We’re curing more people, helping others live well with cancer, and giving patients more time where they want to be—living their lives.
Charles J. Gaulin, MDDelivering chemotherapy directly into cancer cells. Pills that patients take at home. Training the body’s own immune cells to find and attack cancer—cancer care has changed dramatically over the past decade and continues to evolve at a remarkable pace. At Dartmouth Cancer Center’s (DCC) 2025 Survivor Symposium, hematologist-oncologist Charles J. Gaulin, MD, shared how new therapies are helping patients live longer, feel better, and spend more time doing the things they love.
“I first became interested in oncology in 2012,” Gaulin said. “The conversations we were having with patients back then were so different. Since that time, the treatment landscape has completely changed—not just in terms of survival, but in quality of life.”
Gaulin specializes in lymphoma, multiple myeloma, and cellular therapies—areas where innovation is moving especially fast. His message to survivors and families was clear: today’s cancer treatments are smarter, more targeted, and increasingly personalized to each patient’s disease and life goals.
Targeting cancer more precisely
One of the biggest shifts in cancer care is the move toward targeted therapies—treatments designed to attack cancer cells while minimizing harm to healthy tissue.
A key example is antibody-drug conjugates, which Gaulin described as “a Trojan horse.” These treatments use antibodies to find cancer cells and deliver chemotherapy directly inside them. “This approach delivers chemotherapy straight into the cancer cell rather than circulating it through the whole body. The goal is to reduce systemic toxicity and improve outcomes,” he explained. These therapies are now used to treat many cancers, including breast cancer, lymphoma, and bladder cancer.
We’re treating based on the tumor’s blueprint.
Targeted therapies have also transformed lung cancer care. By identifying specific genetic mutations that drive cancer growth, doctors can now prescribe pills that patients take at home. “We’re treating based on the tumor’s blueprint,” Gaulin said. “Patients can live their lives, spend less time in the hospital, and often tolerate these treatments much better than traditional chemotherapy.”
Harnessing the immune system
Immunotherapy has become one of the most powerful tools in modern cancer care. These drugs work by removing the “brakes” on the immune system, allowing it to recognize and attack cancer.
“Cancer develops ways to escape the immune system,” Gaulin said. “When we interrupt those escape mechanisms, we can restore the cancer immunity cycle—and that can lead to deep, durable remissions.”
Immunotherapy is now used in many cancers, from melanoma and lung cancer to lymphoma and colon cancer. One of the most encouraging features is that some patients continue to do well long after treatment stops. “Every immunotherapy trial has a plateau,” he noted. “That tells us there are long-term responders who remain cancer-free, and that’s beautiful to see.”
Immune “matchmakers”: Bispecific T-cell engagers
Taking an earlier BiTE
Several bispecific T-cell engager or “BiTE” therapies, which bring immune cells into close contact with cancer so the body can do the work, are FDA-approved for some blood cancers and small-cell lung cancer, with ongoing developments in other solid tumors.
Having revolutionized outcomes in relapsed lymphoma and myeloma, researchers are now studying BiTE therapies earlier in treatment, where they may be more effective.
One such clinical trial available at DCC is designed for people with follicular lymphoma who have a low tumor burden. The goal of the study is to compare two drug treatments: rituximab, a widely used antibody therapy, and mosunetuzumab, a BiTE therapy. Mosunetuzumab is already approved by the FDA for treating follicular lymphoma after other treatments, but this trial is exploring how well it works as a first-line therapy.
Gaulin also highlighted a newer class of immune-based treatments called bispecific T-cell engagers or “BiTE” therapy, which help the immune system attack cancer more directly.
“These drugs basically force the immune cell, called a T cell, and the cancer cell to meet,” he explained. “They have one arm that grabs the cancer and another arm that grabs the T cell.”
Rather than killing cancer cells like chemotherapy does, BiTE therapies act as matchmakers—bringing immune cells into close contact with cancer so the body can do the work. Several BiTE therapies are already FDA-approved for blood cancers such as lymphoma and multiple myeloma, small cell lung cancer, and others are being studied in solid tumors.
“They’ve really revolutionized outcomes in relapsed lymphoma and myeloma,” Gaulin said. “And now we’re studying them earlier in treatment, where we hope they’ll be even more effective.”
Cellular therapies: Training the immune system
Cellular therapies take immunotherapy a step further by re-engineering the immune system itself. In CAR T-cell therapy, a patient’s own immune cells are collected, “trained” in a lab to recognize cancer cells, and then returned to the patient's body.
“These are not chemotherapy,” Gaulin emphasized. “They have their own side effects, but they’re very different—and they’ve revolutionized care for people with relapsed lymphoma and myeloma.”
Other cellular approaches, including tumor-infiltrating lymphocyte (TIL) therapy, are expanding options for patients whose cancers did not respond to standard immunotherapy. Many of these treatments are now being studied earlier in care, when the immune system is strongest.
Treating earlier—and sometimes less
Another major advance is using effective treatments earlier, including before or after surgery, to improve long-term outcomes. Immunotherapy and targeted drugs are increasingly being used in early-stage disease, with the goal of curing more patients and reducing the need for aggressive treatment later.
At the same time, oncologists are learning when less treatment may be better. For example, new blood tests that detect tiny traces of cancer—called circulating tumor DNA—can help determine who truly needs additional therapy after surgery and who can safely avoid it.
“Not everyone benefits from more treatment,” Gaulin said. “And these treatments have real side effects. If we can safely spare someone chemotherapy or radiation, that’s a win.”
Precision screening, imaging, and survivorship
Advances in imaging, radiation therapy, and artificial intelligence (AI) are also improving care. Highly targeted radiation treatments can deliver therapy directly to cancer cells, while AI tools are helping doctors read mammograms, track lung nodules, and reduce unnecessary biopsies.
Beyond treatment, there is a growing focus on survivorship and long-term wellness. Researchers are studying physical health, emotional well-being, fertility, and financial stress—issues that matter deeply to patients and families.
“Cancer care is a journey,” Gaulin said. “If we can achieve the same outcomes with fewer side effects and less disruption to someone’s life, that’s what we should be aiming for.”
As research continues, Gaulin notes the future of cancer care is increasingly hopeful. “These are really exciting times,” he said. “We’re curing more people, helping others live well with cancer, and giving patients more time where they want to be—living their lives.”
This information was initially presented at DCC’s 2025 Survivor Symposium. Follow DCC on Facebook or check Events for updates and details on the 2026 event, coming this fall.