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AACR Cancer Progress Report: Past federal investments in NIH spurring breakthroughs in care
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The American Association for Cancer Research today released its annual Cancer Progress Report, which reflects how prior investment in the NIH is paying dividends in terms of advances across the spectrum of cancer care.
“During the past few decades, a surge in scientific discovery and technological innovation has stimulated unparalleled progress against cancer,” Elaine R. Mardis, PhD, president of the AACR and co-executive director of the Institute for Genomic Medicine at Nationwide Children’s Hospital in Columbus, Ohio, said in a press release. “Robust annual increases in federal funding for medical research will pave the way for the next major breakthroughs that will transform cancer patient care.”
The report highlighted the following advances:
- Twenty-seven treatments — including the first molecularly targeted therapeutic approved for treating cancers with a specific genetic biomarker regardless of cancer type, and the first immunotherapeutic for breast cancer — were approved by the FDA to treat several cancer types over the last year;
- The number of cancer survivors in the U.S. reached a record high of more than 16.9 million on Jan. 1, 2019; and
- The overall cancer death rate decreased significantly among black men compared with white men between 1990 and 2016, narrowing the disparity from 47% higher for black men to 19%.
However, the report additionally highlighted several challenges. Among them:
- The number of new U.S. cancer cases is predicted to increase from more than 1.7 million in 2019 to more than 2.3 million in 2040;
- Use of e-cigarettes between 2017 and 2018 increased by 78% among high-school students and 49% among middle-school students; and
- Obesity alone is responsible for approximately 8% of cancer cases among U.S. adults today — the prevalence of obesity increased from 11% of men and 16% of women during the early 1960s to 38% of men and 41% of women in 2016.
For fiscal year 2020, AACR called upon elected leaders to:
- Continue to support robust, sustained and predictable growth in the NIH budget by providing an increase of at least $2.5 billion for the NIH, for a total funding level of $41.6 billion;
- Ensure fully appropriated funding through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot;
- Increase the FDA budget by at least $316 million for medical products to support critical regulatory science initiatives; and
- Support the CDC Cancer Prevention and Control Programs with total funding of at least $555 million, which includes funding for comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancer types.
“There has never been a more promising time in history for the cancer field,” Margaret Foti, PhD, MD, CEO of AACR, said in the release. “The rapid pace and broad scope of the progress we are making against cancer are extraordinary and we are now poised to deliver the next wave of lifesaving breakthroughs. If we are to seize these opportunities to make unprecedented advances for patients, it is vital that we ensure that medical research remains a high priority for our nation’s policy makers.”
HemOnc Today spoke with Mardis about the report’s main findings, what actions oncologists can take to continue cancer progress, and what challenges and goals remain for the future.
Question: Why is this annual report important?
Answer : The AACR Cancer Progress Report gives us a chance to look back at the previous year and not only celebrate the accomplishments for the cancer research and clinical translation unity worldwide, but also to figure out what we have done well and what needs improvement. A broad range of individuals access the report, read it carefully and evaluate the progress within the year. We also ensure that the report is placed in the hands of legislators so that they can evaluate the impact federal funding has had on the fight against cancer. We need to continue to advocate for reliable funding and funding increases over time to fuel these important research and clinical translation endeavors.
Q: Can you talk about this year’s key advances?
A: A significant past investment of NIH funding allowed the cancer genomics community to catalog the fundamental changes in cancer genomes that result in the transition from a normal cell to a cancer cell. For example, large-scale projects — like The Cancer Genome Atlas, which was funded by the NIH along with international projects, including the International Cancer Genome Consortium — have worked hard to characterize more than 10,000 cancer genomes from different body sites within the past 12 years. These basic discoveries of cancer’s genomic drivers have, in turn, spurred the development of new targeted therapeutics, such as small molecule inhibitors that are tested in model organisms and then in clinical trials, that aim to inhibit cancer growth.
In particular, this year’s report allowed us to record the largest number of targeted inhibitor therapies approved by the FDA during the 9-year history of generating the Cancer Progress Report. There were 27 treatments approved, some of which were quite novel in terms of the type of therapy or the approach to achieve inhibition. As a participant in these large team science cancer discovery projects, it is incredibly gratifying to see these tangible benefits for cancer therapy profiled in this year’s report.
Q: What areas are still in need of progress and how will the AACR strive to meet those needs?
A: A differential still exists in terms of access to therapies, access to screening for purposes of early detection and access to prevention-based approaches. These disparities disproportionately affect the poor and minorities within our communities across the United States. We have made significant progress in many of these areas, but we still are vitally concerned about ensuring every American has access to these treatments and new modes of imaging and early detection, and to educate about cancer and risk-reducing behaviors.
The other area that continues to be important is progress in our research and understanding of cancer and how best to treat it. This, of course, relies heavily on federal funding to provide sustainable increases for the cancer research field.
Q: What can oncologists do today to help meet these needs?
A: For one, they can strive to identify patients who would benefit from available clinical trials at their institution or in their area. We see a small proportion of adults with cancer, in particular, enrolled on clinical trials, and there is a direct correlation between how quickly these trials accrue patients and accumulate data about the drugs that are being tested and their effectiveness. Ultimately, accrual determines how quickly these therapies can go forward for FDA registration and potential approval. This is an important role of the oncologist, because they interpret the evidence defining the molecular makeup of each patient’s cancer and the likelihood of the therapeutic impact in the clinical trial setting.
In terms of disparities, we see a significant differential in minorities enrolled on clinical trials; this is critically important information following the completion of clinical trials and approval of the drug, which is now an area that the FDA is focused on — real-world evidence. This real-world evidence plays out in the differential that we sometimes see for therapies wherein patients with different ancestral backgrounds respond differently to a drug. Learning those differences early in the clinical trial setting as opposed to later, once the drug is approved and enters clinical use, may be important. Oncologists are on the front lines and we need their encouragement for clinical trial enrollment so that these new therapies can be better evaluated.
Q: Looking ahead, w hat is your ultimate hope for next year’s report?
A: As someone who focuses on pediatric cancer, I am hopeful that a lot of the progress that we are reporting in adult cancers can begin to apply to the pediatric cancer setting. We are still extremely reliant on old-fashioned cytotoxic chemotherapy and radiation. In principle, children and adolescents have not benefited significantly from newer therapeutics, often because the cancers they experience are quite rare or molecularly different from adult cancers. However, the approval of two therapies outlined in this year’s report strikes a hopeful note in this regard, because both drugs achieved FDA approval for adults and children. These results demonstrate that properly designed trials will allow children and adolescents with cancer to start experiencing the same benefits of targeted therapies as adults. This will result in children surviving their cancers and importantly experiencing a better quality of life as cancer survivors.
I also hope we build upon this year’s exciting trend regarding the increased number of cancer survivors in this country, which is now nearing 17 million individuals. This provides tangible evidence that all our efforts have had a significant impact in the fight against cancer. We still have a lot more to do, but this is a hopeful sign that we are turning a lot of patients with cancer into survivors. – by Jennifer Southall
Reference:
AACR Cancer Progress Report 2019. Available at www.cancerprogressreport.org/Pages/default.aspx. Accessed on Sept. 18, 2019.
For more information:
Elaine R. Mardis, PhD, can be reached at Nationwide Children’s Hospital, 700 Children's Drive, Columbus, OH 43205; email: elaine.mardis@nationwidechildrens.org.
Disclosure:Mardis reports no relevant financial disclosures.