The American Association for Cancer Research (AACR) released its yearly Cancer Progress Report 2018, timed to coincide with September's sixth annual Rally for Medical Research in Washington, D.C. The rally drew more than 300 organizations, representing tens of millions of people, who called on Congress to continue strong, sustained funding for the NIH.
The new report, the eighth annual progress report released by AACR, contains good news about strides against cancer, but states that cancer continues to be “an enormous public health challenge worldwide.” The report contains a call to action to ensure that sustained, incremental progress against cancer will continue.
“As we step further into the era of precision medicine, the scope of progress will continue to broaden, providing new hope for many cancer patients who are awaiting more effective treatment options. Research continues to be our best defense against cancer,” AACR President Elizabeth M. Jaffee, MD, FAACR, and AACR CEO Margaret Foti, PhD, MD (hc), wrote in a message introducing the report, which runs to nearly 150 pages. Jaffee, who chaired the report's steering committee, is Deputy Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, where she is also Associate Director of the Bloomberg-Kimmel Institute of Cancer Immunotherapy, and the Dana and Albert “Cubby” Broccoli Professor of Oncology and Professor of Pathology.
Jaffee said that on a personal level the advances she has seen in her career in oncology have been primarily due to basic research. “During the almost 30 years since I began my fellowship in oncology, we have made unprecedented progress against cancer,” she noted. “These advances occurred largely because of tremendous progress in basic research.”
Among the advances cited in the report are the following:
- The age-adjusted U.S. cancer death rate decreased by 26 percent from 1991 to 2015, a reduction that translates to nearly 2.4 million cancer deaths avoided.
- The number of U.S. children and adults living in the U.S. who are cancer survivors has risen to a high of 15.5 million.
- Between Aug. 1, 2017, and July 31, 2018, the FDA approved 14 new anti-cancer therapies, and the agency expanded indications for 11 previously approved anti-cancer therapies for treating new types of cancer.
- Two of the new anti-cancer therapies are pioneering CAR T-cell immunotherapies, while nine are molecularly targeted therapies for precision medicine.
- Over the past decade, the number of immunotherapies has increased almost five-fold, and the number of cancer types that can be treated by at least one immunotherapy has more than tripled.
- Cigarette smoking rates among U.S. adults dropped from 42 percent in 1965 to 14 percent in 2017.
- The percentage of U.S. adults aged 50-75 who are up to date with colorectal cancer screening rose from 66.2 percent in 2014 to 67.3 percent in 2016.
The new report notes that, despite continuing progress, a major public health issue is that the number of people diagnosed each year with cancer in the coming decades is expected to increase. In the U.S., that increase is projected to grow from 1,735,350 diagnoses in 2018 to 2,387,304 diagnoses in 2035. The report notes that this projected rise is largely due to the fact that cancers are primarily diseases of aging, and the segment of the U.S. population aged 65 and older is growing.
Unfortunately, cancer screening tests are not being used as they should for maximum benefit, the report found. It states: “The suboptimal use of cancer screening tests and the significant disparities in cancer screening rates among certain segments of the U.S. population highlight the need for new strategies and public policies to increase cancer screening access and uptake.”
The report also notes that “the burden of cancer is shouldered disproportionately by certain segments of the population, including racial and ethnic minorities and patients of lower socioeconomic status.” Among the patient-focused cancer stories is a special feature, “Increasing Awareness of Breast Cancer in the African-American Community,” by Karen Eubanks Jackson, 75, of Houston, who is African-American. A 25-year survivor of breast cancer, she founded Sisters Network, Inc. “to increase local and national awareness of the devastating impact that breast cancer has in the African-American community.”
Continued Action Needed
The AACR's call to action asks Congress to keep funding for the NIH and FDA robust and stable. “We are at a pivotal moment in cancer research, and the positive funding momentum gained over the past 3 years must continue,” the report states. “During this time of both unprecedented scientific opportunity and increasing incidence and associated mortality of cancer, the most valuable investments of federal dollars that Congress can make are in support of the medical research enterprise.”
Specifically, the call to action requests the following:
- Continue to support robust, sustained, and predictable growth of the NIH budget by providing an increase of at least $2 billion for NIH in fiscal year (FY) 2019, for a total funding level of at least $39.1 billion
- Ensure that the $711 million in funding designated through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot, is fully appropriated in FY 2019 and is supplemental to the healthy increase for the NIH's base budget
- Increase the FDA's base budget in FY 2019 to $3.1 billion, a $308 million increase above its FY 2018 level, to ensure support for regulatory science and to accelerate the pace of development of safe and effective medical products. This funding request by the AACR includes $20 million for the FDA Oncology Center of Excellence in FY 2019
- Support the Cancer Prevention and Control Programs of the CDC with total funding of at least $517 million. This funding includes comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancers. Data in the report indicate that more than four in 10 cancer cases in the U.S. are estimated to be due to preventable causes.
The new AACR report for 2018 is thoroughly referenced and broad in scope, covering how cancer develops; cancer prevention and risk factors; screening for early detection; harnessing research discoveries for patient benefit; patient-centered public policy; cancer health disparities, including disparities in clinical trial participation; and promising directions for the future.
It also spotlights the cancer experiences of a number of patients. These include Nicole DiCamillo, who benefited from a novel way to use radiotherapy to treat neuroendocrine tumors; Chuck Dandridge, Lisa Quinn, and Ron Scolamiero, who benefited from the molecularly targeted therapies of precision medicine; and Tori Lee and Mike Della, who benefited from CAR T-cell therapy.
The report addresses the special needs of cancer survivors, focusing on achieving the best quality of life possible across the continuum of cancer care. Thus, the report covers preventing and palliating physical symptoms, psycho-oncology, and modifying behaviors to improve outcomes.
While celebrating the progress that has been made, the new AACR report also warns that the high costs of cancer care are “startling.” The U.S. direct medical costs of cancer care costs reached $80 billion in FY 2015, a figure which stands in stark contrast to the slightly under $40 billion for the entire NIH budget. Looked at this way, the costs of treating cancer are nearly twice what the U.S. spends on medical research at the NIH. “The cost of cancer is enormous, both in the United States and globally,” affirms the report.
Despite continuing challenges, the new AACR report is optimistic about the future of cancer research, especially if multidisciplinary collaborations increase the pace of progress.
“As we look to the future, many researchers, including AACR President Elizabeth M. Jaffee, MD, are confident that we will be able to accelerate the pace of progress against cancer by increasing collaboration between cancer researchers and experts from other disciplines such as mathematics, physics, chemistry, engineering, and computer science,” states the report. “The new wave of innovations driven by this convergence science approach will allow us to integrate and harness patient data to achieve the full potential of precision medicine.”
Jaffee stated, “I foresee a future in which a patient with cancer, even one with metastatic disease, would visit his or her oncologist periodically during which the patient might receive a treatment or have the treatment regimen tweaked. The cancer would be under control, and it will be possible for the patient to live a normal life.”
Promising specific future directions cited in the report include harnessing patient data to improve outcomes (through the use of “big data” and digital health platforms); a new wave of technologies including artificial intelligence, gene editing using CRISPR and liquid biopsies; and increased understanding of the microbiome and cancer.
Peggy Eastman is a contributing writer.