Predictions are a tricky business — just ask anyone who went on the record with a look-ahead in December 2019. But as we flip our calendars over to start another solar revolution, we can, at least, send some wishes skyward for good things to come in the new year.
We asked scientists at Fred Hutchinson Cancer Research Center for their reads on what’s to come in 2022, whether firm predictions, lofty hopes or something in between.
Experts across the Hutch’s five scientific divisions brought us visions of technological advancements, new standards of care for people with cancer and something even more fundamental: the return of trust.
“As far as scientific predictions, I am not sure this will happen, but it is my hope that 2022 will be the year of evidence-based thinking and a resurgence of public trust in science,” said Fred Hutch nutritional epidemiologist and Cancer Prevention Program head Dr. Marian Neuhouser.
Colorectal cancer is one of the most common cancers in the U.S. and can be deadly at an advanced stage. But unlike many other cancer types, there is a slate of effective screening tests that can detect early colorectal cancers and even precancers so they can be removed before they cause harm.
Fred Hutch experts hope that 2022 will bring an increase in colorectal cancer screening among the millions of people who are eligible, which, as of this year, includes everyone in their mid- to late 40s.
"It is my hope that we are getting colorectal cancer screening rates to above 80% of the eligible population, which is everyone between the ages of 45 to 75, and everyone with a positive first-degree family history of colorectal cancer [meaning a parent, sibling or child had this cancer] between ages 40 and 75,” said Dr. Ulrike Peters, whose research focuses on the genetic epidemiology of colorectal cancer. She added: “It is my specific hope that we particularly encourage screening in African American and Alaska Native people, who have particularly high rates of colorectal cancer.”
Gastroenterologist Dr. Rachel Issaka, whose research focuses on colorectal cancer screening, is also looking forward to getting more people screened in the new year.
“I think screening starting at 45 is really going to be the lead. 2022 is when insurance companies have to begin covering it. It usually begins with Medicare and then other insurance plans follow suit,” Issaka said at Fred Hutch’s Nov. 30 Science Says virtual event. “And so I think we will learn how we will engage people who are between the ages of 45 and 50 in completing screening."
She added: “And, hopefully, what we learn can be applied to the entire population, because one in three adults over 50 has not completed screening yet. We have to do a better job overall, and I think the 40- to 49-year-olds will hopefully push us to do better for everyone.”
Getting screened for cancers such as colorectal, breast and cervical when eligible is one step people can take to take more control of their health. Another is to get more exercise, eat healthy foods and quit tobacco. Psychologist Dr. Jonathan Bricker, who develops and tests new ways to help people change behaviors that affect their health, hopes that all of us use the new year to make more healthy choices.
“As the COVID virus's evolving behavior will continue to impact global health in 2022, it is more imperative than ever we each work to control our own health behavior through exercise, diet and tobacco cessation,” he said.
He shared two ongoing studies his team is conducting that could help.
In recent years, advances in cancer treatment, such as targeted drugs and immunotherapies, have led to better survival for people with a range of cancers. Fred Hutch researchers foresee more progress in 2022.
Imaging can be an important tool in cancer care for making sure a patient is getting the right treatment. Biostatistician Dr. Ruth Etzioni says that as we enter 2022, “cancer imaging is having a moment and we will all need to start learning a lot more about radiology if we want to keep up with the inevitable consequences for staging and treatment.”
Etzioni, whose research focuses on cancer screening and early detection, cites new PET scans that show more clearly and easily sites of metastasis, or cancer spread, in people with prostate cancer. In a positron emission tomography or PET scan, a dye containing a radioactive substance is infused into the body, where a scanner detects it, ultimately yielding 3D images showing the functioning of particular organs and tissues.
There are several new types of PET scan for prostate cancer, Etzioni says, and they are "leading to dramatic upstaging and changes in treatment recommendations in newly diagnosed and recurrent cases. … My prediction is that this is going to be something that becomes available for other cancers too, if not already. The technology is there.”
Dr. Robert Bradley sees progress toward new types of cancer drugs that harness RNA, a cousin of DNA, that is created as cells interpret the information stored in their DNA. Like changes in DNA, changes in RNA can drive cancer. Bradley's recent laboratory work has suggested that drugs designed to disrupt RNA or RNA processing could be potential avenues for treatment, and he sees the larger scientific field moving this way, too.
“I predict that RNA will become an increasingly transformative technology for creating new cancer therapies — developing RNA-based cancer vaccines, using RNA itself as medicine and creating new drugs that alter RNA metabolism within cancer cells,” Bradley said.
Therapies that use genetically engineered immune cells called T cells from a patient’s own body transformed how doctors treat certain advanced blood cancers. T-cell therapies are continuing to change standards of care, said Fred Hutch immunotherapy experts, and more are moving from the lab bench and into the clinic.
“I think it’s going to be an explosive year for cellular therapies,” said Fred Hutch immunotherapy pioneer Dr. Phil Greenberg in the Nov. 30 Science Says event.
“In the field of cellular therapy, I think what we’re going to be talking about is genetic engineering,” he said. Scientists are learning a tremendous amount about how tumor cells and immune cells work, and can now harness that knowledge to intervene using genetic engineering tools, he said. “What we’re going to start seeing are cells that are essentially bionic cells, that respond differently [to cancers] than any normal cell would respond, but respond in a way that we would really want them to,” he said.
This December at the annual meeting of the American Society of Hematology, researchers presented data from large, randomized clinical trials demonstrating that two different engineered T-cell products that are already FDA-approved for some blood cancer patients did a better job than the current standard of care in keeping cancer at bay in particular lymphoma patients with treatment-resistant cancers. These products are both in a category called CD19 CAR T cells, which refers to the target the T cells are engineered to seek out and destroy (CD19) and the type of molecular weaponry that allows them to do so (a CAR, or chimeric antigen receptor).
