HOLLYWOOD, FloridaThe decline in total cancer mortality in the United States that began in 2003 looks set to continue and even accelerate as more research moves "from bench to bedside"unless the basic and translational science feeding that change is strangled by budget cuts and red tape, according to experts at the 11th Annual Conference of the National Comprehensive Cancer Network (NCCN). The panel on "Cancer Care in the 21st Century" identified promising areas of research, pointed out major barriers to advancing that research, and suggested changes that might overcome some of those problems.
The panel had considerable star power. It was moderated by veteran ABC newsman (and melanoma survivor) Sam Donaldson, and included former Senator Connie Mack (R-Fla), as well as oncology leaders from Johns Hopkins, Dana-Farber, Roswell Park, Memorial Sloan-Kettering, M.D. Anderson, the National Cancer Institute (NCI), University of California, San Francisco (UCSF), and Fox Chase Cancer Center.
Robert C. Young, MD, president, Fox Chase Cancer Center, put the discussion in context by pointing out that the age-adjusted cancer mortality rate rose steadily from 1900 to 1990, but then began to fall. "Every year since 1990, the cancer mortality rate has gone down," Dr. Young said. "Naysayers said, due to the larger population of older patients, that mortality would just go up and never go down. But in 2003 it began to go down. The issue is, how do we accelerate the pace."
The panel attributed this change to cancer prevention (especially the decrease in smoking) and to improvements in many aspects of cancer treatment. They also predicted an accelerating pay-off from recent research. "In the next 10 to 20 years, I expect startling improvements in cancer survival," said Martin D. Abeloff, MD, director, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University. Three areas expected to contribute to this are targeted therapy, the fusion of imaging with treatment, and exploitation of the recent discovery of cancer "stem" cells.
John Mendelsohn, MD, president, University of Texas M.D. Anderson Cancer Center, said, "For cancer, the dream scenario is that we would biopsy a tumor, identify the abnormal genes, and either fix the defective gene or replace it or block the gene product. I expect that in another 20 or 30 years we will have a huge medicine chest with 500 possible therapies for cancer, from which we would put together a cocktail. None of this would be possible without the fabulous technologies that have come about because of the Human Genome Project and other basic science."
Margaret A. Tempero, MD, deputy director, UCSF Comprehensive Cancer Center, also predicted that targeted approaches will soon shape all phases of cancer diagnosis and treatment. She noted that recent discoveries on how the cancer cell collaborates with its microenvironment have opened up a whole new range of possible therapeutic targets.
David C. Hohn, MD, president, Roswell Park Cancer Institute, Buffalo, said, "I think we're going to see a fusion of imaging with treatment." He pointed to work with nanoparticles that home to the tumor, are visible with high-resolution scanning, and carry a therapeutic agent. Dr. Hohn said that the National Institutes of Health have made research on this approach a priority.