Beyond Radiation & Chemotherapy — 3 Cancer Treatments That Are Reshaping Care

There’s no doubt that cancer cases are on the rise. It’s estimated that over 2.1 million Americans will get a new cancer diagnosis this year, adding to the 18+ million who have a history of invasive cancer. While cancer has long been associated with older adults, rates of certain cancers are rising among younger populations.  

“Look, the cancer of today, it's not the same cancer your grandfather and your grandmother faced. It's different,” says Nathan Goodyear M.D., an integrative medicine physician associated with the Williams Cancer Institute. 

This shows that the disease process is evolving. The problem is, the standard of care treatments haven’t changed much.

“The strategies that we've employed in the conventional oncology standards for the last 75 to 100 years have been surgery, chemotherapy, radiation, and then immunotherapy,” he notes. “But it's not meeting the changing demographics of cancer.”

Gut health impacts nearly every system in the body. And an unbalanced gut can even fuel disease. 

“Certain types of bacteria actually change the immune system locally, and those local changes can lead to immunosuppression, allowing cancer to not only develop but also to progress,” says Goodyear. “While we often focus on genomic mutations in cancer, and sequencing is certainly helpful, it’s really the immune system that cancer fears. When you look at what the tumors target, they target the evasion of the immune system. And so, in that, we have to step into the gut microbiome.”

Fecal microbiota transplant is a procedure that transfers beneficial gut bacteria from one person to another to help restore microbial balance. And while the name may make you squirm slightly, fecal transplant has actually long been used in medical settings. They’ve been most commonly used to treat recurrent Clostridioides difficile (C. diff), a bacterial infection that can develop after antibiotics disrupt the gut microbiome and allow harmful bacteria to overgrow in the colon.

It’s also being studied for conditions like ulcerative colitis, Crohn’s disease, and (yes) cancer. 

“Certain types of bacteria actually change the immune system locally, and those local changes can lead to immunosuppression, allowing cancer to not only develop but also to progress. While we often focus on genomic mutations in cancer, and sequencing is certainly helpful, it’s really the immune system that cancer fears. When you look at what the tumors target, they target the evasion of the immune system. And so, in that, we have to step into the gut microbiome.”

A fecal transplant can help restore a healthier gut microbiome. “It's not just about particular bacteria or diversity, as you'll hear in the literature. But it's also about promoting a sustained, durable transition and change of the gut microbiome,” says Goodyear. 

These microbial shifts may also affect how the body processes food and fuels immune activity. As the gut microbiome breaks down fiber and other nutrients, it produces metabolites (compounds that can influence immune function throughout the body). 

Another emerging strategy focuses on treating tumors at their source rather than delivering therapies throughout the entire body.

Intra-tumoral ablation is a minimally invasive procedure in which physicians insert a needle directly into a tumor and use heat, cold, or other energy to destroy cancer cells. “We place the needle into that area under CT guidance, and then pass an ablative probe through the needle into the tumor to destroy part of it,” says Goodyear.

Specifically, the needle is inserted into the most metabolically active portion of the tumor. “Research tells us this area often correlates with the most hypoxic [oxygen-deprived] region, which is considered one of the leading mutagenic areas of the tumor and a key site of immune evasion.” 

“The reason we go directly to the tumor is that we can bypass many of the limitations of delivering treatment systemically.”

Systemic therapies (such as chemotherapy) travel throughout the entire body, which can sometimes lead to the widespread side effects most associated with cancer treatment.

Immunotherapy can also be delivered directly into the tumor. “The same idea applies to microdoses of immunotherapy delivered into the tumor rather than throughout the body, sometimes in combination with other therapies,” says Goodyear. “The whole goal is to destroy the tumor while also infiltrating, engaging, and activating the immune system in the presence of the tumor.”

Essentially, this “trains” the immune system in real time at the site of disease, priming that individual’s immune system to recognize that tumor.  

Goodyear notes that, in some cases, this strategy may also be considered before surgical removal of a tumor, with the goal of engaging the immune system while the cancer is still present. The rationale, he explains, is that immune activation prior to surgery may help reduce the risk of recurrence and improve downstream treatment response, though this approach is still being explored.