The American Association for Cancer Research (AACR) released the 10th edition of its annual report on progress against cancer during a virtual briefing highlighting advances, challenges, and the need for continued robust research funding. The AACR Cancer Progress Report 2020 contains much good news on scientific advances made against cancer from August 1, 2019, to July 31, 2020.
However, this year's report features a special section on cancer and COVID-19, showing the chilling effects of this pandemic on cancer research and patient care. In fact, the report states that delays in cancer screenings and treatment are projected to lead to more than 10,000 additional deaths from breast and colorectal cancer over the next 10 years. Still unknown is the toll COVID-19 will take on patients with cancer.
According to the report, "Based on current research, it seems that patients with cancer who develop COVID-19 might be at increased risk for severe disease and for death from the disease." This risk is higher in patients with blood cancer.
Treatment Advances
The new progress report shows that the FDA approved 35 treatments to treat several cancer types for the first time-the highest number reported in previous AACR progress reports over the last 10 years.
These advances, which include the first PARP-targeted therapeutics for prostate cancer and pancreatic cancer and the first antibody-drug conjugate for triple-negative breast cancer, represent the "tireless work of individuals across the spectrum of cancer science," said Antoni Ribas, MD, PhD, FAACR, AACR President and the report's steering committee chairman. Ribas is Professor of Medicine, Surgery, and Molecular & Medical Pharmacology at UCLA, as well as Director of the Tumor Immunology Program at Jonsson Comprehensive Cancer Center.
Ribas cited innovations in cancer genomics research, which he said are continuing to transform cancer treatment. Specifically, he mentioned the targeted therapies of precision medicine and immunotherapy treatments, which are bringing new hope to patients.
"Since I began treating melanoma, I have seen firsthand the significant benefit that molecularly targeted therapy and immunotherapy have had for patients," Ribas said. "That's not by chance. That's because science is turning into treatments."
COVID-19 & Cancer
Both Ribas and AACR CEO Margaret Foti, PhD, said the COVID-19 pandemic has created significant challenges for cancer researchers and clinicians.
"Cancer did not disappear" during the pandemic, emphasized Ribas. Foti said "cancer researchers are uniquely positioned to face the challenges posed by the pandemic through the use of adaptive clinical trial designs, adjustments to clinical trial practices, and remote technology such as telemedicine. But, she noted the pandemic has still taken its toll.
According to the new report, data from electronic medical records within 190 hospitals spanning 23 states show that the number of U.S. screening tests for early detection of cervical, breast, and colon cancer plunged by 85 percent or more after the first COVID-19 case was reported in the United States; and 79 percent of those who are actively undergoing treatment had to delay some aspect of their care as a result of COVID-19.
The report also shows that there was a 74 percent decrease in the number of new patients enrolling in clinical trials during the first 2 weeks of May 2020 compared with the same period in 2019. While enrollment in clinical trials has ticked up somewhat, it still remains 30 percent lower than before the COVID-19 pandemic.
Preventable Cases
Today, 40 percent of cancer cases are estimated to be due to preventable causes, according to Christopher I. Li, MD, PhD, a member of the report's steering committee who is Professor in the Public Health Sciences Division and Faculty Director of Diversity, Equity, and Inclusion at the Fred Hutchinson Cancer Research Center.
Among preventable causes, the report cites tobacco use, obesity, lack of physical activity, alcohol consumption, exposure to UV light from the sun or indoor tanning devices, and failure to use interventions that treat or prevent infection from cancer-associated pathogens, such as certain strains of HPV. While the cigarette smoking rate is less than 14 percent (down from 42% in 1965), it still represents a sizeable chunk of the U.S. population.
Li called obesity a "major epidemic" in the United States. According to the new report, 42.4 percent of American adults age 20-plus and 19.3 percent of American children aged 2-19 are obese. He also decried racial and ethnic differences in U.S. access to cancer screening tests, cancer education, and cancer treatment, some of which he said are due to "systemic racism." There are multiple, complex reasons for these differences."
Value of Cancer Research
The new AACR report states that the U.S. investment in cancer research is critically important now because data project that the number of new U.S. cancer cases will grow dramatically in the next decades-from 1.8 million cases in 2020 to more than 2.3 million by 2040. The projected increase is due to two main factors: 1) overall population growth, and 2) the expansion of the U.S. population age 65 and older, the segment that accounts for the most cancer diagnoses.
"If we don't make those [research] investments, we won't see the benefits 10, 20, 40 years from now," noted retired orthopedic surgeon Al Stroberg, 71, a survivor of non-Hodgkin lymphoma and melanoma. "There is nothing more important for our children and grandchildren." Stroberg is featured in the new report with several other patients, and he participated in the virtual briefing.
Research needs to continue on pediatric cancers as well as adult cancers, stressed Susan L. Cohn, MD, Professor and Section Chief of Pediatric Hematology/Oncology and Stem Cell Transplant at University of Chicago Medicine, and a member of the report's steering committee. She cited the promise of new trial designs and therapies based on cancer genetics. "These advances are bringing hope to patients and their families. I'm incredibly optimistic about the future."
Cohn said the Childhood Cancer Data Initiative of the National Cancer Institute (NCI) offers an important opportunity to mine data on pediatric cancers. She noted that currently about 80 percent of children with cancer are cured and "we hope to get to 100 percent."
Participating in the virtual briefing was Kathrine Green, mother of Camden "Cami" Green, who said she credits a clinical trial with entrectinib for her young daughter's recovery from what had been considered a terminal brain cancer. She urged other parents of children with cancer to enroll their children in clinical trials.
Looking ahead to the future for further advances in cancer research, Ribas cited artificial intelligence approaches such as machine learning for analyzing vast amounts of scientific data, gene editing using CRISPR/Cas to transform cell therapies, and the use of liquid biopsies in the clinic to enhance early detection of cancers.
In the report, Ribas states, "In the next 10 years, I expect that scientific discoveries will ignite another revolution in cancer treatment and further improve outcomes for patients with cancer."
To accomplish that, a strong investment in cancer research is essential, stressed Foti. "During this challenging time, maintaining the momentum against cancer is more important than ever," she said.
She noted the COVID-19 pandemic has highlighted how important consistent, generous federal support from the National Institutes of Health (NIH) and the NCI is in helping researchers understand, prevent, treat, and "ultimately cure cancer as well as all diseases that threaten human lives."
The AACR is calling on elected U.S. leaders to:
* continue to support robust, sustained, and predictable growth in the NIH and NCI budget by providing an increase of at least $3 billion and $522 million, respectively, in fiscal year (FY) 2021, for a total of $44.7 billion for the NIH and $6.9 billion for the NCI;
* ensure funding designated through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot, is fully appropriated in FY 2021 and supplemental to the increase in the NIH base budget;
* support the FDA's critical regulatory science initiatives by providing an increase of at least $120 million in discretionary budget authority in FY 2021;
* support the CDC Cancer Prevention and Control Programs with total funding of at least $559 million, including funding for comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancers; and
* support for cancer research funding.
Congressman Peter T. King (R-NY), age 76, pledged to continue to fight for cancer research even when he retires from Congress.
"These are issues that I have personally seen...I am personally committed," said King, during the virtual briefing. In the report he states, "Cancer has had a profound [impact] on my life through the experiences of my loved ones...Federal investment in medical research is absolutely vital in saving lives." In King's family, he has watched his father, mother, daughter, brother, and niece battle cancer.
Peggy Eastman is a contributing writer.