This article is more than 5 years old. Information may no longer be current.
The Lancet Oncology Commission establishes ‘practical, achievable’ cancer research priorities
Click Here to Manage Email Alerts
Earlier this month, The Lancet Oncology published a rather unusual document titled “Future cancer research priorities in the USA: A Lancet Oncology Commission.”
Arising from one of the initiatives associated with the cancer moonshot task force, this commission was formed to drill down to a deeper, technical level than could be achieved by the moonshot’s blue ribbon panel — composed of representatives of government, the cancer biomedical community and patient groups — and to guide government policy and funding for cancer research.
As might have been expected from a politically driven blue ribbon panel, its recommendations — although generally reasonable — constituted a broad motherhood statement that didn’t really advance anything that was surprising or new.
The panel formally recommended the direction of funding be targeted to a network for patient engagement, the creation of a cancer immunotherapy trials network, molecular prognostication in therapeutics, formation of a national cancer data sharing system, the study of fusion oncoproteins in childhood malignancies, research on symptom control, evidence-based prevention and detection, retrospective leveraging of biorepositories to study determinants of treatment outcome, generation of human tumor atlases and creation of new cancer technologies. It also proposed demonstration projects on pharmacotyping, cancer prevention in Lynch syndrome and the creation of a pediatric immunotherapy translational science system.
Although worthy projects, this was not rocket science, notwithstanding the moonshot designation!
The Lancet Oncology Commission — of which I was a member — was established to create a much more in-depth assessment of need from the perspective of more than 50 leaders from the oncology treatment and research community who have devoted lifetime careers to this field, and who have already been involved in achieving significant progress. Several members of the blue ribbon panel also were active leaders of this latter initiative.
This latest document is certainly worthy of scrutiny but, in a time-is-money era, I provide a “CliffsNotes” version to tempt you to delve further.
The areas not sufficiently emphasized by the blue ribbon panel included the very substantial impact that effective solutions to disparities of care might produce: creating action strategies instead of analysis paralysis; consideration of mechanisms to improve value by removing ineffective or unnecessary treatment paradigms from the national cancer playbook and reimbursement manual; and reconsideration of surgical and radiotherapeutic paradigms — why do we perform multiple metastasectomies, and why is proton beam treatment reimbursed for so many unproven indications?
But I digress ...
The Lancet Oncology Commission report called for increased research linked to the creation of action plans in several important domains, such as:
- precision prevention, including the use of targeted strategies focused on immunobiology and gene mutations, with outcome metrics and validation through large randomized trials;
- a more rational approach to public health measures and cancer prevention with an emphasis on defined high-risk populations (pretty much on point for our mobile lung cancer screening unit at Levine Cancer Institute, if I say so myself!);
- a facilitated and targeted approach to drug discovery and development with a greater emphasis on targets, microenvironment and shared data;
- expedited and expanded access to drug trials, with regulatory support for refined criteria for entry and a focus on pediatric and underserved populations;
- greater focus on pediatric oncology, focusing the blue ribbon panel recommendations on that population;
- much greater emphasis on supportive oncology, palliative oncology and symptom control, with definition of national norms;
- reassessment of paradigms of imaging/diagnostics, surgery and radiotherapy, including broader application of targeted PET imaging, use of radiotherapy for oligometastatic disease, introduction of new technology and silo reduction into surgical oncology (too bad the commission didn’t specify “and provide a greater use of level-one data to support surgical dicta ...”);
- data sharing and big-data analysis, with improved rigor and guidance for approaches to big data, and avenues for patients to share their personal information; and
- health reform, disparities and access to care. There is a major focus on resolving all of the extant policy and practical issues that have functionally been ignored by government and much of the health care community for decades (read the excellent discussion on pages 39 to 44 of the report), including — but not limited to — a focus on making care much more available to the underserved; removing barriers; and reducing high-cost, ineffective treatments that expend large amounts of health care budgets instead of providing simple, curative and preventive approaches to treatment.
What I like about this document is the obvious thought that has gone into its creation, and the real focus on producing practical and achievable strategies that could actually make things better in cancer care — with meaningful increases in survival and quality of life — over the next few years.
All too often we forget the elegantly simple algorithm espoused by the American Cancer Society and quoted in this report — namely, if we could give the survival figures of white, college-educated men to every person with cancer in the United States, we would reduce cancer deaths by 25% or more.
I just wonder if this 54-page document is too long for the average beltway health policy wonks to actually read and execute on the principles set forth.
Reference:
Jaffee EM, et al. Lancet Oncol. 2017;doi:10.1016/S1470-2045(17)30698-8.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan was an author of The Lancet Oncology Commission report.