Clinical Cancer Advances 2021: ASCO’s Report on Progress Against Cancer highlights the most important clinical research advances of the past year and identifies priority areas where ASCO believes research efforts should be focused moving forward. This year’s report also discusses the critical issue of health equity in cancer research and solutions to ensure that every patient with cancer, everywhere, can access the latest advances.
Achieving Equity in Cancer Research
Overall cancer mortality has decreased in the United States1 thanks to tremendous progress in cancer prevention, early detection, and treatment—underpinned by decades of research progress.2
Unfortunately, not all individuals with cancer have benefited equitably from this success, as Blacks,3 patients living in rural areas,4 populations with lower income and education levels,5 and others continue to experience lower survival and higher mortality rates for many cancers.
“As clinicians, we are committed to providing evidence-based, high-quality cancer care to every patient, every day, everywhere. But, if clinical trials don’t represent the individuals we treat, including those from racial, ethnic, and other minority populations, the state of science suffers, and patients with life-threatening conditions may not receive the best— perhaps only—treatment option for their condition.”
—Lori J. Pierce, MD, FASTRO, FASCO, ASCO President, 2020-2021
Disparities in cancer research is a complex, multifaceted issue requiring a multifactorial response that addresses (1) specific interrelated barriers precluding certain populations from trial participation, and (2) structural and systemic challenges that limit the cancer community’s pursuit of research that would benefit underserved populations.
Disparities in cancer outcomes are rooted, in some respects, in the development of novel diagnostics and therapeutics—the clinical research that demonstrates the efficacy and safety of new cancer treatments.
Patients with cancer who might, otherwise, be candidates for clinical trials continue to face multiple barriers, which must be thoroughly understood and appropriately addressed before the cancer community can learn from every individual with cancer.
All populations should have an equal opportunity to participate in, be recognized for, and benefit from research across the spectrum, including clinical trials, health services research, and other types of research studies and methodologies. A collective effort by all stakeholders—including patients, caregivers, providers, policy leaders, pharmaceutical organizations, and advocacy groups—is needed to develop appropriately targeted approaches to achieve this goal.
Advance of the Year: Molecular Profiling Drives Progress in GI Cancers
Surgery, radiotherapy, and chemotherapy have been the mainstay of treatment for GI cancer but have limited effect and can take a heavy toll on quality of life. The development of more effective therapies for GI cancer has lagged. Molecular profiling has helped change the outlook for patients with GI cancer by identifying the molecular and genetic signatures that allow oncologists to deliver treatments that are highly specific to a tumor. For these reasons, ASCO has identified molecular profiling driving progress in GI cancer as the 2021 Advance of the Year. This selection recognizes the treatment advances made possible by molecular testing for patients with GI cancers.
GI cancer includes cancers of the esophagus, stomach, small bowel, gallbladder and biliary tract, pancreas, colon, rectum, and anus and accounts for 26% of the global cancer incidence and 35% of all cancer-related deaths.6 The ability to molecularly profile a GI tumor has expanded the treatment options for individual patients with GI cancers—extending survival while minimizing adverse effects. Specific genetic mutations, amplifications or fusions, epigenetic profile, protein expression, or other molecular features allow oncologists to choose targeted therapies matched to the molecular profile of their patients’ tumor. In the past year, research has shown that targeting human epidermal growth factor receptor 2 (HER2) improves survival in gastric cancer and shows promise for patients with HER2-positive colorectal cancer. Therapy is now approved that targets specific DNA mutations in metastatic colorectal cancer. These advances are moving the treatment of GI cancers closer to personalized medicine.
Additional Major Advances
Advances featured in this year’s report reflect progress in a range of cancers and across prevention and treatment, including:
- Progress in bringing targeted therapies to patients with earlier-stage disease.
- Biomarker-driven treatment approaches that offer more personalized care for lung, colorectal, and gastric cancers.
- Combinations of different therapies that extend survival without increasing toxicity.
- A growing number of targeted therapies are offering extended survival for more patients with difficult-to-treat cancers.
ASCO Research Priorities to Accelerate Progress
As the organization that represents and connects the global community of clinicians who discover new treatments for cancer and deliver the latest advances to patients, each year, ASCO issues its list of top Research Priorities to Accelerate Progress Against Cancer. As cancer care becomes more complex and personalized, the research behind new advances must include all populations who stand to benefit and consider the impact of social determinants of health, such as the social, economic, and cultural factors that influence cancer risk and outcomes.
Research priorities for 2021, listed below in no particular order, represent promising areas of research that have the potential to significantly improve the knowledge base for clinical decision making and address vital unmet needs in cancer care. This year’s list includes a newly added priority on artificial intelligence, recognizing its growing potential to solve complex problems and drive diagnostic, therapeutic, and translational research across the spectrum of cancer prevention and care.
- Develop and Integrate Artificial Intelligence and Deep Learning in Cancer Research
- Identify Strategies That Predict Response and Resistance to Immunotherapies
- Optimize Multimodality Treatment for Solid Tumors
- Increase Precision Medicine Research and Treatment Approaches in Pediatric and Other Rare Cancers
- Optimize Care for Older Adults With Cancer
- Increase Equitable Access to Cancer Clinical Trials
- Reduce Adverse Consequences of Cancer Treatment
- Reduce Obesity’s Impact on Cancer Incidence and Outcomes
- Better Identify Potentially Malignant Lesions and Predict When Treatment is Needed
Progress Against Cancer: Why Federal Support Matters
We are in an exciting and promising era of medical research, and new discoveries are leading to major improvements in the way we prevent, diagnose, treat, and even cure cancer.
