The U.S. Cancer Moonshot has a new strategic plan for cancer research.
In 2016, then Vice President Joe Biden gave a lift to the newly launched Cancer Moonshot by convening a Blue Ribbon Panel (BRP) to make recommendations on how to deliver 10 years of cancer research advances in 5 years. As previously reported in Oncology Times, that panel made 10 recommendations and suggested three demonstration projects (2016;38(19):10).
Now a new Lancet Oncology Commission has published a report of expanded recommendations and a detailed action plan based on the work of the Cancer Moonshot's BRP (2017;18(11):e653-706).
The new commission report was released at a news briefing on Capitol Hill in Washington, D.C. The report was subsequently presented at the United Nations Association of New York Humanitarian Awards, where Biden was honored for his work on improving cancer outcomes through the Cancer Moonshot initiative. Gregory C. Simon, President of the Biden Cancer Initiative, said the new commission report has the potential "to change the course of cancer in our lifetime." He added, "Time is of the essence, and so action must be taken now."
"It's based very heavily on the Blue Ribbon Panel," said Lancet Oncology Editor-in-Chief David Collingridge, PhD, of the new commission report, which is the result of 54 cancer clinician-researchers representing about 40 institutions and many others, including some who contributed to the initial BRP report. Speaking at the Washington briefing, he noted that the commission report "adds granularity" and breadth to the BRP recommendations, focusing on specific research areas that are likely to yield the most promising results.
Research Priorities
The new commission report includes 13 research priorities and lists specific goals under each, giving measures and metrics, and in some cases giving timelines for the accomplishment of these specific goals. As examples of timelines, in immunotherapy the new report calls for expanded therapeutics for cancer epitopes in 2-4 years, and expanded T-cell and checkpoint therapeutics in 2-6 years.
During FY 2017, the NCI initiated eight of the initial 10 BRP recommendations, and a number of new projects are slated to begin in FY 2018 that will complete the BRP's list of 10, said Douglas R. Lowy, MD, the NCI's Acting Deputy Director. Lowy noted that in December 2016 the U.S. Congress earmarked $1.8 billion over a 7-year period (an average of almost $260 million annually) to support implementation of the BRP recommendations. He said the new commission report builds on and extends the initial BRP report.
Lowy cited NCI's Genomic Data Commons (GDC) as an example of one way the BRP's recommendation on data sharing is being carried out. He said the GDC, which started in 2016 with about 14,000 cases, is expected to reach 50,000 cases by the end of 2018. Lowy attributed the current and anticipated rapid growth in cases to partnerships with other relevant groups. Lowy stressed the importance of training and mentoring the next generation of cancer researchers, and said progress against cancer will only come from the full spectrum of research support, "not from the Cancer Moonshot alone." He said that during his time as acting NCI Director he especially focused on cancer health disparities, citing this research priority as a pressing concern.
"We're making amazing progress in basic science," said Commission Co-Chair and report first author Elizabeth Jaffee, MD, Professor of Oncology and Deputy Director of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Associate Director of the Bloomberg-Kimmel Institute for Cancer Immunotherapy; and President-Elect of the American Association for Cancer Research (AACR). These strides in basic science have led to effective precision-based interventions, she noted. Specifically, she cited the more than 25 FDA approvals of immunotherapy agents. Jaffee said that as cancer treatment has moved to a precision-based model, "drug development has moved to precision medicine clinical trial designs."
Jaffee stressed that the number of new U.S. cancer cases is increasing, primarily due to the aging of the population. The blueprint for research progress presented in the new commission report is important, she said, because it has the potential to reduce the economic and social/psychological/emotional burden of cancer. "The best way to contain health care costs is to find cancer cures," she said, adding that cancer is "not only a financial burden, it's a quality of life burden."
Additional Focus
In addition to providing more breadth and depth to the initial BRP report, the new commission report focuses on areas not in the BRP report, including surgical oncology and radiation oncology, said Commission Co-Chair and report second author Chi Van Dang, MD, PhD, Scientific Director at Ludwig Cancer Research and Professor at the Wistar Institute. The new report also focuses in more depth on cancer prevention, noting that only half of patients who develop cancer can be cured with existing therapies.
"In essence, cancers are infected with altered genomes," said Dang. "They become the enemy within." He added, "We're excited about the whole area of immunologic prevention...We have great hope for neoantigens. This is where personalized vaccines can come into play."
