2023-12-15 08:20:55
Paris, France – Hello and welcome to the website of Medscape. I am Doctor Manuel Rodrigues, oncologist at the Institut Curie, in Paris, and today we are going to look back on the year 2023 and look forward to the year 2024 in oncology.
Immunotherapy, an invariable constant
On a medicinal level, the trend of recent years around immunotherapy continues. A double trend: on the one hand, very specific immunotherapies, cellular immunotherapies that are difficult to implement, with significant rates of effectiveness, and on the other hand, therapies that are said to be more off the shelfthat is to say on the shelf, which can be mass produced and which are not specific to a patient and, therefore, less heavy.
These are in particular drug-conjugated antibodies and also certain bispecific proteins, but they are mainly drug-conjugated antibodies. In 2023, ADCs have only confirmed all expectations, whether it is tisotumab vedotin in cervical cancer, or enfortumab vedotin with the anti-PD1 pembrolizumab in cancer of the bladder, which really made an impression at ESMO on the front line, and which completely changed the management of urothelial cancer on the front line.
In 2023, ADCs have only confirmed all expectations
We can also add T-DXd and other similar therapies. T-DXd which is confirmed by targeting the HER2 gene in breast cancers, but also in lung cancers, for example, and in other cancers. This has also been confirmed in gynecological cancers where we see extremely impressive efficacy rates.
The outlook for the years to come shows that this will be even more so. We see this in the current pattern and medical environment, with the difficulties that there can be in terms of space in the hospital when there are antibodies ready to administer. With a high activity rate like these, they will probably win the day in the coming years.
400,000 cases per year and vaccination rates too low
On other themes, there were the new cancer incidence figures: we have now reached 400,000 cases per year (June 2023). It’s important, it continues to increase.
In September-October we launch the major vaccination campaign in colleges against HPV. We were targeting a rate of 30% in December to hope to reach 80% by 2030 and instead of 30%, we reached 3%. It’s still a little early to say that it’s a failure, but if there is not a rapid and effective recovery, we will head straight towards the failure of this campaign in France, unlike our European neighbors. Even when we have an effective treatment to prevent, we cannot convince enough people to vaccinate, which is more than deplorable, since the best way to cure cancer is still not to get it. ‘to have.
Even when we have an effective treatment to prevent, we cannot convince enough people to vaccinate, which is more than deplorable.
Artificial intelligence and medicine
Over the next few years we will rather prospect. We are talking in particular about everything that is generative AI, analytical AI where we have clearly seen how the arrival of Chat GPT has changed things in our practice. This makes certain tasks like file analyzes and text analyzes easier.
AI is arriving massively in large companies, from the research stage to the production stage and very probably also in clinical trials. We know that CROs – these companies which are responsible for coordinating clinical trials – are in the process of investing massively and there is every reason to believe that in the future clinical trials and clinical trial files will be looked at by these artificial intelligences in place of the ARCs – these clinical research centers which come to verify the files.
This AI will be able to look in the file, check everything problematic, ask all the questions, make all the requests it wants to the investigator.
On the other hand, behind, we risk having a small problem if the investigator does not have an AI to respond due to the risk of significant requests. Overall, what is predicted for AI in the future is that the broad use of AI comes at a time when we are short of human resources and human time. It arrives to replace human time, to help us analyze files, to give us case summaries, to make consultation summaries, too, with AI which can listen to us and prepare a consultation report.
However, behind this promise of having more free time for the doctor to do other things, we must remember that with each new major electronic or even technical, technological innovation in recent decades, there has still been an increase in workload.
Indeed, since the doctor has more time to take care of other things, he will be called upon more. In the same way that AI could help us with the files of clinical research assistants in clinical trials, it could bring an additional burden, with more requests, more data collected. AI will therefore not necessarily change things in the coming years. We will have to remain wary and only use it to the extent that it can be of service to us.
Since the doctor has more time to take care of other things, he will be called upon more.
A new organization of clinical research?
Finally maybe the news end of year: announcements from Emmanuel Macron who is launching his revolution on the organization of research over the coming months, or the next few years, with a plan that we feel wants to be ambitious.
Perhaps the end of year news: the announcements from Emmanuel Macron who is launching his revolution on the organization of research over the coming months
However, you will have to remain wary and pay attention to what exactly will be explained in the new organization. For example, the President of the Republic wants to transform research organizations into program agencies – paying attention to the term program and not means agency, as could have been mentioned at certain times. The difference being that a resources agency is an agency which gives money and which is not going to hire people, unlike a program agency. This was precisely a red flag waved for researchers, since it would mean having more precarious positions, so we will have to remain attentive to this.
A program agency, on the other hand – which would be INSERM for health, as announced by Emmanuel Macron – is an agency which will be able to determine the most important program themes.
Researchers could here also lose autonomy over the subjects… We will have to be attentive, we will have to see, we must hope, precisely, that there is a little flexibility and be careful.
It should be noted, however, that a presidential advisory committee on this topic was organized with 12 personalities, among them a few people from the medical world and in particular – a notable fact – an oncologist, Fabrice André. We can therefore hope that Dr. André will have, precisely, this vision, at the same time of research and the clinic, and also a vision of what will happen in the future in order to organize things and best advise the President in this process.
An approach which will be crucial in the coming months to try to catch up with the delays made in recent years, these last decades, by French research.
So. On this note, I wish you happy holidays, a happy end to 2023 and I hope the best for you and your loved ones for 2024.
See you soon on the website Medscape.
Among them are a few people from the medical world and in particular – a notable fact – an oncologist, Fabrice André
See all of Dr. Rodrigues’ blogs here.
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