Dr. Brian Till, an immunotherapy researcher and blood cancer doctor who saw the presentations, predicted that in 2022, these CAR T-cell therapies will become a standard treatment for patients like those in the trials: those with diffuse large B cell lymphoma, a type of non-Hodgkin lymphoma, whose cancers come back less than a year after their first line of treatment (a multidrug regimen of chemotherapy, cancer-targeting antibodies and a steroid).
While doctors can’t start giving this treatment until approval comes from the Food and Drug Administration, Till hopes that will be soon. Currently, these relapsed patients receive a different chemotherapy followed by a transplant of their own blood stem cells.
"It is exciting to see CAR T-cell therapy starting to move to earlier lines of treatment, and it will hopefully improve the chances of cure for these high-risk patients and reduce the amount of chemotherapy they are exposed to,” Till said.
Genetic engineering was on physician-scientist Dr. Andrew Hsieh’s mind too, both in therapy and as a research tool. Thanks to CRISPR, scientists can now edit a DNA code in a living cell with incredible precision to, for example, correct inborn genetic diseases, or to study how cells work in the lab. This trend will continue in 2022, he said.
“This technology is revolutionizing the way we study cancer and genetic diseases and holds the great promise of being able to precisely engineer mutations or fixes to mutations in patients,” Hsieh said.
DNA is just one piece of our biological equation. How cells are turning their DNA on and off in different cells and at different times is another key piece of the puzzle of how life works, and Dr. Steven Henikoff sees advances in technology for understanding it coming in 2022.
“I am optimistic that affordable high-throughput epigenomics is around the corner,” he said, referring to the study of the “software” of the cell — the epigenome — that writes the programs that turn that DNA on and off. “The Hutch is especially well-positioned to take advantage of technological and conceptual advances in the field to apply the rich gene regulatory information encoded in the epigenome for research and clinical applications.”
While we’d hoped, early in the pandemic, that by 2022 the COVID-19 virus would be gone, we all now know that won’t be the case. SARS-CoV-2 joins the diverse range of other viruses, from HIV to flu, that have found the human body to be a hospitable place to reproduce over the years.
Fred Hutch's Dr. Rachel Bender Ignacio predicts that we’ll soon get a better arsenal of both vaccines and drugs to prevent and treat infection with the coronavirus, which will be critical for managing life with this ever-changing virus.
“We will have a much fuller complement of effective vaccines, early treatments with antivirals, monoclonal antibodies and immunomodulators for people with severe COVID, as well as treatments for post-acute COVID,” also known as long-haul COVID-19, Bender Ignacio said at the Nov. 30 Science Says. “And I think that really the story for this next year is how to apply these to the correct populations and get them to people. … We need to be getting people into treatment.”
Bender Ignacio is medical director of the COVID-19 Clinical Research Center at Fred Hutch, which is conducting clinical trials of investigational treatments for people with, or at high risk for, COVID-19 or long-haul COVID-19. Learn more about the studies the CCRC is enrolling and what it’s like to participate.
Drug combinations, specifically, are needed in the new year to treat people with COVID-19 and other viral illnesses, wrote infectious disease physician and math modeler Dr. Joshua Schiffer, Bender Ignacio and colleagues in a perspective published Dec. 21 in the journal mBio. The development of combination treatments in the new year will increase efficacy of treatment, limit toxicity and avoid the development of drug resistance, they wrote.
Virologist Dr. Julie Overbaugh, too, is looking ahead at treatments for the COVID-19 virus in 2022 — and looking out for a different deadly pandemic virus.
“In 2022, the dynamic will be between using neutralizing antibodies vs. more classic antiviral approaches for SARS-CoV-2 and for HIV,” Overbaugh said. (Neutralization is the ability of antibodies to stop virus particles from infecting cells.) She cited research showing that both SARS-CoV-2 and HIV mutate to avoid neutralization by antibodies. “For SARS-CoV-2, current therapeutic antibody approaches directed to the spike protein may be less effective with omicron and other variants, and there will be a chance to see how antivirals directed to other proteins in the virus work. We will likely learn resistance can develop and we will need to use combinations.”
She agreed with Bender Ignacio that getting people into treatment in a timely fashion will be key: “A big challenge will be delivery of effective antivirals in the window where they have the most impact.”
For HIV, Overbaugh said, “in 2022, we will learn if a combination of neutralizing antibodies can prevent HIV, and if that is not the case, it will hopefully be a time of reflection in the field and potentially a redirection towards continuing to improve antiviral applications.”
Computational biologist Dr. Trevor Bedford anticipates being able to gain important insights in 2022 from the study of people's relatively well-defined COVID-19 vaccination and infection histories that could inform the design of future vaccines for other diseases, such as flu. Much of his work before COVID-19 involved tracking flu as it spread and evolved to help inform the tricky work of designing yearly flu vaccines.
“We’ll be able to understand more about how you make a vaccine that targets specific strains that are circulating,” Bedford said.
Neither flu, nor HIV, nor SARS-CoV-2 are diseases of one particular country or continent. The more connected the world becomes, the more our viruses will circulate throughout all humanity.
Perhaps, Overbaugh concludes, next will be the year we finally realize what we need to do.
“I truly hope that 2022 is a year where the U.S. and other first-world countries take a global perspective on the pandemic, recognizing this is an infectious disease that will be with us for some time,” she said, “and that we are in this together."
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