"Technology is transforming prevention and disparities research," said commission member and report co-author Scott Lippman, MD, Professor of Medicine, Senior Associate Dean and Associate Vice Chancellor for Cancer Research and Care at the University of California, San Diego. Lippman cited nonalcoholic steatohepatitis (NASH) as an example of a condition ripe for cancer prevention. NASH, a risk factor for liver cancer, is associated with the metabolic syndrome, obesity, and type 2 diabetes, and is more common in Hispanics, especially males. Lippman told Oncology Times that fibrosis in NASH is a major predictor of liver cancer mortality. Ultrasound screening of high-risk people with NASH before fibrosis occurs could potentially lead to dietary and lifestyle interventions that could lower the risk of liver cancer, he said.
"Pre-malignancy has been a complete black box," Lippman said, noting that what is needed is a premalignant precursor atlas to drive precision medicine prevention trials. This is one of the commission's specific research recommendations, as it was in the BRP report; NCI is currently developing such an atlas. "This would change everything," said Lippman of a premalignant precursor atlas.
Agreeing on the need for more focus on cancer prevention was commission member and report co-author Dean Ornish, MD, Clinical Professor of Medicine and President and Director of the Preventive Medicine Research Institute at the University of California, San Francisco. "It's not only just prevention, lifestyle can be treatment as well," Ornish told Oncology Times. In the section on lifestyle and cancer, the new report stresses the importance of physical activity, maintaining a normal weight, not smoking, and eating a largely whole foods, plant-based diet in lowering cancer risk. The report states, "A responsible approach to lifestyle medicine for cancer is to integrate the best of traditional and non-traditional methods in prevention and treatment interventions."
"I see this as global," said commission member and report co-author Peter Naredi, MD, PhD, Professor and Head of the Institute of Clinical Sciences at the University of Gothenburg, Sweden. "This is an EU issue as well," he said of cancer prevention. "I think prevention is key."
Like NCI's Douglas Lowy, commission member and report co-author Jeffrey Peppercorn, MD, MPH, emphasized the importance of reducing disparities in cancer care in order to realize the goals of the Cancer Moonshot. He also emphasized the need to better define high-quality care, so that all Americans have access to and receive the best in diagnosis and treatment. "We think there need to be greater efforts to define what is high-value care," said Peppercorn, Director of the Survivorship Program at Massachusetts General Hospital Cancer Center and Associate Professor of Medicine at Harvard Medical School, Boston.
Commission member and report co-author Ruth I. Hoffman, MPH, National Executive Director of the American Childhood Cancer Organization, told Oncology Times she was happy that pediatric oncology is one of the 13 priority research areas. She said there is a need to better understand not only cancers in children, but also cancers in adolescents. The new report recommends increasing access to novel drugs and clinical trials in pediatric oncology within the next 1-2 years.
Meeting the Challenge
The fundamental challenge the cancer community now faces-to accomplish 10 years of progress in cancer research in half that time-is "audacious and ambitious, but it's not beyond reach," said commission member and report co-author Clifford Hudis, MD, CEO of ASCO. Meeting this challenge is "dependent on doing our jobs a little bit better," said Hudis, former Chief of Breast Medicine at Memorial Sloan Kettering Cancer Center, New York. Hudis said the goal is nothing less than to create a new cancer ecosystem that is completely integrated and accelerates progress. Like Lowy, he emphasized the importance of partnerships. "The entire Moonshot effort is built on goodwill and collaborations," he said. And like Lowy and Peppercorn, he emphasized the need to reduce disparities in cancer care. "We cannot ethically tolerate differential outcomes."
Hudis cited ASCO's TAPUR (Targeted Agent and Profiling Utilization Registry) as an example of using real-world evidence to accelerate progress in cancer research. "It's essentially a collection of phase II studies," he said of this registry. The goal of TAPUR is to learn from the real-world practice of prescribing targeted therapies to patients with advanced cancer whose tumor harbors a genomic variant known to be a drug target. Thus, TAPUR educates oncologists about the implementation of precision medicine in daily clinical practice.
Hudis said that coming out of the Obama administration there was a reversal of the prevailing flat budget for cancer research. He added that he is encouraged about a recent ASCO opinion survey showing that three-quarters of Americans would accept higher taxes and a larger deficit if it meant more money for cancer research. Asked by Oncology Times if he thinks the current administration and Congress will be favorable toward generous funding for cancer research, Hudis said, "I'm more optimistic about sustaining this funding than I was 3 years ago." He added that he is optimistic because he believes public opinion and Congress are now aligned to provide strong financial support for cancer research.
Peggy Eastman is a contributing writer.
Priority Areas of Research
1. Precision cancer prevention
2. Early detection and public health
3. Drug discovery and development
4. Precision tumor assessments
5. Expediting patient access to new drugs with expanded clinical trials
6. Immunotherapy
7. Pediatric oncology
8. Supportive oncology
9. Radiation oncology
10. Nuclear medicine and imaging
11. Surgical oncology
12. Data-sharing and big data analysis
13. Health disparities and access to care
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