Clinical Cancer Advances 2019: ASCO’s Annual 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.
Since 1992,1 there have been nearly 25 consecutive years of decline in overall incidence and mortality rates for all types of cancer.2 In addition, the number of people living 5 years or more after a cancer diagnosis is projected to increase 31% by 2026,3 representing an increase of more than four million survivors in less than a decade. Cancer research, including the advances in this report, helps make progress possible.
Advance of the Year: Progress in Treating Rare Cancers
This year, ASCO names Progress in Treating Rare Cancers as the Advance of the Year. In the United States, rare cancers account for approximately 20% of all cancers diagnosed each year, and incidence rates vary worldwide.4 Progress has historically lagged behind the achievements made in more common cancers; however, five major studies offer significant steps forward, making this a notable year for advances in rare cancers:
- A new combination of targeted therapies for a rare, hard-to-treat form of thyroid cancer produced responses in more than two thirds of patients.
- Sorafenib became the first treatment to improve progression-free survival for desmoid tumors, a rare type of sarcoma.
- A new therapy that delivers targeted radiation to tumor cells, lutetium-177 (177Lu)–Dotatate, lowered the risk of disease progression or death by 79% for patients with advanced somatostatin receptor-positive midgut neuroendocrine tumors, compared with standard treatment.
- Trastuzumab, a standard treatment for human epidermal growth factor receptor 2 (HER2)–positive breast cancer, significantly slowed progression of HER2-positive uterine serous carcinoma.
- The first promising therapy—the colony-stimulating factor-1 (CSF-1) inhibitor pexidartinib—for a rare cancer of the joints known as tenosynovial giant cell tumor showed an overall response rate of 39.3% in patients taking pexidartinib v 0% in patients taking a placebo.
This progress in rare cancers can be attributed, in part, to ongoing efforts of several major initiatives sponsored and led by the National Institutes of Health (NIH), including The Cancer Genome Atlas (TCGA). The systematic characterization of a broad range of tumors by TCGA has led to effective targeting of activated pathways. Future funding of these and other similar efforts is vital to accelerating progress in rare cancers.
Additional Major Advances
Landmark advances in molecular diagnostics continue, with the most significant achievement made as a result of the TAILORx (ClinicalTrials.gov identifier: NCT00310180) breast cancer study. This study demonstrated that as many as 70% of women with hormone receptor–positive, node-negative breast cancer could safely forgo adjuvant chemotherapy based on results from a 21-gene assay.
Immunotherapy advances continue to grow, expanding to cancers in which there have been few immunotherapy treatment successes to date:
- A new combination immunotherapy regimen was proven to boost overall survival in patients with renal cell cancer, gaining US Food and Drug Administration (FDA) approval and becoming the new standard of care.
- An investigational programmed cell death-1 (PD-1) inhibitor showed promise for advanced squamous cell cancer of the skin, which has few other treatment options.
New successes are being achieved with targeted therapies, including the introduction of medicines that delay the progression of breast and lung cancers.
Growing microbiome research field has identified specific bacteria possibly associated with risk for certain head and neck cancers.
ASCO Research Priorities to Accelerate Progress
For the first time, ASCO is identifying areas on which future research efforts should be focused to help accelerate progress against cancer. These priority areas, listed in no particular order, address an unmet need or help fill a knowledge gap in areas critical to improving patient care and outcomes:
- Identify strategies that better predict response to immunotherapies.
- Better define the patient populations that benefit from postoperative (adjuvant) therapy.
- Translate innovations in cellular therapies to solid tumors.
- Increase precision medicine research and treatment approaches in pediatric cancers.
- Optimize care for older adults with cancer.
- Increase equitable access to cancer clinical trials.
- Reduce the long-term consequences of cancer treatment.
- Reduce obesity and its impact on cancer incidence and outcomes.
- Identify strategies to detect and treat premalignant lesions.
These priorities build on an understanding gleaned from years of research efforts and over time will evolve with the cancer research landscape.
