CancerNetwork® reviews the biggest news on initiatives and advancements in cancer care on World Cancer Day.
February 4 is an international tribute day for building awareness around issues related to cancer care, such as its prevention, detection, and management. This year, CancerNetwork® looked at the greatest initiatives to combat this disease and achievements by stakeholders in the field.
Cancer Mortality Is on the Decline
According to statistics reported in the American Cancer Society’s “Cancer Statistics, 2021” report, overall death rates from cancer have been in a continuous decline which includes a 2.4% decrease from 2017 to 2018.1
Advances in the treatment of lung cancer—which is the leading cause of cancer deaths, accounting for more than breast, prostate, and colorectal cancers combined—are reflected in better outcomes from therapy in non–small cell lung cancer, with death rates reducing by 5% annually from 2014 to 2018. For the same time period, mortality in colorectal cancer decreased by 2% per year, 1% per year in breast, and stayed static in prostate cancer. Conversely, mortality in diseases such as hepatocellular carcinoma and pancreatic, head and neck, and thyroid cancers have increased slightly over the most recent years examined.
Notable among the data were statistics regarding health inequity, with 5-year survival rates varying between White and Black patients, at 68% versus 63%, respectively. In fact, survival rates for all cancers are lower in Black versus White patients, with the exception of pancreatic cancer.
“While recent advances in treatment for lung cancer and several other cancers are reason to celebrate, it is concerning to see the persistent racial, socioeconomic, and geographic disparities for highly preventable cancers,” William G. Cance, MD, chief medical and scientific officer of the American Cancer Society, said in a press release.2 “There is a continued need for increased investment in equitable cancer control interventions and clinical research to create more advanced treatment options to help accelerate progress in the fight against cancer.”
The disparity in mortality between Black and White patients declined from a peak of 33% (279 vs 211 per 100,000 patients, respectively) in 1993 to 13% (174 vs 154 per 100,000 patients) in 2018. Additionally, geographical disparities were most pronounced in preventable cancers, such as lung and cervical, where incidence and mortality rates may vary by up to 5-fold.
Cancer Community Continues to Grapple With COVID-19
As a result of the coronavirus disease 2019 (COVID-19) stay-at-home orders that spanned from the early to middle parts of 2020 had a significant impact on cancer screenings and diagnoses as well as clinical trial participation, with new data emerging to indicate its gravity.
A study published in JAMA Oncology looked at data from the New England region of the United States by pre-, peak, and post-pandemic time periods and showed a pronounced decrease in screenings (up to 82%) and diagnoses resulting from screening (up to 78%) when peak and non-peak periods were compared. Using pre-pandemic data as a comparator, the investigators estimated that close to 1500 cases of cancer and precancerous lesions had gone undiagnosed during this period.3
In addition to these effects, the industry saw clinical trials delayed or halted and enrollment plummet during the first half of the year. In response, the “American Society of Clinical Oncology Road to Recovery Report: Learning from the COVID-19 Experience to Improve Clinical Research and Cancer Care” proposed strategies to improve clinical research and cancer care that would permanently enable more efficient and equitable access to trial participation.4
“When the pandemic is over, patients deserve more than a return to the way things were before COVID-19. We have an opportunity to provide better care to everyone with cancer drawing from the insights we’ve gained during the pandemic,” Lori J. Pierce, MD, FASTRO, FASCO, American Society for Clinical Oncology (ASCO) president, said in a statement. “Cancer care is marked by the same inequities as our society at large. To emerge from the pandemic stronger, we have to make sure every patient can benefit from advances in cancer research and care.”
The organization calls on specific bodies as well as a combination of stakeholders to improve in 2 key areas: cancer research and cancer care delivery. Strategies focus on streamlining processes, increasing flexibility, and improving access through virtual approaches; these reflect tactics adopted during the pandemic.
World Health Organization’s Global Cervical Cancer Initiative
On November 17, 2020, the World Health Organization (WHO) answered a Call to Action from director-general Tedros Adhanom Ghebreyesus, PhD, MSc, to end suffering from preventable and curable cancers by announcing the launch of its Global Strategy to Accelerate the Elimination of Cervical Cancer.5
“The huge burden of mortality related to cervical cancer is a consequence of decades of neglect by the global health community. However, the script can be rewritten,” WHO assistant director-general Princess Nothemba (Nono) Simelela, said in a statement. “Critical developments include the availability of prophylactic vaccines; low-cost approaches to screening and treating cervical cancer precursors; and novel approaches to surgical training. Through a shared global commitment to the Sustainable Development Goals6 and leaving no-one behind, the countries of the world are forging a new path to ending cervical cancer.”
This was a historic milestone as it marked the first time 194 countries came together for the common goal of eliminating a cancer. Goals of the initiative include a 90% global administration rate of human papillomavirus vaccinations; 70% screening coverage; and access to treatment for cervical precancer and cancer, including palliative care, in 90% of women.
