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Commission harnesses ‘rare moment of unity’ to deliver cancer moonshot initiatives
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Nearly 2 years after former Vice President Joe Biden unveiled the cancer moonshot initiative, The Lancet Oncology Commission has detailed a roadmap to deliver on the recommendations of the moonshot’s blue ribbon panel.
“The underlying goal of this entire effort is to accelerate existing progress so that we deliver in 5 years what would have historically taken 10,” Clifford A. Hudis, MD, FACP, CEO of ASCO and former chief of breast medicine at Memorial Sloan Kettering Cancer Center, said in a press briefing.
“It is not really about money, although money is important,” Hudis added. “It’s about getting groups of investigators, advocates, patient groups, the general public and our vast infrastructure to avoid redundancy, increase coordination and drive more efficient results.”
The commission launched Nov. 1 at an event on Capitol Hill. Researchers then presented the report on Nov. 3 at the United Nations Association of New York Humanitarian Awards, where Biden was honored for his work on improving cancer outcomes.
In December 2016, Congress overwhelmingly passed the 21st Century Cures Act, which dedicated $1.8 billion for cancer research over 7 years through the NCI.
The report, authored by more than 50 cancer experts from across the United States, identified priority areas toward which that funding should be directed. Report authors highlighted how technological advances — including understanding and mapping precancer biology and the rapid adoption of big data — as well as new collaborations across industry, patient groups, academia, government and clinical practice will be critical to advancing research and, ultimately, improving patient care.
“The Lancet Oncology Commission report takes these initiatives and provides a detailed roadmap to deliver on the blue ribbon panel recommendations, including a focus on prevention, a new model for drug discovery and development, a vast expansion of patient access to clinical trials, and an emphasis on targeted intervention to improve cancer care for underserved groups,” Elizabeth Marion Jaffee, MD, professor of oncology, deputy director of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine, and president-elect of the American Association for Cancer Research, said during the press briefing.
Underserved populations
The report emphasized the importance of addressing health disparities for underserved populations — specifically children, adolescents and minority groups — in all recommendations.
The fact that cancer outcomes are poorer for minority groups and those from lower socioeconomic status can be linked to several factors, including “inadequate access to prevention, diagnosis, treatment and research; minority community suspicion of the health care system and of doctors from other cultures; poverty; lack of health insurance; stigmas associated with cancer and death; linguistic and literacy barriers; impaired nutrition and other resources; comorbidities; and poor expectations of outcome from cancer treatment,” the authors wrote.
Based on these disparities, the report authors called for regulation of cancer research, a focus on understanding and eliminating disparities, and efforts to define high- vs. low-value care.
Sophisticated geographic information systems can now identify population clusters at higher risk for cancer, allowing for more concentrated prevention and treatment efforts in those areas, according to Scott M. Lippman, MD, professor of medicine and director of University of California, San Diego, Moores Cancer Center, and one of the report’s authors.
“Overcoming language barriers is a health disparity,” Lippman said. “If you’re targeting an area that has a high risk [for] colorectal cancer in a largely Hispanic population, promoting colorectal screening doesn’t work if people don’t understand.”
The report also specifically highlighted needs for children with cancer, both during treatment and survivorship phases.
“Pediatric oncology has its own very special needs, given that the cancers in children are quite different biologically, requiring new models,” Chi Van Dang, MD, PhD, professor and scientific director at The Wistar Institute and Ludwig Institute for Cancer Research, told HemOnc Today.
Cancer prevention
Because only half of patients who develop cancer can be cured with existing therapies — and those who are cured will suffer chronic morbidities — the blue ribbon panel originally identified cancer prevention as a main scientific priority.
The new recommendations included the development of a premalignant cancer atlas to identify small changes in healthy tissue at the earliest stages of cancer development, opening up new opportunities for precision-based cancer prevention.
“There is more focus on prevention, which extends way beyond what the blue ribbon panel report had,” Van Dang said. “I think some of those recommendations are worth paying attention to.”