Voices for Cancer Research
Clinical Cancer Advances 2019 includes the personal stories of oncologists who have dedicated their lives to clinical cancer research and the patients who inspire them to continue their work. These researchers and patients are featured in ASCO’s “I Live to Conquer Cancer” campaign, which aims to put a human face on cancer research and underscore the importance of federally funded research in making progress against cancer.
“In an age of rapid discovery, these advances are not being applied fast enough to the places where people really need them—we have to bridge that gap. This is what drives me every day.” —Raymond U. Osarogiagbon, MD, FACP
“In medical school the doctors I worked with were so hopeful that we would find something better to offer our patients, and indeed, every year, thanks to cancer research, there has been something new.” —Judith Kaur, MD
“Pediatric oncology is one of the great success stories of medicine because of our nation’s commitment to curing this disease.” —Tara Henderson, MD, MPH
“There are real lives at stake, and they’re at stake every day. As long as we have people who are dying of cancer, as long as we have people who suffer long-term effects related to cancer or its treatment, we can do better, and we must do better.” —Alan P. Lyss, MD
“Because of cancer research and the people who have participated in clinical trials, I have a good quality of life. I can do the things I want to do.” —Gina Hollenbeck
“We wouldn’t be here today if it weren’t for what research did for us in 2009. I never even had to think about my son participating in a clinical trial—some other mother gave permission for her child so that my child could be in the position he is in today. It’s a domino effect.” —Renee Bakos-Pournaras with son Yano
Cancer Research: Why Federal Support Matters
Research funded by the NIH and National Cancer Institute (NCI) has played a pivotal role in advances in cancer prevention, diagnosis, and treatment. In fact, federal funding supported three of the five major advances in rare cancers and nearly one third of the studies highlighted in this year’s Clinical Cancer Advances report.
What the nation’s investment in research means for people with cancer:
- A 27% decline in cancer death rates (since peak in 1991)5
- More than 130 new cancer drugs or indications approved by the FDA since 20066
- Increased 5-year cancer survival (two out of three people with cancer live at least 5 years after diagnosis)7
- 15.5 million survivors of cancer (up from 11.4 million in 2006)5
After more than 10 years of stagnant funding, Congress has demonstrated tremendous bipartisan leadership by passing four annual consecutive NIH and NCI funding increases. Most recently, lawmakers passed a $2 billion (5.4%) NIH funding increase.
Fiscal year 2019 funding8 is as follows:
- NIH: $39.1 billion
- NCI: $6.147 billion
- Beau Biden Cancer Initiative: $400 million (full funding, as authorized under 21st Century Cures Act)
But our work is far from over.
- In the United States, a one-third increase in new cancer cases is expected over next decade.9
- We are only now nearing prerecession NCI funding levels.8,10
- Despite increases, NCI is still only able to fund a small fraction of new research proposals (12% in 2017 v 28% in 1997).11
- There was a 75% decrease in the number of studies presented at ASCO’s Annual Meeting (from 2008 to 2017)12 that were primarily funded by NIH.
When we invest in cancer research, everyone benefits.
- Research funded by NIH generates $69 billion in new economic activity across the country and supports 402,816 jobs nationwide (directly and indirectly).
- 67% of Americans say the US government should spend more money on finding treatments and cures for cancer, even if it means higher taxes or adding to the deficit.
As long as cancer continues to be the life-threatening burden it is today, our nation must continue to prioritize investment in cancer research. ASCO is hopeful that recent budget increases represent a promising future of renewed focus on federally funded cancer research.
Contact your Members of Congress to urge their continued support for NIH and NCI funding. ASCO makes it easy for you to reach them directly. Just visit ASCO’s ACT Network at asco.org/actnetwork.
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 14th edition, is developed by a 20+ 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 2017 to September2018, 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.
Founded in 1964, the American Society of Clinical Oncology, Inc. (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 45,000 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.
About Conquer Cancer, the ASCO Foundation
Conquer Cancer 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. Several of the top advances featured in this report (approximately 20%) were made possible by funding from Conquer Cancer or were led by past grantees who have continued their careers in oncology research.