A fundamental shift in how cancer research is conducted and how cancer care is delivered in the U.S. is required in order to deliver on the Cancer Moonshot initiative, according to a major new report published today in The Lancet Oncology journal.

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. In all recommendations, the report emphasizes the importance of addressing health disparities.

“The Lancet Oncology Commission on Future Research Priorities in the USA,” authored by over 50 leading American oncologists [1], including members of top U.S. cancer organizations, sets out 13 key priority areas—each with measurable goals—to focus the $2 billion of U.S. funding released to the National Cancer Institute as part of the 21st Century Cures Act.

It highlights how technological advances, including understanding and mapping pre-cancer biology and the rapid adoption of big data, as well as new collaborations across industry, patient groups, academia, government and clinical practice will be critical to advancing research, and ultimately improving patient care.

The commission will be launched Nov. 1 at an event on Capitol Hill and presented Nov. 3 during the United Nations Association of New York Humanitarian Awards dinner, where former Vice President Joe Biden will be honored for his work on improving cancer outcomes as part of the Cancer Moonshot initiative.

Elizabeth Jaffee, M.D., professor at the Johns Hopkins University School of Medicine, president-elect of the American Association for Cancer Research and co-chair of the Lancet Oncology commission, says: “The U.S. 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. This commission maps an ambitious path ahead to guide researchers, funders, industry and policymakers in prioritizing the best research to benefit patients.” [2]

Professor and commission co-chair Chi Van Dang, M.D., Ph.D., of the Ludwig Institute for Cancer Research in New York and The Wistar Institute in Philadelphia, says: “The cancer research community has embraced the extraordinary opportunity of the Moonshot initiative with remarkable energy. To ensure that cancer research in the U.S.A. continues to be world-leading, it is imperative that investment is concentrated into specific research areas. The commission identifies key areas to prioritize across technology, clinical research, public health and drugs policy to achieve this goal.” [2]

Commenting on the commission, Gregory Simon, president of the Biden Cancer Initiative, says the report “provides a road map 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.”

The commission highlights the importance of cancer prevention, including the development of a pre-malignant 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 toward targeted screening will also be important.

Report co-author and professor Scott Lippman, M.D., of the University of California San Diego Moores Cancer Center, says: “Past efforts to prevent cancer have been limited and sometimes hindered by serious and substantial disparities. A one-size-fits-all strategy does not work. That’s the premise of precision medicine and it should be for prevention efforts as well, such as screenings, which should be tailored by age, risk, demographics and other factors. Colorectal screening, for example, is extremely poor in Latinos, especially of low income, but there are new programs that overcome language and social barriers to boost breadth and success. Obesity research is crucial given the growing global epidemic and promise of recent work in special energetics, sedentary behavior and meal timing. These strategies will have a great effect on minimizing morbidities and mortality from cancer in future generations.” [2]

Data sharing and patient-centred priorities will be critical to advancing research and improving care. The report strongly supports developing data systems that allow patients to input their personal data for use by the cancer community and providing outputs for 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, so 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 has been approved for marketing by the U.S. Food and Drug Administration, 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 that 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 ensure equitable access that is financially sustainable for the individual and society.

Commission co-chair and professor Jeffrey Peppercorn, M.D., M.P.H., from Massachusetts General Hospital, Harvard Medical School, in Boston, says: “As we make advances in cancer care, one of our priorities must be to ensure that all patients who may benefit have access to high quality care. We need to better understand and address costs of cancer care and disparities in care in the U.S. and internationally. This is an exciting time in cancer care and research, and we need to make sure that the oncology community comes together, working beyond national borders whenever necessary, to accelerate global effort to control cancer and improve the lives of patients.”[2]

Report co-author Clifford Hudis, M.D., CEO of the American Society of Clinical Oncology (ASCO) and former chief of breast medicine at Memorial Sloan Kettering Cancer Center in New York, says: “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 four to five 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 10 years of progress in half that time. The time for action is now.”

