Although research advances in more effective therapies and diagnostics and improved screening technology over the past 2 decades have led to a 23% reduction in the cancer death rate in the United States, saving nearly 2 million lives,1 cancer remains the second leading cause of death after heart disease, killing about 600,000 people each year.2 Unless cancer research becomes a national priority with a robust and sustained funding commitment by the federal government, cancer deaths could skyrocket—along with costs—to 1 million annually over the coming decades as the population ages, according to findings from the American Association for Cancer Research (AACR) 2016 Cancer Progress Report: Saving Lives Through Research.
A lot of our excitement in cancer advances is wrapped around treatment, as it should be, but we should never forget the importance of evidence-based prevention and screening strategies to reduce the risk of developing cancer or finding it early through screening and increasing the possibility of cure.— Nancy E. Davidson, MD
Despite a $2 billion budget increase for the National Institutes of Health (NIH) in 2016—the first significant budget increase in more than a decade—and another $2 billion increase proposed in fiscal year (FY) 2017, if increases in federal funding to the NIH, the National Cancer Institute (NCI), and the U.S. Food and Drug Administration (FDA) do not remain consistent and predictable, accelerating the pace against cancer will be hampered, especially in the two most promising areas of research: precision therapy and immunotherapy, warns the report. To continue to advance improvements in how cancer is prevented, detected, diagnosed, and treated, in addition to supporting the Senate Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee’s FY 2017 funding bill, the AACR is calling on Congress to pass the 21st Century Cures Act; support the National Cancer Moonshot Initiative; approve an FDA budget of $2.85 billion in FY 2017; and readjust the discretionary budget caps for FY 2018 and beyond to allow funding increases for the NIH, the NCI, and the FDA in the future.
“It is incredibly important for us to recognize that the progress in research we have made was possible because of strong federal investment, and it is absolutely imperative that Congress sees the value of that investment and continues to build on it,” said Nancy E. Davidson, MD, President of the AACR and Director of the University of Pittsburgh Cancer Institute in Pennsylvania. “We are urging Congress and the current and future Administration to make sure that the NIH, the NCI, and the FDA get the robust and sustained funding increases necessary each year to build on the successes we already enjoy.”
Understanding the Complexity of Immunotherapy
Among the advances highlighted in the report is the increased scientific understanding of how the immune system interacts with cancer cells, which has resulted in the discovery and FDA approval of immunotherapeutics for several cancers, including lung, melanoma, some types of lymphoma, multiple myeloma, kidney, and bladder, changing the trajectory of cancer in some patients. Determining why programmed cell death protein 1 (PD-1) inhibitors, such as nivolumab (Opdivo) and pembrolizumab (Keytruda), or chimeric antigen receptor (CAR) T-cell therapy activate the immune system to recognize and destroy cancer cells in some patients but not in others is the subject of intense research, with one study showing the success of PD-1 inhibitors may depend on the composition of patients’ genetic mutations in their cancer cells.3
“There is a lot of work going on right now to find out why immunotherapy is effective in some but not all patients, including studying whether molecular markers may predict resistance or sensitivity to these approaches or why some tumors are initially sensitive to an immunotherapy and then become resistant to it,” said Dr. Davidson. “I don’t think there is a magic answer to these questions, but we are still in the early days of this research. When you look at what has been accomplished in the development of immunotherapies over the past 5 years and how their use has gone from the treatment of two cancers, lung and melanoma, just a year ago to the treatment of four more cancers, multiple myeloma, Hodgkin lymphoma, bladder, and kidney, that is real progress.”
Homing in on Precision Cancer Prevention
Also emphasized in the AACR Cancer Progress Report is the importance of increasing public awareness of the many factors, including smoking, obesity, physical inactivity, exposure to ultraviolet light, and failure to comply with interventions that prevent cancer-associated infections (such as human papillomavirus and hepatitis B vaccinations) that contribute to an individual’s risk of developing cancer and how eliminating these preventable causes could potentially result in reducing half of the number of cancer cases worldwide each year. Determining how best to accomplish these goals will take more research and resources, according to the report.
The development and implementation of new strategies that combine science’s increased molecular understanding of cancer development with the knowledge of an individual’s cancer risk profile will spur a new era of precision cancer prevention and early detection and result in better outcomes for patients, said the report.
“This is a really important area of research. A lot of our excitement in cancer advances is wrapped around treatment, as it should be, but we should never forget the importance of evidence-based prevention and screening strategies to reduce the risk of developing cancer or finding it early through screening and increasing the possibility of cure,” said Dr. Davidson.
Furthering Progress Against Cancer
Increasing the progress that has been made in the understanding of the biology of cancer and developing new strategies for translating that knowledge into more targeted therapies that result in better outcomes for patients will take greater financial investments not just in biomedical research, but in the development and training of the next generation of scientists at all career levels as well, according to the report. It will also involve increased patient participation in precision medicine clinical trials and support for crosscutting programs such as the Cancer Moonshot and the NIH’s Precision Medicine Initiative. Only then, according to the report, will the pace of advances against cancer be accelerated and the goal of preventing and curing cancer be realized.
To download a copy of the AACR 2016 Cancer Progress Report, go to http://cancerprogressreport.org/2016/Documents/CPR2016.pdf. ■
Disclosure: Dr. Davidson reported no potential conflicts of interest.
1. American Cancer Society: Cancer Facts & Figures 2016. Available at http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/. Accessed September 26, 2016.
2. National Cancer Institute: Cancer Statistics. Available at https://www.cancer.gov/about-cancer/understanding/statistics. Accessed September 26, 2016.
3. McGranahan N, Furness AJ, Rosenthal R, et al: Clonal neoantigens elicit T cell immunoreactivity and sensitivity to immune checkpoint blockade. Science 351:1463-1469, 2016.