A conversation with Dr. Sylvia Richey, Chief Medical Officer, West Cancer Center
By JAMES DOWD
As the overall death rate from cancer continues to decline in the United States, innovative therapies and treatments offer hope to patients whose conditions might once have been considered fatal. Statistics from the National Cancer Institute show that in 2024, about 2 million new cases of cancer were diagnosed in the U.S., with the most prevalent being breast, prostate, and colon cancers.
For women, breast, lung, and colorectal cancer accounted for 51 percent of all cancer diagnoses in 2024. For men, prostate, lung, and colorectal cancers made up 48 percent of all cancer diagnoses. Overall cancer death rates have declined for the last three decades, and survival rates have increased. There are more than 18 million cancer survivors in the U.S. now, and that figure is projected to exceed 22 million within the next decade.
Researchers continue to make great strides in the prevention, diagnosis, and treatment of cancer, including advances in immunotherapy and precision medicine, said Dr. Sylvia Richey, Chief Medical Officer of West Cancer Center.
Sylvia Richey
Richey, who joined the center as a Hematology/Oncology specialist in 2005, led the development of the center’s Integrative Oncology program and now leads Clinical Practice Quality initiatives.
“Cancer is like a black box to anyone outside of it, but I think you have to understand that cancer is not simply one disease that you treat the same way in each person who gets it,” Richey said. “Cancer is many diseases and there are types within types. We now know that even patients in advanced stages of cancer or those who may not be as fit because of other diseases or treatments are being effectively treated with immunotherapy and targeted therapy.”
Because cancer is not a singular disease, but a collection of distinct diseases, each with unique subtypes and treatment challenges, Richey said treatment plans for patients have become much more diversified and individual during the last 20 years. For example, whereas traditional chemotherapy was for years the mainstay of treatment, targeting the cell cycle indiscriminately often led to significant side effects. However, modern advancements in oncology have paved the way for more targeted therapies that enhance treatment efficacy while reducing toxicity.
Immunotherapy represents a change in basic assumptions in cancer treatment, Richey explained, leveraging the patient's own immune system to recognize and attack malignant cells. By enhancing the body's natural defenses, immunotherapy has demonstrated remarkable efficacy, particularly in cancers that were once considered untreatable. Combination strategies, such as using immunotherapy alongside chemotherapy, offer greater variability in treatment response, and allows some patients with metastatic cancers to achieve long-term remission.
“In many cases, what was once considered a terminal diagnosis is now being managed as a chronic condition,” Richey said. “Research and treatment advances make it possible to offer patients significantly extended survival and improved quality of life. We are seeing metastatic cancers that were once considered incurable now being in long-term remission. We are now able to give many patients years of life they would not have had before.”
A notable case illustrating the success of immunotherapy, Richey offered, is that of former U.S. President Jimmy Carter, who was successfully treated for metastatic melanoma. His case underscores the potential of immunotherapy as a standard of care in select patient populations.
“When he was diagnosed, the metastatic melanoma had spread to his brain and liver and particularly at his age, the outlook didn’t appear promising,” Richey said. “However, after immunotherapy and radiation therapy, he was eventually considered cancer-free.”
Targeted therapy has further revolutionized oncology, Richey said, by focusing on tumor-specific genetic mutations rather than broadly affecting healthy cells. Molecular profiling of tumors allows for personalized treatment strategies, identifying mutations within tumor DNA and matching them with targeted medications.
Many of the treatments are oral, providing a more convenient and tolerable alternative to intravenous chemotherapy. Unlike traditional chemotherapy, which attacks both healthy and malignant cells, targeted therapies hone-in on cancer-specific mutations, improving efficacy and reducing adverse effects.
Looking ahead, Richey said that harnessing the immune system remains one of the most promising avenues in cancer treatment. Emerging therapies, such as bispecific T-cell engagers (BiTE therapy), are at the forefront of research, with ongoing clinical trials exploring their potential in solid tumors.
Chimeric Antigen Receptor T-cell (CAR-T) therapy is another groundbreaking approach, involving the genetic modification of a patient’s T cells to recognize and attack cancer cells. This highly personalized treatment involves extracting T cells, engineering them in a laboratory to target tumor antigens, and reinfusing them into the patient. While currently limited due to the complexity and cost of production, CAR-T therapy is demonstrating curative potential in refractory cases. As research progresses, it is expected to be introduced earlier in treatment regimens and expanded to additional cancer types.
With all cancer patients, but particularly for those in later stages of the disease, managing expectations and providing as many options as possible remain key.
“One of most important things in an advanced patient population and those with end-of-life issues, is taking into consideration the whole patient and having shared decision-making with the patient,” Richey said. “We treat the whole patient – mind, body and spirit – and take a multidisciplinary approach that includes nutrition, exercise and mental health, to offer the best quality of life possible.”