 

NOTES TO EDITORS

[1] Full list of commissioners:

Elizabeth M Jaffee, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Chi Van Dang, Ludwig Institute for Cancer Research, New York, NY, USA

David B Agus, University of Southern California, Beverly Hills, CA, USA

Brian M Alexander, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

Kenneth C Anderson, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

Alan Ashworth, University of California San Francisco, San Francisco, CA, USA

Anna D Barker, Arizona State University, Tempe, AZ, USA

Roshan Bastani, Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA

Sangeeta Bhatia, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA

Jeffrey A Bluestone, University of California San Francisco, San Francisco, CA, USA

Otis Brawley, American Cancer Society, Atlanta, GA, USA

Atul J Butte, University of California San Francisco, San Francisco, CA, USA

Daniel G Coit, Department of Surgery, Memorial Sloan-Kettering, Cancer Center, New York, NY, USA

Nancy E Davidson, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA

Mark Davis, California Institute for Technology, Pasadena, CA, USA

Ronald A DePinho, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Robert B Diasio, Mayo Clinic Cancer Center, Rochester, MN, USA

Giulio Draetta, University of Texas MD Anderson Cancer Center, Houston, TX, USA

A Lindsay Frazier, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

Andrew Futreal, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Sam S Gambhir, Stanford University, Stanford, CA, USA

Patricia A Ganz, Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA

Levi Garraway, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

Stanton Gerson, Case Comprehensive Cancer Center, Cleveland, OH, USA

Sumit Gupta, Division of Haematology/Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, Canada

James Heath, California Institute for Technology, Pasadena, CA, USA

Ruth I Hoffman, American Childhood Cancer Organization, Beltsville, MD, USA

Cliff Hudis, Breast Cancer Medicine Service, Memorial Sloan-Kettering, Cancer Center, New York, NY, USA

Chanita Hughes-Halbert, Medical University of South Carolina and the Hollings Cancer Center, Charleston, SC, USA

Ramy Ibrahim, Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA

Hossein Jadvar, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

Brian Kavanagh, Department of Radiation Oncology, University of Colorado, Denver, CO, USA

Rick Kittles, College of Medicine and the University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA

Quynh-Thu Le, Stanford University, Stanford, CA, USA

Scott M Lippman, University of California San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA

David Mankoff, Department of Radiology and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Elaine R Mardis, The Institute for Genomic Medicine at Nationwide Children’s Hospital Columbus, OH, USA

Deborah K Mayer, University of North Carolina, Lineberger Cancer Center, Chapel Hill, NC, USA

Kelly McMasters, The Hiram C Polk Jr MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA

Neal J Meropol, Flatiron Health, New York, NY, USA

Beverly Mitchell, Stanford University, Stanford, CA, USA

Peter Naredi, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Dean Ornish, University of California San Francisco, San Francisco, CA, USA

Timothy M Pawlik, Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA

Jeffrey Peppercorn, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Martin G Pomper, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare, Charlotte, NC, USA

Christine Ritchie, University of California San Francisco, San Francisco, CA, USA

Sally W Schwarz, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

Richard Sullivan, King’s College London, London, UK

Richard Wahl, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

Jedd D Wolchok, Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA

Sandra L Wong, Department of Surgery, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

Alfred Yung, University of Texas MD Anderson Cancer Center, Houston, TX, USA

[2] Quotes direct from authors and cannot be found in the text of the commission report.

For interviews, please contact:

Commission co-chairs

• For interviews with professor Elizabeth Jaffee, Johns Hopkins University School of Medicine, Baltimore, please contact Amy Mone: [email protected].
• For interviews with professor Chi Van Dang, Ludwig Institute for Cancer Research, New York, please contact Rachel Steinhardt: [email protected], 001 646-371-7394.

Commission report co-authors

• For interviews with professor Scott Lippman, University of California San Diego, please contact Scott LaFee: [email protected], 001 858-249-0456.
• For interviews with professor Jeffrey Peppercorn, Massachusetts General Hospital, Harvard Medical School, Boston, please contact him directly (email preferred): [email protected], 001 919-451-1058.
• For interviews with Clifford Hudis, CEO of the American Society of Clinical Oncology (ASCO), please contact the ASCO press team: [email protected] or [email protected].

For interviews with Comment author Gregory Simon, president of the Biden Cancer Initiative, please contact him via the press office: Cecelia Arradaza, [email protected].

Links to the commission:

For embargoed access to the commission, please visit thelancet-press.com/embargo/OncologyCommission.pdf.

NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY. IF YOU WISH TO PROVIDE A LINK FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS:

thelancet.com/commissions/usa-oncology.