It has been a special honor to serve as editor-in-chief of CURE magazine for the past 18 years. During that time, we have witnessed an accelerating pace of advances in cancer care and the underlying biology that drives it. It was also a privilege to follow the previous and co-founding editor, 

, an informed cancer survivor and wise observer who encouraged those around her to learn, act and collaborate to combine humanity and science to normalize the lives of patients with cancer. It is now my turn to hand over the editorial reins, so I take this opportunity to look back at where we have been and what we have learned, especially how the future might look in this dynamic era.

There have been successive revolutions from the earliest advances in pathology to understand that cancer came from our own cells and later to classify cancers based on the area of the body from where they arose and the accompanying clinical features. Radiation was one of the first tools that brought some relief for select patients, and the advent of chemotherapy was born out of the battlefield where nitrogen mustard, a caustic agent used in combat, was found to be effective for lymphoma and subsequent modifications created our first inventory of chemotherapy agents. Scientific advances have been made in understanding cellular physiology, receptors and aberrations in DNA as the ultimate culprit of almost all cancers.

The genetic basis of cancer and advances in model systems that could mimic cancer in the laboratory provided targets that can be pharmacologically addressed in an explosion of new and successive therapies that were better than their predecessors. That brings us to the modern era, where many patients can expect new drugs to be developed over the course of their disease. The emerging use of artificial intelligence in every aspect of our lives is moving us at warp speed with forecasting the behavior of cancer and helping us decipher the genomic and biochemical intricacies of cancer evolution and optimal methods to arrest the cancer machinery that can make the most difficult cancers more treatable. Importantly, we expect that advances can be made in preventing cancer or detecting it long before it can take hold. We are learning more about lifestyles that can modify the timeline of aging and cancer. Even when cancer is diagnosed at later stages, treatments are being modified to have less harmful effects on the body and spirit. Combining the latest technologies with integrative approaches is making the trek through cancer smoother and less disruptive.

Over the history of CURE magazine, we have come along way, and we will continue to report on the challenges and successes in the accompanying stories that bring to life developing knowledge, along with personal stories and perspectives that can teach, illuminate and inspire.

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Reflecting on 18 years as editor-in-chief of CURE magazine, significant advancements in cancer care and biology have been observed. From early pathology to modern therapies, the understanding of cancer has evolved, with breakthroughs in genetics and model systems leading to new treatments. Artificial intelligence is accelerating cancer research, aiding in understanding and treating complex cases. Future prospects include cancer prevention, early detection, and less harmful treatments. CURE magazine remains committed to sharing stories that educate and inspire, highlighting ongoing challenges and successes in cancer care.

CURE magazine's outgoing editor-in-chief, Dr. Debu Tripathy, reflects on 18 years of advances in cancer care, the impact of AI and the evolving future of oncology treatment.

We Have Come a Long Way

For countless patients over the years, a cancer journey has involved surgery. Radical surgeries to remove the affected organ were the standard of care for many cancers, from rectal and bladder to certain types of stomach and uterine cancers. Although these surgeries offered a chance for a cure, they often came at a significant cost. Patients faced life-altering side effects, including issues with digestion, sexual function, fertility and overall quality of life.

However, a new era in cancer treatment is dawning, as we detail in this seasonal issue of CURE. Advancements in research and technology are allowing doctors to offer patients more options than ever. We explore the growing field of organ-sparing therapies, which use systemic treatments such as chemotherapy, immunotherapy and targeted therapies to shrink tumors or control the disease, potentially eliminating the need for surgery.

In this issue, you will find insight from Joanna Fawzy Doran, CEO of the nonprofit organization Triage Cancer and a CURE advisory board member, about what patients can do if they face the common issue of insurance denials during their cancer journey.

Additionally, we examine real-world data on the use of Carvykti (ciltacabtagene autoleucel) in the treatment of patients with relapsed/refractory multiple myeloma and spotlight treatment advancements for triple-negative breast cancer as part of our “Speaking Out” discussion series.

Furthermore, we speak with a pair of experts about what the “new normal” may be like for someone entering cancer survivorship.

