The Lancet Oncology CommissionFuture cancer research priorities in the USA: a Lancet Oncology Commission
Section snippets
Part 1: Introduction
In a US State of the Union address in 2016, President Barack Obama called on US Vice President Joe Biden to lead a new, national Cancer Moonshot to accelerate efforts to prevent, diagnose, and treat cancer—to achieve a decade of progress in just 5 years. The resulting Cancer Moonshot Task Force brought together all relevant federal agencies and fostered more than 70 private sector collaborations to focus on transforming cancer research and care. The Blue Ribbon Panel (BRP) was established as
Part 2: Prevention
Only half of patients who develop cancer can be cured with existing therapies; the other half will die of their disease. Therapeutic interventions have improved, converting some previously fatal cancers to ones that can be treated like chronic diseases. However, even under these circumstances, patients will suffer chronic morbidities that limit their quality of life. For this reason, the BRP identified the development of cancer prevention approaches as a scientific priority. Available
Part 3: Early cancer detection, population sciences, and public health
Epithelial cancers develop over a long period of time, with a natural history that can extend for several decades, offering recurring opportunities to detect early preinvasive changes to fully developed disease (eg, cervical, colorectal, breast, prostate, and aerodigestive cancers). This wide window of opportunity is key for the targeted deployment of multiple strategies (existing and emergent) for cancer prevention and early detection, in the clinic and at the population level.71 Existing
Part 4: Drug discovery, development, and delivery
The challenge of developing breakthrough therapies in cancer lies in its genetic, biological, and clinical heterogeneity. It stands to reason that successful drug development would emerge from an intense focus on patient needs and coordinated integration of academic researchers, pharmaceutical drug developers, and clinical disease experts. However, drug approvals are expensive and have a high risk of failure. Several factors within the traditional drug discovery process contribute to this
Part 5: Genomic and immune analysis of tumour cells and the tumour microenvironment
As the USA takes on the three aims of improving cancer care, improving cancer outcomes, and making better investments in cancer care, at least one target is hidden in plain sight—ensuring that technology developed in the past decades is used to characterise c ancer cells and their associated normal cells at the molecular level, and that use of these technologies leads to new knowledge and to the precise identification of matching targeted or immunotherapies. The use of modern technologies to
Part 6: Expediting access to cancer drugs for research and patient access to clinical trials
An essential step toward reducing the burden of cancer is to increase the availability of anticancer drugs for research and expand patient access to clinical trials. Everything that is known about chemoprevention and medical treatment of cancer today is because of a strong drug discovery ecosystem and the commitment of previous generations of patients, families, researchers, and doctors to maintain a high quality in clinical trials. Opportunities also certainly exist to greatly accelerate
Part 7: Applying advanced technologies to catalyse cancer breakthroughs
Cancer is a complex disease with phenotypic and functional heterogeneity that demands an interdisciplinary approach to accelerate progress in prevention, detection, and therapeutics.111 With a growing appreciation of the cancer's molecular landscape and the associated complexities, the research community has broadened collaborations across scientific disciplines to understand the varied biological signatures of these diseases and engineer options that can help improve the lives of patients.112
Part 8: Cancer immunotherapy, combination therapy, and precision oncology
Advances in biology and technological developments have revolutionised immunotherapy. In the past few years, a number of immunotherapies have been developed to block inhibitory signals in cancers and activate T-cell-mediated anticancer responses, with FDA approvals for the treatment of a number of deadly cancers.130 Importantly, these responses are often durable with minimal toxicities, providing improved quality of life for patients with previously terminal diagnoses. In this section, we
Part 9: Paediatric oncology
The steady improvement in survival of children and adolescents with cancer over the past 50 years is one of the major victories of modern medicine. Although certain childhood malignancies have seen little or no progress, and redoubled effort is certainly necessary for these diseases, more than 80% of children diagnosed with cancer in high-income countries can now expect long-term cure.139 This extraordinary success has resulted in an ever-expanding population of paediatric cancer survivors,
Part 10: Supportive care
The goals of Cancer Moonshot are to dramatically accelerate efforts to end cancer as we know it. About 15·5 million (5%) of the American population are cancer survivors, and this population is expected to grow to 26·1 million survivors by 2040.178 As part of the Cancer Moonshot initiative, it is therefore important to focus on the care that is needed to return people to their fullest possible functioning in society after a cancer diagnosis. Supportive care, including survivorship, palliative,
Part 11: Radiation oncology
Tremendous technological progress has been made in radiation oncology in the past three decades, with the advent of software and hardware inventions that integrate three-dimensional tumour imaging with highly accurate treatment delivery methods. Consequently, patients treated for common malignancies have better tumour control and fewer side-effects than ever before. In many instances, such as selected head and neck, lung, bladder, uterine cervix, and prostate cancers, radiotherapy—sometimes
Part 12: Nuclear medicine and imaging
Precision oncology relies on highly specific targeting of cancer or other key cells in the tumour microenvironment and identifying malignant lesions to help select a treatment that will be effective. In-vitro diagnostics, imaging, and radionuclide therapy have important roles in tailoring treatment to an individual's unique biology, making therapy more effective and reducing costs.
The combination of imaging and therapeutics can deliver cancer-targeting and pharmacokinetic information that can
Part 13: Surgical oncology
Despite tremendous advances in cancer genomics, transcriptomics, proteomics, metabolomics, and other omics; the advent of rational drug design based on structural biology and specific molecular targets; the renaissance of immunotherapy for cancer; the emergence of advanced imaging, nanotechnology, bioinformatics, large data networks, cancer epidemiology, and biostatistics; and the improvements in conventional systemic therapy and radiation therapy; complete surgical resection of solid tumours
Part 14: Big data and enhanced data-sharing
Big data is redefining the science and management of cancer, with an unprecedented variety, volume, and speed of acquisition.349, 350 This new, data-rich reality, deriving in large measure from the convergence of advanced technologies such as next-generation sequencing, nanotechnology, and imaging with the molecular and clinical sciences, portends a future of precision medicine in which patients receive molecularly targeted therapies and individualised disease management.351, 352 However, the
Part 15: Health disparities, health-system reform, oncopolicy, and regulation
Advances in cancer care must be matched by provision of high-quality care to patients in need. In the USA, and worldwide, costs of cancer care are high and increasing, and this threatens access to care and the potential for all patients to achieve the best possible outcome. Research is needed to better understand the current status of cancer care delivery, the impact of costs of care, and the disparities in access and outcome. Innovations both in the clinic and in policy could improve access to
Part 16: Summary and call for action
The cancer research community has embraced the extraordinary opportunity afforded by Former US Vice President Joe Biden when he initiated the Cancer Moonshot. Few foresaw the remarkable energy, creativity, and scientific dialogue and redirection that emerged between February and October, 2016, with the publication of the BRP report. This Commission delves further into the topics and outlines, with decisiveness, key priorities to achieve the Cancer Moonshot goal of achieving a decade of progress
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