Lancet Oncology recently released its Commission on Future Research Priorities in the USA, which sets out 13 key priority areas to help focus the $2 billion of funding released to the National Cancer Institute as part of the 21st Century Cures Act.
The 21st Century Cures Act was designed to accelerate the discovery, development, and delivery of medical products, innovations, and advances. The law authorized $1.8 billion over 7 years to fund the Beau Biden Cancer Moonshot. As part of that initiative, a Blue Ribbon Panel report from 2016 described 10 transformative research recommendations for achieving the Moonshot’s goal of making a decade’s worth of progress in cancer prevention, diagnosis, and treatment in just 5 years.
However, in order to deliver on this promise, a fundamental shift in how cancer research is conducted and how cancer care is delivered in the United States will be required, according to the Commission.
The Commission on Future Research Priorities in the USA sets out a detailed road map to deliver on the Blue Ribbon Panel recommendations, including a focus on prevention; a new model for drug discovery and development; a vast expansion of patient access to clinical trials; and an emphasis on targeted interventions to improve cancer care for underserved groups, specifically children, cancer survivors, and minority groups. It also emphasizes the importance of addressing health disparities in all recommendations.
Technological advances are highlighted, including understanding and mapping pre-cancer biology and the rapid adoption of big data, as well as new collaborations across industry, patient, academia, government, and clinical practice groups that will be critical to advancing research and ultimately improving patient care.
The importance of cancer prevention is also emphasized, including the development of a premalignant cancer atlas to identify small changes in healthy tissue at the earliest stages of cancer development, opening up new opportunities for precision-based cancer prevention. The need to move towards targeted screening will also be important.
Data sharing and patient-centered priorities will be critical to advancing research and improving care. The Commission strongly supports developing data systems that allow patients to input their own personal data for use by the cancer community and, in return, provide outputs to patients that allow them to identify the most scientifically sound clinical trials for which they might be eligible. The ultimate goal is to align research and care in a seamless continuum, so that all patients have access to clinical trials as part of standard care and their clinical course and experience informs future research.
An unprecedented number of therapies have been approved for marketing by the US Food and Drug Administration in the past 2 to 3 years, but this continues at immense costs, with hundreds of drugs failing in clinical trials. Bringing a single new therapy to the market is estimated to cost $2.6 billion. Among the Commission’s goals is an overhaul of the drug discovery process so that projects can be discontinued earlier in the clinical development phase, as well as a change in how academia, industry, and clinical groups collaborate so as to vastly improve efficiencies.
Patients with cancers that were once lethal are now living longer with a chronic condition, meaning that guidelines must be developed to address the long-term healthcare needs of patients undergoing therapy and of survivors.
Finally, patient outcomes are greatly affected by racial, cultural, and socioeconomic backgrounds, and there is a need both to better understand the context of care and to ensure equitable access to care that is financially sustainable for the individual and society.
Clifford Hudis, MD, CEO of the American Society of Clinical Oncology and former chief of breast medicine at Memorial Sloan Kettering Cancer Center in New York, who co-authored this report, said, “Although clinical research has been challenged by reduced support as well as regulatory and administrative burdens, we have recently seen truly remarkable progress across a range of malignancies. The blueprint laid out by the Blue Ribbon Panel and this Commission should help us prioritize our efforts to accelerate meaningful clinical advances in the next 4 to 5 years. The provisions provide an opportunity for cancer investigators, federal agencies, universities and research institutes, and private philanthropic supporters worldwide to direct their investments and help the global community meet the ambitious goal of delivering 10 years’ progress in half that time. The time for action is now.”