A fundamental shift in how cancer research is conducted and how cancer care is delivered in the United States is required in order to deliver on the Cancer Moonshot initiative, according to a major new report unveiled Wednesday at a special event in Washington, DC.
The report, called The Lancet Oncology Commission: Future Research Priorities in the USA, is authored by over 50 leading oncologists, including members of leading US cancer organizations, and sets out 13 key priority areas, each with measurable goals, to focus the $2 billion of funding released to the National Cancer Institute (NCI) as part of the 21stCentury Cures Act.
About 70 people gathered on the top floor of the Hart Senate Office Building on Capitol Hill for the event, with more than 600 watching live on the internet. Panelists included Joy Lee of the Senate Health, Education, Labor & Pensions (HELP) Committee, which has jurisdiction over the 21st Century Cures Act. (Watch a livestream of the event.)
Dr. Douglas Lowy, Deputy Director of the US National Cancer Institute, speaks as panelists look on (left to right): Dr. David Collingridge, Editor-in-Chief of The Lancet Oncology and Publishing Director of The Lancet Group; Dr. Elizabeth Jaffee, President-elect of the American Association for Cancer Research (AACR) and Commission co-Chair and co-author; and Dr. Chi Van Dang, Scientific Director of the Ludwig Institute for Cancer Research and Commission co-author. (Photo by Chris Capot)
The report sets out a detailed road map 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 interventions to improve cancer care for underserved groups, specifically children, cancer survivors and minority groups. The report emphasizes the importance of addressing health disparities in all recommendations.
“This report digs a little bit deeper into the Blue Ribbon Panel recommendations adding granularity into what would you actually spend research dollars on,” said Dr. David Collingridge, Editor-in-Chief of The Lancet Oncology and Publishing Director of The Lancet Group, which is owned by Elsevier. “Rather than fund a wide range of activities, what are the big buys that would yield greatest benefit, plus what reforms would improve cancer care affordability.”
Commission partners included Johns Hopkins Medicine, Johns Hopkins InHealth, the Ludwig Cancer Research Center and The Wistar Institute.
“The US 21st Century Cures Act provided nearly $2 billion in funding to accelerate cancer research, but strategic allocation of resources will be crucial to accelerate research, treatment and ultimately patient care,” said Dr. Elizabeth Jaffee , President-elect of the American Association for Cancer Research (AACR) and co-Chair of the Commission from Johns Hopkins University School of Medicine and a commission author. “This Commission maps an ambitious path ahead to guide researchers, funders, industry, and policy makers in prioritizing the best research to benefit patients.”
The Commission highlights the importance of cancer prevention, including 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. The need to move towards targeted screening will also be important.
Commenting on the Commission, Gregory Simon, President of the Biden Cancer Initiative, said the report “provides a roadmap to change the course of cancer in our lifetime — a journey in which we should actively participate. Patients, caregiver, doctors, researchers, nurses, and scientist all need to embark on the course of action proposed by the report, without delay. Time is of the essence, and so action must be taken now.”
Data sharing and patient-centered priorities will be critical to advancing research and improving care. The report strongly supports developing data systems that allow patients to input their own personal data for use by the cancer community and, in return, provide outputs to patients that allow them to identify the most scientifically sound clinical trials for which they might be eligible. The ultimate goal 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.
An unprecedented increase in the number of therapies have been approved for marketing by the US Food and Drug Administration in the past two to three years, but this continues at immense costs, with hundreds of drugs failing in clinical trials. Bringing a single new therapy to the market is estimated to cost $2.6 billion. Among the Commission’s recommendations is the need for an overhaul of the drug discovery process so projects can be discontinued earlier in the clinical development phase, and to transform how academia, industry and clinical groups collaborate to vastly improve efficiencies.
Patients with cancers that were once lethal are now living longer with cancer as a chronic condition, meaning that guidelines must be developed to address the long-term health care needs of patients while undergoing therapy and of survivors. Finally, patient outcomes are greatly affected by racial, cultural, and socioeconomic background, and there is a need both to better understand the context of care and to ensure equitable access to care that is financially sustainable for the individual and society.
Report co-author Dr. Clifford Hudis, CEO of the American Society of Clinical Oncology (ASCO) and former Chief of Breast Medicine at Memorial Sloan Kettering Cancer Center, explained:
"Although clinical research has been challenged by reduced support as well as regulatory and administrative burdens, we have recently seen truly remarkable progress across a range of malignancies. The blueprint laid out by the BRP and this Commission should help us prioritize our efforts to accelerate meaningful clinical advances in the next 4 to 5 years. The provisions provide an opportunity for cancer investigators, federal agencies, universities and research institutes, and private philanthropic supporters worldwide to direct their investments and help the global community meet the ambitious goal of delivering ten years progress in half that time. The time for action is now."