Research into cancer vaccines represent the next frontier in cancer research and prevention, according to the report.
“Recent data suggest you may be able to determine whether a patient will get cancer, where that cancer will be and in what mutations it will occur,” Lippman said. “It’s exciting work, and it’s just emerging. If you could give someone at high risk ... booster vaccines for lifetime protection, it would obviously be a real game changer.
“I’m excited about the future and this is a call to action to move on this,” Lippman added. “We have an incredible opportunity and the potential for prevention is far greater than therapy if we can make this happen. But, it will take a concerted effort and investment.”
Further, more than half of cancers can be prevented by addressing factors such as diet, nutrition and physical inactivity, the authors wrote.
Because obesity and lifestyle are major cancer risk factors, the report authors highlighted ways in which the obesity epidemic can be addressed in the United States. For instance, more walkable cities have a lower incidence of cancer than cities designed to move large volumes of traffic, Lippman said.
“It was estimated that designing cities differently can save 2 million lives annually,” he added.
Rethinking big data, drug discovery
The ultimate goal of the moonshot initiative is to align research and care in a seamless continuum such that all patients have access to clinical trials as part of standard care, and their clinical course and experience informs future research.
The authors noted that, despite an unprecedented increase in the number of therapies approved by the FDA in the past 2 to 3 years, hundreds of drugs fail in clinical trials. Further, those approved carry an estimated cost of $2.6 billion.
To expedite patient access to cancer drugs and clinical trials, the report called for the promotion of novel trial designs, reduction of regulatory and financial burden, and optimization of the drug approval process.
“We need to expedite patients’ access to new drugs and reduce the burden of early-phase trials,” Van Dang said. “And, we need to ensure the pediatric oncology patient population is well enrolled in clinical trials and measure that enrollment over the next 5 years.”
Among these recommendations is the need for an overhaul of the drug discovery process so that projects can be discontinued earlier in the clinical development phase, and to transform how academia, industry and clinical groups collaborate to vastly improve efficiencies.
“These are, in some cases, less sexy than cutting-edge, high-technology scientific advances, but they represent the actual implementation of our scientific progress,” Hudis said. “It is obvious that making advances without a clear ability to deploy them where they are needed is only half of the battle.”
It is particularly important that the technology currently in use in developed countries is implemented in countries most in need of advanced treatments, Van Dang said.
“We need to take the advances in technology that detect cancer as it develops, or if it recurs, and scale it in such a way it can be applied in third-world countries,” he said.
Although “big data” are transforming cancer care, the management and best use of these data requires unique resources to keep up with its ever-increasing pace. The development of a national data system would facilitate data-sharing and integration of data across platforms, according to the report. For instance, a system could allow patients to input their own personal data for use by the cancer community and, in return, provide outputs for patients to identify the most scientifically sound clinical trials for which they might be eligible.
An ASCO-sponsored Harris poll of more than 4,000 adults indicated that Americans support an expanded federal role in cancer research and would support higher taxes and deeper deficits to accomplish the goals of the moonshot initiative, Hudis said.
“We have a rare moment of unity [in which] our political forces and our general public are aligned behind the goal of the moonshot effort, and what we have to do is deliver,” he said. “The cancer community as a whole has been energized and we now have very specific measures and metrics. The commission was brave enough to set timelines with deliverables that are promised in specific ranges of time.” – by Chuck Gormley
Reference:
Jaffee EM, et al. Lancet Oncol. 2017;doi:10.1016/S1470-2045(17)30698-8.
For more information:
Chi Van Dang, MD, PhD, can be reached at The Wistar Institute, 3601 Spruce St., Philadelphia, PA 19104.
Disclosures: Jaffe reports grants and personal fees from Aduro Biotech and grants from Bristol-Myers Squibb. Hudis, Lippman and Van Dang report no relevant financial disclosures.