Cancer is one of the world’s most pressing health care challenges. On the whole, research progress from one year to the next is incremental, and true breakthroughs are exceptional. Nevertheless, every year brings new knowledge and insights that help direct further research and ultimately improve the outlook for patients with cancer. This report highlights the most important clinical advances of 2016 and previews where cancer science is headed.
Accelerated by the National Cancer Act of 1971 and then by a responsive research infrastructure and increasingly innovative regulatory environment, cancer research today delivers new treatments to patients faster than ever. In just 1 year’s time (from November 2015 through October 2016), the US Food and Drug Administration (FDA) has approved 20 therapies for more than a dozen different types of cancer (Table 1). An example of this accelerating progress is cancer immunotherapy.
What’s Next for Cancer Immunotherapy?
A hundred years in the making, cancer immunotherapy is now a standard treatment option for people with a growing number of different cancers. In 2016 alone, the FDA approved immunotherapies for advanced forms of lung, kidney, bladder, and head and neck cancers, as well as Hodgkin lymphoma.
For some people with these advanced-stage cancers, the advent of cancer immunotherapy is truly life changing. It often offers the only chance to live longer and better. And many believe that this first wave of success with cancer immunotherapy is just the beginning.
Building on our initial success, a key next step is to understand why fewer than half of patients currently selected for treatment actually benefit from immunotherapy and why the benefit, if it occurs, may be short lived. In 2016, several reports revealed early insights into patient and cancer characteristics (i.e., biomarkers) that might predict whether immunotherapy could work well in an individual patient. For example, it seems that for some cancers, the subset of tumors with many genetic mutations can be more responsive to current immunotherapy options.
While we are trying to identify who will benefit, we are also exploring whether combining immunotherapy treatments with one another or with other cancer treatments, such as radiation therapy and chemotherapy, might extend the impact of this new group of therapies. Together, these efforts mark the next phase of immunotherapy: Immunotherapy 2.0: Expanding Use and Refining Patient Selection, the American Society of Clinical Oncology’s (ASCO) Advance of the Year.
The advances highlighted in this report attest to a key trend that is driving progress against cancer today: cancer therapies are becoming increasingly precise, thereby enabling a more personalized approach to treatment selection. The research into cancer biology is propelling rapid development of novel treatments targeting the key molecules that allow cancers to grow and spread. In 2016 alone, this strategy resulted in new targeted therapies for people living with advanced cancers of the lung, breast, and kidney, as well as several hard-to-treat forms of blood cancer.
Today, new molecular technologies can quickly pinpoint molecular changes in the tumor or free-floating cancer DNA in the blood. For a growing number of patients, such changes can be matched to either existing targeted treatments or experimental treatments that are being tested in clinical trials. Although this approach is not yet routine, early research suggests it could open viable new treatment options for patients with a wide range of hard-to-treat cancers (as described in Looking to the Future).
Cancer by the Numbers
The World Health Organization projects that the number of new cancer diagnoses will reach 22 million per year in the next two decades, up from 14 million in 2012. In the same timeframe, cancer-related deaths may increase by as much as 70%. Seven of 10 deaths resulting from cancer occur in Africa, Asia, and Central and South America, regions of the world with limited access to cancer screening and treatment.1
In the United States, an estimated 1.7 million people were diagnosed with cancer in 2016.2 Because of the growing population of older adults and changing demographics, US annual cancer incidence is expected to reach 2.2 million per year by 2030.3
The good news is that, for most people, a diagnosis of cancer is not as grim as it used to be. Today, 68% of adults and 81% of children with cancer will be alive at least 5 years after a diagnosis. This is a big improvement from the 1970s, when only 50% of adults and 62% of children were surviving 5 years.4 Although annual US cancer death rates have been declining in the last 20 years, the number of deaths resulting from cancer remains high because of overall population growth.
- Stewart BW, Wild CP (eds): World Cancer Report 2014. Lyon, France, IARC Press, 2014
- American Cancer Society: Cancer Facts and Figures 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf
- Rahib L, Smith BD, Aizenberg R, et al: Projecting cancer incidence and deaths to 2030: The unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74:2913-21, 2014
- National Institutes of Health: Fact Sheet: Cancer. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid575
Caring for the Whole Patient
In the 21st century, people with cancer are not only living longer than ever, but also enjoying a better quality of life than before. Indeed, an entire field of cancer survivorship has emerged—studying ways to improve life as well as extend it. Although treating the physical illness remains a priority, more and more attention is being paid to caring for the whole patient, which includes his or her emotional and psychosocial needs.
With increased access to health information, patients today can be more active partners in their health care. A patient’s values and preferences are critical when it comes to decisions about cancer screening and prevention measures, as well as cancer therapy selection. Indeed, lifestyle and environmental factors along with genomics represent the keys to precision medicine.
