Approximately 1.7 million people received a cancer diagnosis in the United States in 2017.1 Today, more than 15 million Americans, nearly one in 20, is a survivor of cancer, which means that they have had or are living with cancer.2 The number of survivors is growing steadily; experts estimate that there will be 26 million by 2040, with 73% of them 65 years of age or older.3
At the same time, the rate of cancer death has been decreasing, and people are living longer with cancer than ever before. Approximately 64% of US patients diagnosed with cancer in 2005 have lived 10 years or more beyond diagnosis, up from 35% for those diagnosed in 1975.4
These trends reflect our and other nations’ investments in cancer research and the relentless efforts to advance discovery and care. The volume and pace of cancer research are growing rapidly. For example, the number of medical journal articles with the word “cancer” in the title quadrupled in the last decade, from approximately 28,000 in 2007 to 120,000 in 2017.
Yet more work lies ahead. Because of the aging and growing population, there will be more new patients with cancer every year, both in the United States and worldwide. For every life saved, there are still many people waiting for the next breakthrough for themselves or their loved ones.
This report highlights the most important clinical advances of 2017 and previews where cancer science is headed. New treatments help patients with melanoma and ovarian, lung, bladder, brain, and prostate cancer live longer, and many other new therapies delay cancer worsening or lower the chance of recurrence.
In the span of just 1 year—from November 2016 through October 2017—the US Food and Drug Administration (FDA) approved 31 new therapies for more than 16 types of cancer. Among the new approvals are two firsts: an adoptive cell immunotherapy—the ASCO Advance of the Year—and a tumor agnostic therapy; that is, treatment that works against different types of cancers that share a common genetic abnormality.
First Adoptive Cell Immunotherapy and Gene Therapy for Cancer
In August 2017, the FDA approved the first adoptive cell immunotherapy, also known as CAR T-cell therapy, and the first gene therapy for cancer, tisagenlecleucel. This double first approval stems from decades of research on how to train the patient’s own immune cells to fight cancer.
Even more important than the historic significance of this achievement is the medical need this unique new therapy is poised to fill. Tisagenlecleucel may be the first treatment to truly turn the tables on recurrent pediatric acute lymphoblastic leukemia (ALL), one of the most common cancers in children. In a clinical trial, cancer in four of five patients went into remission after treatment, which was custom prepared in the laboratory from the patients’ own blood cells.
In October 2017, the FDA approved the second CAR T-cell therapy, axicabtagene ciloleucel, to treat adults with certain types of lymphoma. Other CAR T-cell therapies seem promising in clinical trials of people with multiple myeloma. CAR T-cell therapy represents an exciting innovation that has the potential to transform cancer care. It also raises the ongoing issue of cost and reminds us that, as a community, we need to find solutions that will assure that every patient with cancer has access to the care they need. See Advance of the Year: Adoptive Cell Immunotherapy for more about these advances.
The other historic first among FDA approvals in 2017 marks a milestone in precision oncology. The immune checkpoint inhibitor pembrolizumab became the first cancer treatment to receive a tumor-agnostic indication. It received accelerated approval to treat any type of solid tumor that has mismatch repair deficiency, a defect that undermines the cell’s ability to repair DNA damage. This approval provides patients with a wide range of different cancers an effective way to control the disease.
Another promising treatment, larotrectinib, which homes in on a different, rare genomic abnormality in the tumor known as tropomyosin receptor kinase (TRK) gene fusion, also seems to work across tumor types and in both adults and children. Larotrectinib has the potential to become the first tumor-agnostic targeted therapy for cancer.
Meanwhile, fundamental cancer biology research is uncovering new molecular pathways that are being explored as potential therapeutic targets. In 2017 alone, the FDA approved more than 13 new targeted medicines for people with leukemia and multiple myeloma, as well as ovarian, breast, and lung cancer.
Targeted Agent and Profiling Utilization Registry Study
In 2017, ASCO’s Targeted Agent and Profiling Utilization Registry (TAPUR) Study (ClinicalTrials.gov identifier: NCT02693535) continued expanding. As of November 2, 2017, there were more than 495 participants enrolled on a study drug at more than 83 sites in 18 states, each offering 17 different targeted therapy options provided by the seven participating pharmaceutical companies.
In addition, the study protocol was revised to lower the age of eligibility for the trial from 18 years to 12 years to extend the opportunity for participation to adolescent patients with advanced cancer in cases in which there is a defined adolescent dose for the study drugs.
The objective of the TAPUR Study is to evaluate molecularly targeted cancer drugs and collect data on clinical outcomes to learn about additional uses of these drugs outside of the indications already approved by the FDA. The TAPUR Study is registered with a full list of inclusion and exclusion criteria and other information. Prospective patients, researchers, and practices interested in participating can visit the TAPUR website or e-mail the TAPUR Study team.
As life expectancy after a cancer diagnosis continues to improve, there is growing recognition of the need to address patients’ emotional and psychosocial needs from the time of diagnosis through treatment and survivorship. 2018 Clinical Cancer Advances highlights efforts to preserve patient quality of life by avoiding unnecessary treatment or by lowering therapy dose or duration. Furthermore, new tools that engage patients in their own care, such as Web programs for symptom monitoring, psychological support, and end-of-life planning, are showing benefits for both patients and health care systems.
