara, et al. “Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: a population-based study.” The Lancet Global Health 11.11 (2023): e1700-e1712.
- Luo G, Zhang Y, Etxeberria J, Arnold M, Cai X, Hao Y, Zou H. Projections of lung cancer incidence by 2035 in 40 countries worldwide: Population-based study. JMIR Public Health and Surveillance. 2023 Feb 17;9(1):e43651.
- Benitez Fuentes, Javier David et al. “Global Stage Distribution of Breast Cancer at Diagnosis: A Systematic Review and Meta-Analysis.” JAMA oncology, e234837. 9 Nov. 2023, doi:10.1001/jamaoncol.2023.4837
- Pettinato, Mark C. “Introduction to Antibody-Drug Conjugates.” Antibodies (Basel, Switzerland) vol. 10,4 42. 27 Oct. 2021, doi:10.3390/antib10040042
- Darvishi, Mohammad, et al. “Recent progress in cancer immunotherapy: Overview of current status and challenges.” Pathology-Research and Practice 241 (2023): 154241.
- Siegel, Rebecca L., et al. “Cancer statistics, 2023.” Ca Cancer J Clin 73.1 (2023): 17-48.
- Kong, X., Gao, P., Wang, J. et al. Advances of medical nanorobots for future cancer treatments. J Hematol Oncol 16, 74 (2023). https://doi.org/10.1186/s13045-023-01463-z
- Khan, Sonia Y., et al. “Cryoablation Allows the Ultimate De-escalation of Surgical Therapy for Select Breast Cancer Patients.” Annals of Surgical Oncology 30.13 (2023): 8398-8403.
- Moulin, Benjamin et al. “Single-Probe Percutaneous Cryoablation with Liquid Nitrogen for the Treatment of T1a Renal Tumors.” Cancers vol. 15,21 5192. 28 Oct. 2023, doi:10.3390/cancers15215192