“Often it’s kind of a series of physical adjustments,” Dr. Kevin Billingsley of Yale Cancer Center and Smilow Cancer Hospital in New Haven, Connecticut, told us. “It takes weeks to months to recover from the physical rigors, often of a combination of chemotherapy and surgery. Even young, healthy people ... need to rebuild themselves, often with a program involving exercise under the guidance of a trainer or physical therapist, as well as some nutritional consultation.

“It can take longer than people expect. There [are] also the emotional adjustments of getting back into the normal flow of life and dealing with the uncertainty that [accompanies] a cancer diagnosis. … This is because even when treatments are highly successful, people live with the uncertainty that cancer may return at some point, which can be quite stressful.”

Patients in remission enter a “survivorship care period,” as Frank J. Penedo of Sylvester Comprehensive Cancer Center in Miami told us. “The [National Cancer Institute] defines a cancer survivor as somebody from the day of diagnosis through the balance of their life,” said Penedo, who leads teams in cancer survivorship, translational behavioral sciences, and supportive care, and the psychophysical mechanisms and health out-comes lab, at Sylvester. “Survivorship care is the care that a person is receiving in addition to their medical treatment post completion of their primary treatments. In that survivorship care, it’s really critical that the patient remains very involved with their care team for a variety of reasons.”

For all the up-to-the-minute oncology updates, stay tuned to curetoday.com. There, you will find everything from breaking news on the latest Food and Drug Administration approvals to expert context on major cancer news and much more.

Our goal is to empower our readers with knowledge and provide patients with the information they need to make informed decisions about their cancer care. Throughout these pages, you will find personal stories and expert insights. As always, we hope you find them inspirational and informative. Thank you for reading.

Advancements in cancer treatment are shifting from radical surgeries to organ-sparing therapies, utilizing systemic treatments like chemotherapy and immunotherapy. This approach aims to reduce life-altering side effects and improve quality of life. Insights from experts highlight the challenges of insurance denials, the evolving landscape of cancer survivorship, and the importance of survivorship care. Real-world data on Carvykti for multiple myeloma and advancements in triple-negative breast cancer treatment are also discussed. The focus remains on empowering patients with knowledge for informed decision-making in their cancer care journey.

New advancements in cancer treatment are reducing the need for radical surgeries, offering organ-sparing therapies and enhancing survivorship care and support for patients.

The Dawn of a New Era in Cancer Treatment

Navigating insurance denials is the most common issue faced by Triage Cancer, a nonprofit organization dedicated to educating patients and caregivers about legal and practical aspects of a cancer journey, as its CEO told CURE.

“Certainly, the lack of understanding about people’s options and the steps that they can take contributes to not only lack of access to care but also [is] contributing to financial burden because if patients aren’t getting insurance to cover their care, they’re faced with the decision of either not getting access to that care or paying for it out of pocket,” said Joanna Fawzy Doran, who is also a member of the CURE advisory board.

Being faced with such denials, Doran said, is common for patients. “When someone is going through cancer treatment, they are very likely at some point during their continuum of care to face a denial for something, whether it’s surgery or a prescription drug or some type of treatment regimen; insurance denials are very common,” Doran said.

However, she noted that data on insurance denials are scarce because, in most cases, insurance companies are not required to share that information. “The data that we do have on insurance denials is based on laws … that require certain types of plans to provide that data, like marketplace plans,” she said, “but we do know certainly from anecdotal experience that people are experiencing denials. And that could be denials before care, so with preauthorizations for care, but it could also be after care is received, where the insurance company is denying coverage for that care.”

Patients with private insurance plans have two appeal levels available, as Doran explained. They can go through an internal appeals process conducted within the insurance company — and if the denial still stands, they have the option of an external appeal.

When a patient receives an internal denial, their insurance company is supposed to provide them with instructions on how to file an external appeal, Doran said. But, a patient can also start the process by reaching out to their state department of insurance. Depending on the state, someone may then be sent to the Department of Health and Human Services (HHS). Information on which states use a state-run process and which states’ processes are HHS-run can be found on Triage Cancer’s website.