Finally, we are entering a new era in care in which biomedical research is no longer solely driven by researchers and physicians, but also by patients who are more and more directly engaged in driving progress forward. By donating tissue samples and clinical information, or by helping to design research studies and formulate practice guidelines, patients are providing valuable perspectives and contributing to better care for other patients now and in the future.
The only failure in cancer research is when you quit or are forced to quit because of a lack of funding. It takes decades of sustained research investment to test the safety and efficacy of cancer drugs. Congress needs to give researchers resources to discover the treatments that lead to better outcomes for those individuals with cancer.
Representative Brian Higgins (D-NY-26)
Co-Chair, House Cancer Caucus
Federal Support for Cancer Research Is Critical
Federally funded cancer research has driven many of the major prevention and treatment advances of the past 50 years and has led to substantial improvements in patient survival and dramatic improvements in quality of life for people with cancer. The National Cancer Institute (NCI) funds studies in areas that private industry has little incentive to address, such as research on cancer prevention, screening, and rare cancers, as well as groundbreaking foundational research.
The US National Institutes for Health (NIH) is the single largest public funder of biomedical research in the world. Federally funded biomedical research helps keep the United States globally competitive by contributing $65 billion in economic growth, supporting 380,000 jobs, and generating 2.21 dollars in local economic growth for every dollar in NIH funding.5,6 It is estimated that NIH-funded basic research provides a positive return to public investment of 43%.7
Research funded by the NIH also fuels the innovation on which companies depend to bring new treatments to the marketplace, helping make the United States the global leader in developing treatments. Studies show that NIH investments in biomedical research stimulate increased private investment: Every dollar of increase in public clinical research stimulates 2.35 dollars of industry investment at 3 years.7
Funding from the NIH and other federal agencies supported more than 25% of the top advances featured in this report. Among the most notable are studies that have found:
- Prolonged survival with new approaches:
- A new treatment regimen helps women with recurrent ovarian cancer live longer.
- A Web-based tool for self-reporting symptoms during chemotherapy helps patients with advanced cancer live longer.
- Longer hormone therapy reduces the risk of breast cancer recurrence.
- Reduced adverse effects with less treatment:
- Shortening the duration of adjuvant chemotherapy for stage III colorectal cancer is safe and reduces adverse effects.
- In patients with melanoma, less extensive surgery lowers the risk of lymphedema without compromising survival.
- Lowering the radiation dose for oropharyngeal cancer reduces health complications without compromising survival.
- Effective strategies to help patients with advanced cancer understand and cope with their prognosis.
- For cancer-related fatigue, exercise and psychological support are more effective than medication.
- New insights on the adverse effects of certain prostate cancer and lung cancer treatments will help inform treatment and survivorship discussions.
In the last year, Congress has made critical investments to improve and accelerate cancer research through supplemental funding for the Cancer Moonshot Initiative and the 21st Century Cures Act. In addition, Congress included a boost in funding for NIH and NCI in fiscal year 2017; however, despite these funding increases, NCI’s budget, when adjusted for inflation, remains below prerecession levels8.
One manifestation of this reduced budget is that it is more difficult for researchers to secure funding. For example, in 2015, only 16% of new research proposals received funding compared with 27% in 2001.9 This decline in funding means that it is more difficult for the field to recruit and retain young researchers, which threatens future progress against cancer. Flat funding and budget cuts translate into less innovation, fewer studies launched, fewer patients enrolled in clinical trials, fewer researchers entering the field, and fewer discoveries.
Predictable funding increases are critical to sustaining progress against cancer. Dependable and robust funding is essential for planning and conducting multiyear trials that advance new treatments.
A Call to Action to Congress
Americans are counting on our leaders to invest in biomedical innovation that will deliver the next generation of cancer cures to patients. ASCO urges Congress to give hope to millions of Americans with cancer by continuing to build on its investment in cancer research and providing predictable funding increases to NIH and NCI.
Join Us: Tell Your Representatives to Support Cancer Policy Priorities
More than 100 ASCO members from across the country came to the US capitol in September 2017 for ASCO’s annual Advocacy Summit, where members urged Congress to support issues critical to improving cancer research and care. During meetings with members of Congress and staff, ASCO members asked Congress to support policies to increase federal research funding, ensure access to chemotherapy services for patients enrolled in Medicare, and improve the affordability of cancer drugs.
ASCO members have an opportunity to make their voices heard throughout the year by engaging with their members of Congress on key issues related to cancer policy. To learn more about participating in ongoing advocacy efforts, visit the ASCO ACT Network.
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, Conquer Cancer works to conquer this disease by funding breakthrough cancer research and sharing cutting-edge knowledge with patients and physicians worldwide, and by improving the quality of care and access to care, enhancing the lives of all who are touched by cancer.
Over 34 years, more than $109 million in funding has been provided through Conquer Cancer’s Grants and Awards Program to support clinical and translational scientists, at all levels of their careers and 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 1,800 grants and awards in 71 countries. Conquer Cancer grants have helped researchers launch successful careers and make discoveries that benefit patients with cancer.
One of the top patient care advances featured in this report was made possible by funding from Conquer Cancer (see Patient Engagement Leads to Improved Care), and several other studies that are highlighted were led by past Conquer Cancer grant recipients who have continued their careers in oncology research.
This report was supported, in part, by funds from Conquer Cancer’s Mission Endowment.