Feb 02, 2021
In the release of its annual report on progress against cancer, Clinical Cancer Advances 2021, ASCO recognized the treatment advances made possible by molecular testing for patients with gastrointestinal (GI) cancers as the Advance of the Year. The report catalogs a year’s worth of remarkable research advances, reinforces the need for sustained federal research funding, and details other major issues in oncology.
“While there have been significant advances in the treatment of many types of cancer, the development of more effective therapies for GI cancers has lagged. However, the growing use of molecular profiling has helped change the outlook for patients with these cancers by identifying the molecular and genetic signatures that allow oncologists to deliver treatments that are highly specific to a tumor,” said 2020-2021 ASCO president Lori J. Pierce, MD, FASTRO, FASCO.
The Clinical Cancer Advances report not only reviews the prior year’s progress, but also recognizes important issues and conversations in cancer research and highlights areas where progress is most promising. This year’s report includes a discussion of health equity in clinical cancer research, offering potential solutions. Annual Research Priorities to Accelerate Progress Against Cancer for the cancer community are included, and intended to address vital unmet needs in cancer care. This year a priority around the role of artificial intelligence (AI) in oncology was added to the list.
Advance of the Year: Molecular Profiling Drives Progress in GI Cancers
Surgery, radiotherapy, and chemotherapy have been the mainstay of treatment for GI cancer but have limited effect and can take a heavy toll on quality of life. Molecular profiling allows clinicians to identify the molecular and genetic signatures that help to deliver treatments that are highly specific to a tumor.
“Molecular profiling tools like 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,” said chair of the ASCO Board Howard A. "Skip" Burris III, MD, FACP, FASCO.
GI cancers account for 26% of the global cancer incidence and 35% of all cancer-related deaths.1 The ability to molecularly profile a GI tumor has expanded the treatment options for individual patients with GI cancers, extending survival while minimizing adverse effects. Specific genomic mutations, amplifications, or fusions, epigenetic profile, protein expression, or other molecular features allow oncologists to choose targeted therapies matched to the molecular profile of the tumor.
In the past year, research has shown that targeting HER2 improves survival in gastric cancer and shows promise for patients with HER2-positive colorectal cancer. Treatment has also been approved by the U.S. Food and Drug Administration that targets a specific mutation in the BRAF gene (V600E) in metastatic colorectal cancer.
The report includes pivotal research on a range of therapies, including immunotherapies, targeted therapies, combination therapies, surgery, and radiation therapy, for breast, lung, prostate, hepatocellular carcinoma, and blood cancers, among others. In many cases, these advances have resulted in newly approved therapies. Other research provided evidence for new approaches to minimize side effects like anemia, delay progression of brain metastases, and genetically engineer T cells to directly target cancer cells.
“Progress in cancer treatments over the past year provide improved therapy for cancers like breast and lung,” said Sonali M. Smith, MD, editor in chief of Clinical Cancer Advances 2021. “We also saw new treatment options for patients with difficult-to-treat cancers, such as bladder and nasopharyngeal cancers.”
Explore ASCO’s Cancer Progress Timeline for a historical overview of major milestones in cancer research that have led to dramatic improvements in patients’ survival and quality of life. The timeline chronicles more than 400 treatment and prevention advances spanning over 170 years—many of which were made possible by federal investment in cancer research.
Achieving Equity in Cancer Research
The report includes an examination of health inequities in cancer care and clinical research. National and global events of the past year have raised the profile of health inequities as one of the greatest challenges currently facing medicine. Disparities in cancer outcomes are rooted, in some respects, in the development of novel diagnostics and therapeutics—the clinical research that demonstrates the efficacy and safety of new cancer treatments.
“As clinicians, we are committed to providing evidenced-based, high-quality cancer care to every patient, every day, everywhere,” said Dr. Pierce. “But, if clinical trials don’t represent the individuals we treat, including those from racial, ethnic, and other minority populations, the state of science suffers, and patients with life-threatening conditions may not receive the best—perhaps only—treatment option for their condition.” Cancer care equity has been a theme during Dr. Pierce’s tenure as president.
The underrepresentation of minority groups in cancer research contributes to disparities in cancer care and outcomes by failing to provide the evidence that clinicians need to safely treat patients with cancer from minority populations. The report outlines strategies and actions that can be used to lower the barriers to clinical trial participation and thereby increase the pool of participants. These include expanding eligibility criteria; simplifying trial design and improving availability; focusing on patient education, recruitment, and support; providing patient navigation; employing novel consent strategies; and offering financial assistance.
Research Priorities to Accelerate Progress Against Cancer
Clinical Cancer Advances features an annual list of Research Priorities to Accelerate Progress Against Cancer. These priorities are intended to spark new momentum in overlooked areas of research and to provide the cancer community with direction to focus their investments and resources.
This year ASCO added AI and deep learning in cancer research to the list. AI has the potential to drive diagnostic, therapeutic, and translational cancer research, making it critical to educate oncologists about the fundamentals, advantages, and potential pitfalls of AI and deep learning techniques. In particular, focus should be given to cancer diagnosis based on biospecimen analysis; the utility of AI to enhance and improve radiographic imaging, analysis, and reporting; and integrating large amounts of clinical data to aid clinical decision-making and measurement of clinical outcomes.
In addition to this new priority, eight priorities were updated for 2021. The full list of priorities, in no particular order, are:
- Develop and integrate artificial intelligence and deep learning in cancer research
- Identify strategies that predict response and resistance to immunotherapies
- Optimize multimodality treatment for solid tumors
- 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’s impact on cancer incidence and outcomes
- Better identify potentially malignant lesions and predict when treatment is needed
“While clinical research has resulted in longer survival and better quality of life for many patients with cancer, we can’t rest on our laurels. With ASCO’s Research Priorities to Accelerate Progress Against Cancer, we continually evaluate and highlight critical gaps in cancer prevention and care that we believe to be most pressing and where opportunities for rapid progress are greatest. These priorities are intended to guide the direction of research and accelerate progress,” said Dr. Burris.
Importance of Federal Funding
Many major medical breakthroughs in cancer started with the U.S. National Institutes of Health (NIH) and the U.S. National Cancer Institute (NCI). This year marks the 50th anniversary of the December 1971 signing of the National Cancer Act, which led to the establishment of the National Cancer Program and significantly expanded the authorities and responsibilities of NCI.
Through the research, training, and infrastructure programs of NCI, cancer care and research expanded from a few pioneering research institutions to cancer centers, community hospitals, and oncology practices across the United States.
Federal research investments have driven many of the most important cancer prevention and treatment advances of the last half-century. Research funded by the U.S. government also generates billions of dollars in new economic activity and supports hundreds of thousands of jobs. According to ASCO’s 2018 National Cancer Opinion 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.
Over the past few years, Congress has demonstrated tremendous bipartisan leadership by passing annual consecutive budget increases for the NIH. In Fiscal Year 2020, Congress provided a $2.6 billion funding increase for the NIH. ASCO is continuing to encourage Congress to build on its investment in cancer research to maintain the pace of scientific discovery and continue progress against cancer.
“Substantial progress has been made in cancer prevention, diagnosis, and treatment just over the last two decades. However, U.S. cancer cases are predicted to rise by roughly a third over the next decade. Investment in cancer research saves lives,” said ASCO chief medical officer and executive vice president Richard L. Schilsky, MD, FACP, FSCT, FASCO. “Critical research relies in part on support at the federal level. This continued support is crucial to continuing progress.”
- Arnold M, Abnet CC, Neale RE, et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020;159:335-349.e15.