“You get to go outside the insurance company to an independent entity, and they decide whether or not [something is] medically necessary, and that decision is binding on the insurance company,” Doran said. “So, this is what I refer to as the best-kept secret of our health care system because even though the advocacy community fought hard for this protection that was made federal law by the Affordable Care Act, no one knows about it. And when I say no one, I mean, actually, no one. I speak to providers all the time; I speak to patients; everybody is surprised that this exists.

“And a lot of times, people think that the peer-review process where the insurance company speaks to your health care provider and has a conversation is the external appeal, and it’s not — the peer review process is just an internal process for the insurance company. So even if the peer review is denied, you still get to go outside the insurance company to the external review.”

For more news on cancer updates, research and education, don’t forget to 

subscribe to CURE®’s newsletters here.

Insurance denials are a prevalent issue for cancer patients, often leading to financial burdens and limited access to care. Patients frequently encounter denials for treatments, surgeries, or medications, yet data on these denials is limited due to lack of reporting requirements. Patients with private insurance can appeal denials through internal and external processes, with the latter involving an independent review that is binding on the insurer. Despite being a federal protection under the Affordable Care Act, awareness of the external appeal process remains low among patients and providers.

The CEO of Triage Cancer discussed the “best-kept secret” of the health care system in an interview with CURE.

What Patients Need to Know About Appealing Insurance Denials 

When Sarah Rack talks about her diagnosis of rectal adenocarcinoma on Election Day 2020, she does not mince words.

It was the fear of illness and death, concern for her children — one a college sophomore at the time and the other still in high school — and the threat of surgical removal of her rectum and living the rest of her life with a colostomy, the surgical connection of the colon to an abdominal opening that lets stool be collected in a bag outside the body.

"Now, I'd be able to handle it better, but at the time, I said I'd rather be dead than have a colostomy. I was so depressed," says the 58-year-old psychiatrist who lives in Memphis, Tennessee.

But Rack was offered a possible escape from that fate: a spot in a clinical trial that would test whether treatment with medication alone could eliminate the need for surgery in people with tumors that had specific genes that suggested they would respond well to the medication.

Surgical removal of the affected organ was once a foregone conclusion in many cancers, including certain cancers of the rectum, colon, stomach, bladder and uterus. These life-altering surgeries may have consequences for digestion, excretion, fertility, sexual function and countless other aspects of daily life. But now, an increasing number of people with some of these cancers have a choice: surgical removal of the organ or systemic therapy and added surveillance.

“Depending on the organs involved and what the surgical pathway would have looked like, surgical resection can greatly reduce your quality of life,” says Dr. Kaysia Ludford, an assistant professor in the Department of General Oncology at The University of Texas MD Anderson Cancer Center in Houston. “An organ-sparing approach is paradigm-shifting.” 

Although the removal of an organ often offers the greatest chance of a cure in cancers such as rectal and bladder, these surgeries come at a cost. For some people, rectal resection can mean living with a permanent colostomy along with other potential collateral effects. “Even with a minimally invasive approach, we can affect sexual function, bladder function and fertility,” says Dr. Fergal Fleming, a colorectal surgeon at the University of Rochester Medical Center in New York.

The same is true of bladder removal, a procedure called radical cystectomy, for bladder cancer. The procedure not only takes the bladder but also part of the small intestine, which is used to create a “neobladder,” a pouch to hold urine. Nearby organs and tissue are also removed, which can affect fertility and sexual function.

"It’s fraught with complications," says Dr. Roger Li, a genitourinary oncologist at Moffitt Cancer Center in Tampa, Florida, "because it’s one of the most complex surgeries we do in urology, and it’s oftentimes done in a patient population who is not at their healthiest."

Saving Organs in Cancers With Specific Genes

Rack got into a clinical trial at MD Anderson that tested whether treatment with the immune checkpoint inhibitor Keytruda (pembrolizumab) before surgery might eliminate the need for surgery in people whose tumors had cells with mutations in genes that correct DNA errors, a condition known as mismatch repair deficiency.

Twenty-seven of the 35 trial participants, including Rack, had colon or rectal adenocarcinoma. The remaining eight had adenocarcinoma of the stomach, pancreas, duodenum (an upper part of the small intestine), ampulla (a small opening that enters the duodenum) or uterus. One patient had a type of brain tumor called a meningioma.

