Feb 04, 2020
In the release of its annual report on progress against cancer, Clinical Cancer Advances 2020, ASCO recognized progress in the refinement of the surgical treatment of cancer as the Advance of the Year. In particular, the emergence of novel systemic therapies—combined in new and better ways—has significantly changed the role of cancer surgery. The report catalogs a year’s worth of remarkable research advancements, reinforces the need for sustained federal research funding, and details other major trends in oncology.
“It is fair to say that cancer treatment began with surgery, with accounts dating back to ancient times. In recent years, other treatment approaches have emerged, with the role of surgery in cancer care continuing to evolve,” said 2019-2020 ASCO president Howard A. “Skip” Burris III, MD, FACP, FASCO. “ASCO’s 2020 Advance of the Year recognizes the way systemic cancer therapies have improved the effectiveness of surgery, lessened the extent of surgery needed for many patients, and even eliminated the role of surgery altogether for some patients.”
The Clinical Cancer Advances report not only reviews the prior year’s progress, but also looks forward, highlighting areas where progress is most promising. ASCO also issued a list of research priorities for the cancer community, designed to address vital unmet needs in cancer care.
Advance of the Year: Refinement of the Surgical Treatment of Cancer
While considerable progress in the development of novel systemic therapies has been made over the years, the impact of these advances on surgical treatment of cancer has been seen only recently. The increasing effectiveness of systemic treatments has led to reductions in the amount of surgery required for some patients, and even the need for it in others. At the same time, these advances have also increased the number of patients who can undergo surgery when needed.
“Advances in systemic therapies have helped refine our approach to surgery in patients with cancer, even changing who needs to undergo surgery,” said ASCO immediate past president and chair of the Board Monica M. Bertagnolli, MD, FACS, FASCO, who is also a co-executive editor of Clinical Cancer Advances 2020. “Neoadjuvant therapies—those given before surgery—can, in some cases, dramatically reduce the amount of surgery a patient needs. Not only can these approaches lead to longer survival, they can mean shorter recovery for patients, and ultimately better quality of life.”
Advances in systemic therapies for melanoma, as well as kidney and pancreatic cancers, have helped reshape the role of surgical treatment, making them some of this year’s most impressive research successes.
- Melanoma: Two featured studies examined the efficacy and safety of pre-surgery combination immunotherapy treatments. These studies are already changing practice, helping patients with locally advanced melanoma avoid surgery in many cases.
- Kidney cancer: Surgical resection has traditionally been the primary treatment of many solid tumor cancers, including renal cell carcinoma. Results from two randomized controlled trials provided evidence for targeted therapy-based approaches that might reduce the role of upfront surgery for some patients with metastatic renal cell carcinoma.
- Pancreatic cancer: While surgical resection offers the best chance of survival for patients with pancreatic cancer, many either have tumors that are difficult to surgically remove entirely or cannot be removed at all. Two preliminary studies featured in the 2020 report suggest that more patients with pancreatic cancer may be eligible for surgery following upfront systemic treatment.
Prevention, Molecular Diagnostics, and Treatment
This year’s report also includes important research on cancer prevention, molecular diagnostics, and treatment. In the realm of prevention, long-term data showed that vaccines against human papillomavirus are reducing cervical cancer risk in real-world settings.
Some mutations, which can be identified through genetic/molecular testing, can serve as biomarkers for cancer. One study suggested that biomarkers, such as germ-cell BRCA testing, can also inform which therapies may be most effective. In another important study, a genomic biomarker was used to accurately predict clinical stage, tumor size, and response to treatment of testicular germ-cell tumors. The results of this study mark a significant advance in the use of molecular biomarkers as effective tools for diagnosis and disease management.
Advances in treatment approaches included successes with combination therapies, suggesting that survival can be extended without increasing toxicity for patients with certain types of cancer. Research also continued to demonstrate the efficacy of targeted therapies for more patients with difficult-to-treat cancers.
“The past year has seen tremendous progress in cancer treatment, including surgery, radiotherapy, combination therapies, immunotherapies, and others” said Merry-Jennifer Markham, MD, FACP, co-executive editor of Clinical Cancer Advances 2020. “Not only did we see important results in major cancers, such as breast and lung cancers, but we also saw promising results for difficult-to-treat cancers, such as glioblastoma and bladder cancer.”
Research Priorities to Accelerate Progress Against Cancer
In 2019, ASCO debuted its list of “Research Priorities to Accelerate Progress Against Cancer,” which was developed to spark momentum in overlooked areas of research, and to provide the cancer community with direction to focus their investments and resources. The priorities are intended to identify areas on which future research efforts should be focused to help accelerate progress against cancer. Listed in no particular order, ASCO’s Research Priorities for 2020 are:
- Identify strategies that better predict response and resistance to immunotherapies.
- Limit extent of surgery by optimizing systemic therapy.
- Increase precision medicine research and treatment approaches in pediatric and other rare cancers.
- Optimize care for older adults with cancer.
- Increase equitable access to cancer clinical trials.
- Reduce adverse consequences of cancer treatment.
- Reduce obesity and its impact on cancer incidence and outcomes.
- Better identify premalignant lesions and predict when treatment is needed.
“What we know about cancer—from prevention to treatment to survivorship—is rapidly changing. Our vision for finding the next generation of cancer cures and reducing cancer’s impact on patients’ lives must evolve as well,” said ASCO chief medical officer and executive vice president Richard L. Schilsky, MD, FACP, FSCT, FASCO, co-executive editor of the report. “These priorities are intended to keep clinicians, patients, and other stakeholders abreast of the areas where progress is most promising and opportunity is greatest.”
Importance of Federal Funding
For 15 years, ASCO’s Clinical Cancer Advances report has highlighted the year’s most important cancer advances, many of which were driven by federal research investments. This year, nearly one-third of the advances featured in the report received funding from the National Institutes of Health and other federal agencies.
“Despite progress in cancer prevention, diagnosis, and treatment, U.S. cancer cases are set to rise by roughly a third over the next decade. Research that saves lives is still urgently needed,” Dr. Bertagnolli said. “Many of the advances highlighted in this report would not be possible without federal funding. Federal investment supports vital research—like research into prevention and screening, comparative effectiveness, and rare cancers—that others are unable to take on. This continued support is critical to continuing progress.”
According a 2018 ASCO survey, 67% of Americans say the U.S. government should spend more money on finding treatments and cures for cancer, even if it means higher taxes or adding to the deficit.