Every major medical breakthrough in cancer started with research funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI). This year marks the 50th anniversary of the December 1971 signing of the National Cancer Act, which led to the establishment of the National Cancer Program and significantly expanded the authorities and responsibilities of NCI. Through the research, training, and infrastructure programs of NCI, cancer care and research expanded from a few pioneering research institutions to cancer centers, community hospitals, and oncology practices across the United States.
Research funded by NIH and NCI generates biomedical innovations that fuel the entry of new therapies into the market— helping to make the United States the global leader in developing new cancer treatments. They also fund vital cancer research that private industry has little incentive to conduct, such as studies focused on prevention and screening, identifying treatments for rare cancers, and comparing the effectiveness and safety of similar treatments.
Over the past few decades, federal investment in cancer research has helped lead to:
- 29% decline in overall cancer death rates (since peak in 1991)7
- 2.9 million cancer deaths averted in the United States7
- 1501 new cancer drugs or indications approved by the US Food and Drug Administration (FDA) since 2006
Sustaining the national commitment to cancer research is essential to transform research discoveries into new treatments and improve care for millions of people with cancer.
Progress in a Pandemic: Cancer Research Funding at Risk
Recently, there has been broad, bipartisan support in Congress for increased investment in NIH. In fiscal year (FY) 2020, Congress provided a $2.6 billion (in US dollars) funding increase for NIH, including a $300 million increase for NCI.8
However, the COVID-19 public health emergency threatens to reverse years of momentum. Laboratories conducting cancer research have closed or space has been redirected to COVID-19 research. Clinical trials have halted or slowed, creating a costly loss in research progress and delays in patient access to potentially life-saving treatments. NIH and NCI need emergency funding on top of a robust annual increase to their baseline budgets to mitigate disruptions caused by the pandemic and get the nation’s biomedical research enterprise up and running again. However, tight budget caps and shifting funding priorities as a result of the public health emergency have complicated the annual funding process, causing uncertainty for future funding for NIH and NCI.
We know that even minor funding cuts can have a major impact on cancer research. After the last financial crisis, federal funding for cancer research declined by nearly 25%, and even with recent continued increases, NIH’s purchasing power is only now beginning to reach pre-2006 levels (adjusted for inflation).9 NCI’s budget is still $1.1 billion less than it would be if funding had kept pace with biomedical inflation since FY 2003.10 We cannot repeat history.
"Stable, predictable funding increases will allow our nation to continue to build on the promise of today’s research and improve outcomes for all patients with cancer."
—Richard L. Schilsky, MD, FACP, FSCT, FASCO, Chief Medical Officer (CMO) and Executive Vice President of ASCO
COVID-19 has caused immense personal suffering and disruptions across nearly every aspect of society. We cannot let this pandemic stop our progress against cancer and disrupt essential innovation any further.
Progress Needs You: Take Action to Support Federal Investment in Cancer Research
Increased federal funding for cancer research is more important than ever to help the research community tackle new setbacks while pursuing the life-changing research that patients with cancer and their families rely on.
Lend your voice. Together, nothing will stop us from conquering cancer. Use the Association for Clinical Oncology’s ACT Network to contact your Members of Congress and urge them to support an increase in funding for NIH and NCI. Visit ASCO.org/actnetwork to take action.
About Clinical Cancer Advances
ASCO’s Clinical Cancer Advances report highlights current trends in the field and identifies cancer research priorities that have great potential to advance progress against cancer. The report, now in its 16th edition, is developed by a 26-member editorial board of experts in a range of cancer types, subspecialties, and care issues. The editors reviewed scientific literature published in peer-reviewed journals or presented at major medical conferences, primarily from October 2019 to September 2020, and selected advances that improve meaningful patient outcomes and have a strong scientific impact. The editors also proposed priority areas of research that address vital unmet needs in cancer care and have the potential to improve the knowledge base for clinical decision making.
About ASCO and the Association for Clinical Oncology
ASCO (the Society) and the Association for Clinical Oncology (the Association) are committed to the principle that knowledge conquers cancer. ASCO represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of high-quality and equitable patient care, the Society works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. The Association works to ensure that all individuals with cancer have access to high-quality and equitable care; that the cancer care delivery system supports optimal cancer care; and that our nation supports robust federal funding for research on the prevention, screening, diagnosis, and treatment of cancer. Learn more about the Society at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, Instagram, and YouTube. Learn more about the Association at www.ascoassociation.org and follow us on Twitter.
About Conquer Cancer, the ASCO Foundation
Conquer Cancer, the ASCO Foundation funds research into every facet of cancer to benefit every patient, everywhere. As ASCO’s foundation, Conquer Cancer helps turn science into a sigh of relief for patients around the world by supporting groundbreaking research and education across cancer’s full continuum. Nearly a third of the clinical trials included in this report were conducted by researchers previously funded by Conquer Cancer.