This report features efforts to ensure that every patient with cancer receives the best possible care. Among these efforts are Web-based tools for self-monitoring symptoms, education and navigation programs for underserved populations, and a better way to prevent nausea triggered by chemotherapy. Lastly, this report reviews clinical research addressing a long-standing unresolved question in a common malignancy: prostate cancer.
ASCO is calling on lawmakers to continue to build on investments in NIH with predictable and sustainable future funding increases to meet the promise of today's research.
Federal Funding Supports Pioneering Research
Clinical cancer research in the United States is made possible through funding from both public and private sectors. When it comes to high-risk, pioneering research, federal funding is often indispensable and has been a unique asset over the decades since World War II. Often only federal funding can support research that the private sector typically does not pursue, such as cancer prevention and screening and treatment comparisons.
Funding from the US National Institutes of Health (NIH) supported approximately one-third of the top advances highlighted in this report. Among the most notable are:
- Early evidence that immunotherapy is effective against an aggressive, nonmelanoma skin cancer
- A new, life-extending targeted treatment of an aggressive blood cancer
- Improved therapies for children with high-risk neuroblastoma and adults with glioma
- First insight into how genetic changes evolve during the development of melanoma
- Discovery of two genes linked to increased risk of ovarian cancer
- Identification of heritable genetic mutations in children with cancer and people with suspected Lynch syndrome
- Applications of liquid biopsy testing in cancer care
Sustained and steady funding of the NIH and National Cancer Institute (NCI) is critical to maintaining the pace of scientific discovery and continued progress against cancer. However, although the NIH received its first budget increase in more than a decade in 2016, the budget of the NCI, when adjusted for inflation, remains below prerecession levels (Fig 1). Failure to sustain the historic US investment in research places health outcomes, scientific leadership, and economic growth at risk.
Cancer touches all Americans. At its core, funding for cancer research reflects the American values that support innovation and research breakthroughs that improve and save lives. A regular, manageable and predictable investment in the NIH and the National Cancer Institute will allow the scientific community to plan for the future and make progress against cancer and other life-shortening diseases.
U.S. Representative Tom Cole (R-OK)
Chairman of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies
About Clinical Cancer Advances
ASCO developed this annual report, now in its 12th year, to document the important progress being made in clinical cancer research and highlight emerging trends in the field. Clinical Cancer Advances serves to outline to the public progress achieved in clinical cancer research and care each year. As a whole, this document attests to the exciting current state of the science and envisions future directions of cancer research.
The content of Clinical Cancer Advances was developed under the direction of a 20-person editorial board composed of experts in a wide range of oncology subspecialties. The editors reviewed research reports published in peer-reviewed scientific and medical journals or presented at major scientific meetings over a 1-year period (October 2015 to October 2016). The advances highlighted in this report cover the full range of clinical research disciplines: prevention, treatment, patient care, and tumor biology.
About the American Society of Clinical Oncology
Founded in 1964, ASCO is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at ASCO.org, explore patient education resources at Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.
ASCO Advocacy Summit Spotlights Need for Action on Cancer Policy
Volunteer advocates from across the United States participated in the first annual ASCO Advocacy Summit to urge Congress to take action on critical policies that would advance cancer research and treatment and ensure that the 14.5 million patients with cancer and survivors of cancer have access to high-quality, high-value health care.
Through in-person meetings and letters to members of Congress, ASCO volunteers asked lawmakers to support policies to advance data sharing, increase funding for medical research, and ensure patient access to necessary cancer treatment, among other issues.
For more information on ASCO’s policy statements and advocacy initiatives, visit ASCO in Action.
The Conquer Cancer Foundation
The Conquer Cancer Foundation was created by the world’s foremost cancer physicians of ASCO to seek dramatic advances in the prevention, treatment, and cure of all types of cancer. Toward the vision of a world free from the fear of cancer, the foundation works to conquer this disease by funding breakthrough cancer research, sharing cutting-edge knowledge with patients and physicians worldwide, and by improving quality of care and access to care, enhancing the lives of all who are touched by cancer.
Over 33 years, more than $105 million in funding has been provided through the Conquer Cancer Foundation Grants and Awards Program to support clinical and translational scientists at all levels of their careers, working around the globe to address the full spectrum of oncology—from prevention through survivorship and end-of-life care. The foundation has given more than 1,700 grants and awards in 68 countries. Foundation grants have helped researchers launch successful careers and make discoveries that benefit patients with cancer.
Several of the studies featured in this year’s Clinical Cancer Advances report were led by past Conquer Cancer Foundation grant recipients who have continued their careers in oncology research.