They received Keytruda every three weeks for six months. At the six-month mark, they could have surgery or continue the medication for a year, followed by observation.

Eighteen participants chose the nonsurgical option of Keytruda, 10 of whom completed the full year. After three years of follow-up, 14 of the 18 patients were alive with an intact organ. Two patients were lost to follow-up. One patient died of unrelated causes. Another died from disease progression. Although the majority of those in the study and the majority who benefitted from treatment had colorectal cancer, one patient who took the nonsurgical option had gastric cancer and is still in remission now, nearly four years later.

“The patient still has the organ intact and didn’t require the stomach to be resected,” says Ludford, who co-led the study. “As you can imagine, certain organs have serious implications for quality of life if they have to be resected, [such as] the stomach, for instance, so we want to explore the possibility of sparing those organs, and that’s what led to this study.”

The results were published in 2023 in the 

. In a similar study, 14 people with locally advanced rectal cancer with mismatch repair deficiency had a complete clinical response to the immunotherapy drug Jemperli (dostarlimab), which works in the same way as Keytruda, eliminating the need for surgery.

Rectal tumors do not have to carry the mismatch repair deficiency mutation to be eligible for a nonsurgical approach. The treatment plan for many rectal cancers used to be what is called “sandwich therapy,” Fleming says. “You got a little bit of radiation and a very small dose of chemo, which we call a sensitizing dose; then you’d have surgery and then three to six months of chemo afterwards.” But now researchers are testing the effects of front-loading the treatment plan with all the systemic therapies and radiation and then reassessing to see whether the patient still needs surgery.

Not too long ago, Fleming says, “Chemoradiation [for rectal cancer] without surgery would have been considered heresy.” Now, he adds: “Sometimes very well-read, motivated patients say they don’t want surgery, and also, we started seeing very good responses to systemic therapy. It wasn’t actually the primary end point of some of these studies, but they started realizing patients had a complete response.”

The approach is showing promise in many other cancers as well. Published research has explored the effects of organ-sparing approaches in cancers of the throat, vagina, sinus cavity and bladder.

Organ-sparing treatment for bladder cancer has allowed 65-year-old Darrell Murray of Orlando, Florida, to keep his bladder intact since his cancer diagnosis in 2016 and, for the most part, carry on with life as usual.

Murray had non-muscle invasive bladder cancer, an early-stage cancer restricted to the lining of the bladder. He got the standard therapy — 21 rounds of bacillus Calmette-Guerin (BCG), a combination therapy that includes a cancer vaccine and immunotherapy. Afterward, he was cancer-free until a recurrence in 2020.

The thinking in bladder cancer has typically been that if it recurs after BCG, there is a higher risk for it to spread into the muscle wall of the bladder, becoming what is called muscle invasive and eventually metastasizing. “There has traditionally been this aggressive approach that once you develop recurrence, it’s an indication for us to perform radical cystectomy to remove the bladder and reconstruct the urinary tract,” Li says.

Since 2020, Murray has had four recurrences. “Every physician, every time,” Murray says, “would bring up cystectomy as an option. I realize that’s the gold standard, but I had to ask myself what life would look like with a cystectomy.”

“They would take the bladder, prostate, lymph nodes and about 18 inches of your intestine to create a vessel for urine,” Murray says. “But the intestines are designed to absorb nutrients, not store urine. You’d absorb waste products from your kidney in the neobladder. There’s mucus buildup and sometimes blockages, so you have to catheterize yourself.”

Increasingly, people like Murray with recurrences of non-muscle invasive bladder cancer are being offered alternatives to surgery. At every turn, Murray has chosen to keep his bladder and receive the next available medication. He reasons that even after radical cystectomy, there is no guarantee a recurrence will not happen.

After Murray’s first recurrence, he had six rounds of Keytruda; after another recurrence, he had eight rounds of chemotherapy; on the third recurrence, he had BCG plus interferon, which helps the body’s immune system fight diseases.

