Cancer care
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The American Association for Cancer Research (AACR) released its annual Cancer Progress Report on Wednesday that highlighted advances in cancer treatments and survival while also advocating for continued funding by the US government to sustain progress.

“The advances in cancer research, particularly in the last two decades, have been breathtaking,” notes AACR President Philip Greenberg, MD, FAACR. “We are in an era of unparalleled opportunity to make even more breakthroughs for patients. For the cancer research community to achieve these breakthroughs, however, our representatives in Congress must continue to prioritize funding for biomedical research, from basic research to clinical trials.”

While Greenberg’s executive summary highlights the significant progress made in cancer survivorship—with a death rate from cancer that has decreased by one-third in the past 30 years—the reports notes that there remain challenges in the continuing fight against the disease. These include slow progress against particular forms of cancer such as pancreatic cancer and uterine cancer, disparities in cancer care based on geography, race, ethnicity, and socioeconomic status, and the financial toll cancer exacts on cancer patients and their families.

Recent advances

Between the research community, industry, academia, physicians, regulators, patient advocates and other stakeholders, AACR report notes the following positive trends and advances:

  • From August 1, 2022, to July 31, 2023, the FDA approved 14 new anticancer therapeutics, including a new gene therapy-based immunotherapeutic for certain patients with bladder cancer; a first-in-class antibody drug conjugate for patients with ovarian cancer; and four new T-cell engaging bispecific antibodies for a range of hematologic malignancies.
  • The FDA approved two new imaging agents and expanded the use of 12 previously approved anticancer therapeutics to treat additional cancer types, including the first approval of an immune checkpoint inhibitor for pediatric and adult patients with a rare form of sarcoma.
  • Advances in prevention, early detection, and treatment, the age-adjusted overall cancer death rate in the U.S. fell by 33% between 1991 and 2020—an estimated 3.8 million cancer deaths averted. In particular, breast cancer mortality declined by 43% between 1989 and 2020, leading to an estimated 460,000 fewer breast cancer deaths and The decrease in lung cancer mortality has accelerated from 0.9% a year between 1995 and 2005 to nearly 5% a year between 2014 and 2020. The decrease in lung cancer mortality was attributed to both a steep reduction in the U.S. smoking rate as well as the development of numerous highly effective molecularly targeted therapeutics and immunotherapeutics.

The report also highlights the advances in cancer care and treatments that have been the result of developing a range of immunotherapy approaches, which has been responsible for many of the advances in survival rates particularly in once hard-to-treat cancers like lung cancer and melanoma. Of note:

  • Since 2011, the FDA has approved 11 immune checkpoint inhibitors, Many of which are approved for more than one type of cancer, making immune checkpoint inhibitors a treatment option for 20 different cancer types and tumosr with specific specific molecular characteristics.
  • Since 2017, the FDA has approved six CAR T-cell therapies to treat a range of hematologic malignancies.

“Over the past decade, cancer immunotherapy has emerged as one of the most exciting new approaches to cancer treatment,” the report states. “This is, in part, because some patients with metastatic disease who have been treated with these revolutionary anticancer treatments have had remarkable and durable responses, raising the possibility that they might be cured. It is also because some of the immunotherapeutics have been shown to work against anincreasingly broad array of cancer types.”

Challenges persist

Despite the exicting advances being made, the report notes ongoing challenges poiting out that in the U.S. this year there will be an estimated 2 million new cancer cases diagnosed and more than 600,000 deaths. Specfic challenges highlighted include:

  • Cancer disparities have racial and ethnic minorities and other medically underserved U.S. populations shouldering a disproportionally higher burden of cancer.
  • There has been uneven progress against different cancer types such as pancreatic cancer or glioblastoma. 5-year relative survival rates for these cancers are extremely low.
  • Incidence rates for some cancers are increasing, including for early-onset colorectal cancer, pancreatic cancer, and uterine cancer, in part due to the rising rate of obesity.
  • Financial toxicity is widespread, exacerbated by the rising cost of cancer care. In 2019, U.S. cancer patients paid an estimated $16.2 billion in out-of-pocket cancer care costs and lost an additional $5 billion in “time costs.”

Advocating for continued federal funding

“Eight consecutive years of funding increases for medical research have contributed to the development of breakthrough therapies, as well as improvements in cancer prevention and screening, leading to a steady decline in U.S. cancer deathrates for both men and women,” Greenberg writes in his executive summary. “…. Policymakers must continue to provide robust, sustained, and predictable funding increases for NIH to ensure greater availability of promising cancer treatments and to amplify cancer prevention and screening measures.”

In particular, AACR advocates:

  • $1.7 billion in dedicated funding for Cancer Moonshot activities in FY 2024 across NCI, FDA, and Centers for Disease Control and Prevention (CDC) with the assurance that Moonshot funding will supplement rather than supplant NIH funding in FY 2024.
  • Appropriation at least $472.4 million in FY 2024 for the CDC Division of Cancer Prevention to support comprehensive cancer control, central cancer registries, and screening and awareness programs for specific cancers.
  • Allocation of $50 million in funding for the Oncology Center of Excellence at FDA in FY 2024 to allow regulators with the capable staff and necessary tools to conduct expedited review of cancer-related medical products.
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