Following the “90-70-90” targets in low- and middle-income countries, mathematical models illustrate the possibility for cervical cancer rates to fall by 42% in 2045 and 97% by 2120, which would avoid over 74 million new cervical cancer cases.7
CAR T-Cell Therapies Move to New Heights
Several new chimeric antigen receptor (CAR) T-cell therapies are expected to gain FDA approval in the first half of 2021, while early phase research into allogeneic products continues to show promise.
For large B-cell lymphomas, a biologics license application (BLA) for the CD19-directed therapy lisocabtagene maraleucel (liso-cel) is currently being considered by the FDA for treatment of patients who have undergone 2 or more prior therapies after receiving priority review status in February 2020. Due to several delays, in part due to travel restrictions of the coronavirus disease 2019 (COVID-19) pandemic, the target action date for the approval has been delayed and the drug’s developer, Bristol Myers Squibb, continues to work closely with the FDA to facilitate the application’s forward momentum.
Another CAR T-cell therapy, idecabtagene vicleucel (ide-cel; bb2121), is a B-cell maturation antigen (BCMA)–targeting therapy for the treatment of patients with heavily pretreated multiple myeloma. The BLA submitted by the drug’s developer, Bristol Myers Squibb, is indicated for the treatment of patients who have received at least 3 prior therapies—including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody—and was also granted priority review in 2020. The target action date for a decision on this application is March 27, 2021.
Moreover, data for allogeneic, sometimes referred to as “off-the-shelf”, CAR T-cell therapies continue to develop in the hematologic cancers pipeline. In a presentation at the 2020 American Society of Hematology Annual Meeting and Exposition, the CD22-directed allogeneic T-cell product, UCART22, showed signs of activity in patients with relapsed/refractory CD22-positive B-cell acute lymphoblastic leukemia in the phase 1 BALLI-01 (NCT04150497) trial. At the same meeting, results from the ongoing phase 1 UNIVERSAL study (NCT04093596) demonstrated that the off-the-shelf product ALLO-715 elicited responses in heavily pretreated patients with relapsed/refractory multiple myeloma.
Other notable therapies include TruUCAR GC027 in relapsed or refractory T-cell acute lymphoblastic leukemia and PBCAR269A, which was granted fast track designation in 2020 for the treatment of relapsed/refractory multiple myeloma.8
ASCO Names Molecular Profiling for Gastrointestinal Cancers as “Advance of the Year”
Due to a number of advancements in the treatment of gastrointestinal cancers, ASCO recognized “Molecular Profiling Driving Progress in Gastrointestinal Cancers as the Advance of the Year in Clinical Cancer Advances 2021”.9
“Molecular profiling tools, such as next-generation sequencing, give us the ability to identify specific molecular and genomic-targeted treatments that are likely to benefit an individual patient. Personalized medicine is becoming a reality,” ASCO Board Chairman Howard A. "Skip" Burris, III, MD, FACP, FASCO, said in a statement.
Examples of recent advancements that support this decision include data in HER2-overexpressing gastric or gastroesophageal junction (GEJ) adenocarcinoma from the phase 2 DESTINY-Gastric01 trial (NCT03329690), results of which supported the FDA approval of fam-trastuzumab deruxtecan-nxki (Enhertu) in this indication; and data surrounding BRAF gene mutations in colorectal cancer, such as recently released results from the SWOG S1406 trial (NCT02164916).
1. Cancer facts & figures, 2021. American Cancer Society. 2021. Accessed February 2, 2021. https://bit.ly/2MiefTd
2. Record drop in cancer mortality for second straight year due to improved lung cancer treatment; COVID-19 impact still unknown. News release. American Cancer Society. January 12, 2021. Accessed February 2, 2021. https://bit.ly/3thvdBz
3. Bakouny Z, Paciotti M, Schmidt AL, Lipsitz SR, Choueiri TK, Trinh QD. Cancer screening tests and cancer diagnoses during the COVID-19 pandemic. JAMA Oncol. Published January 14, 2021. doi: 10.1001/jamaoncol.2020.7600
4. ASCO issues comprehensive recommendations to strengthen cancer care and research during and beyond the COVID-19 pandemic. News release. American Society of Clinical Oncology. December 8, 2020. Accessed February 2, 2021. https://bit.ly/3rg61ty
5. A cervical cancer-free future: First-ever global commitment to eliminate a cancer. News release. World Health Organization. November 17, 2020. Accessed February 2, 2021. https://bit.ly/3rjuyxV
6. Sustainable development goals. United Nations Fund. Accessed February 2, 2021. https://bit.ly/3czrXLW
7. Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization. November 17, 2020. Accessed February 2, 2021. https://bit.ly/36xz5ow
8. Precision BioSciences receives fast track designation from U.S. Food and Drug Administration for PBCAR269A, an investigational allogeneic CAR T therapy for relapsed/refractory multiple myeloma. News release. Precision BioSciences, Inc. September 9, 2021. Accessed February 2, 2021. https://bit.ly/2MIlKT8
9. ASCO Names Advance of the Year: Molecular Profiling Drives Progress in Gastrointestinal Cancers. News release. February 2, 2021. Accessed February 2, 2021. https://bit.ly/2Mv6JEv