Finally, at the fourth recurrence, Murray was almost ready to give in and have his bladder removed when he was offered a spot in the BOND-003 trial led by Li at Moffitt Cancer Center. In this trial, people with non-muscle invasive cancer that did not respond to BCG received 21 treatments with the oncolytic, or tumor-destroying, virus cretostimogene grenadenorepvec (CG0070), designed to replicate inside cancer cells and kill them. It also releases a protein that helps the immune system kill cancer cells.

Murray was among the more than 75% of trial participants who had a complete response to the treatment. The Food and Drug Administration has granted the experimental drug both fast-track and breakthrough therapy designations to speed its path to approval. Research is underway to test the same approach in muscle invasive bladder cancer.

Murray is once again cancer-free. He has been for over two years.

Although he has no regrets about keeping his bladder intact, the treatments he has endured over the past eight years have been no picnic, he says. Bladder cancer medications are intravesical, which means they go directly into the bladder, and the patient must hold them in, resisting an intense urge to urinate, for a half-hour or more. “I kind of liken it to battery acid, Coca-Cola and a package of Mentos,” Murray says of the sensation. “It was really tough sometimes.” The more treatments he underwent, the harder it was.

Is Organ-Sparing Treatment Right for You?

Each time Murray faced a recurrence, he carefully weighed the surgical versus nonsurgical approach. “I wouldn’t say it was a no-brainer,” he says.

People who have the option of organ-sparing cancer treatment should consider several issues. First, they should understand their individual risk of recurrence and whether a recurrence might be more aggressive.

They should compare the options. When comparing the removal of a vital organ and treatment with medication, organ removal typically requires a longer recovery and significant adjustment to a new life without the organ. Still, those facing this choice should ensure that they can tolerate the intense medication therapy they would receive instead of organ removal. That includes possible side effects from medication and downtime after treatment days.

Patients should also understand what kind of follow-up will be needed in the coming months and years. A nonsurgical approach usually requires more follow-up, imaging and testing than would be required of someone who had the organ removed. This is to ensure the cancer has not come back and to catch it early if it has.

The treatment and intense follow-up often require travel to a large cancer center. “Individuals need to have access to the medical facility where they can continue this very close monitoring,” Ludford said. Transportation, additional time, added costs, time away from work and child care or eldercare may all figure into this increased monitoring.

Finally, organ-sparing treatment might be best suited to people who are less prone to anxiety. All those follow-up tests can be a source of great anxiety.

“This is something we chat with our patients about,” Fleming says. “How do you cope with uncertainty? Some people can just shut the door on uncertainty while others just can’t stop looking at the issue.” Most patients in Fleming’s practice who choose to watch and wait, even if they have a recurrence, are happy with their decision, he says.

Rack, the psychiatrist in Memphis who had rectal cancer, traveled to MD Anderson in Houston for Keytruda infusions every three weeks for 18 months. After finishing treatment, she went back to Houston for scans and labs every three months for about a year. Now, she goes every six months.

Today, cancer-free, she says she actually enjoyed the trips to the cancer center in Texas. “The treatment down there was great, and then I’d come back to work and put it out of mind,” she says.

As for whether Rack regrets holding onto the organ where her cancer scare began, there is no question she made the right choice, she says. “This is one of the happiest times in all my life.”

Organ-sparing treatments are emerging as viable alternatives to traditional surgical interventions for certain cancers, offering patients the possibility of maintaining organ function and quality of life. Clinical trials, such as those involving immune checkpoint inhibitors like Keytruda, have shown promising results in patients with specific genetic mutations, allowing some to avoid surgery altogether. This approach requires careful consideration of individual risk factors, potential side effects, and the need for ongoing surveillance. Patients must weigh the benefits of preserving organs against the demands of intensive treatment and follow-up.

Feature

Avoiding surgery for rectal cancer, Sarah Rack of Memphis traveled to Houston for treatment every three weeks for 18 months. 

CURE Spring 2025

We Have Come a Long Way

The Dawn of a New Era in Cancer Treatment

What Patients Need to Know About Appealing Insurance Denials

Organ-Sparing Treatments Bring New Life After Cancer

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