Elsevier

The Lancet Oncology

Volume 18, Issue 11, November 2017, Pages e653-e706
The Lancet Oncology

The Lancet Oncology Commission
Future cancer research priorities in the USA: a Lancet Oncology Commission

https://doi.org/10.1016/S1470-2045(17)30698-8Get rights and content

Summary

We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.

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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