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Commission issues roadmap to deliver cancer moonshot initiatives

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November 1, 2017

Clifford A. Hudis
Elizabeth Marion Jaffee

Nearly 2 years after former Vice President Joe Biden unveiled the cancer moonshot initiative, The Lancet Oncology Commission has detailed a roadmap to deliver on the recommendations of the moonshot’s blue ribbon panel.

“The underlying goal of this entire effort is to accelerate existing progress so that we deliver in 5 years what would have historically taken 10,” Clifford A. Hudis, MD, FACP, chief executive officer of ASCO and former chief of breast medicine at Memorial Sloan Kettering Cancer Center, said in a press briefing.

“It is not really about money, although money is important,” Hudis added. “It’s about getting groups of investigators, advocates, patient groups, the general public and our vast infrastructure to avoid redundancy, increase coordination and drive more efficient results.”

The commission launched today at an event on Capitol Hill in Washington, D.C., and will be presented on Friday, Nov. 3 at the United Nations Association of New York Humanitarian Awards, where Biden will be honored for his work on improving cancer outcomes.

In December 2016, Congress overwhelmingly passed the 21st Century Cures Act, which, through NCI, dedicated $1.8 billion for cancer research over 7 years.

The Lancet Oncology Commission report takes these initiatives and provides a detailed roadmap 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 intervention to improve cancer care for underserved groups, specifically children, cancer survivors and minority groups,” Elizabeth Marion Jaffee, MD, professor of oncology, deputy director of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine, and president-elect of the American Association for Cancer Research, said during the press briefing.

The report also emphasizes the importance of addressing health disparities for underserved populations — specifically children, adolescents and minority groups — in all recommendations.

“Pediatric oncology has its own very special needs, given that the cancers in children are quite different biologically, requiring new models,” Chi Van Dang, MD, PhD, professor and scientific director at The Wistar Institute and Ludwig Institute for Cancer Research, told HemOnc Today.

Chi Van Dang
Scott M. Lippman

The report, authored by more than 50 cancer experts from across the United States, highlights how technological advances, including understanding and mapping precancer biology and the rapid adoption of big data, as well as new collaborations across industry, patient groups, academia, government and clinical practice will be critical to advancing research and improving patient care.

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Sophisticated geographic information systems can now identify population clusters at higher risk for cancer, allowing for more concentrated prevention and treatment efforts in those areas, according to Scott M. Lippman, MD, professor of medicine and director of University of California, San Diego, Moores Cancer Center, and one of the report’s authors.

“Overcoming language barriers is a health disparity,” Lippman said. “If you’re targeting an area that has a high risk [for] colorectal cancer in a largely Hispanic population, promoting colorectal screening doesn’t work if people don’t understand.”

Obesity also is associated with cancer risk. More walkable cities have a lower incidence of cancer than cities designed to move large volumes of traffic, Lippman said.

“It was estimated that designing cities differently can save 2 million lives annually,” he added.

The new recommendations include 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.

“There is more focus on prevention, which extends way beyond what the blue ribbon panel report had,” Van Dang told HemOnc Today. “I think some of those recommendations are worth paying attention to.”

The continued advancement of immunotherapies and research into cancer vaccines are included in the report’s roadmap and represent the next frontier in cancer research and prevention.

“Recent data suggest you may be able to determine whether a patient will get cancer, where that cancer will be and in what mutations it will occur,” Lippman said. “It’s exciting work, and it’s just emerging. If you could give someone at high risk one or two or three booster vaccines for lifetime protection, it would obviously be a real game changer.

“I’m excited about the future and this is a call to action to move on this,” Lippman added. “We have an incredible opportunity and the potential for prevention is far greater than therapy if we can make this happen. But, it will take a concerted effort and investment.”

The report 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 of the moonshot initiative is to align research and care in a seamless continuum such that all patients have access to clinical trials as part of standard care, and their clinical course and experience informs future research.

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“We need to expedite patients to new drugs and reduce the burden of early-phase trials,” Van Dang said. “And, we need to ensure the pediatric oncology patient population is well enrolled in clinical trials and measure that enrollment over the next 5 years.”

A greater emphasis on imaging and radiation oncology also is included in the new report.

The authors noted that despite an unprecedented increase in the number of therapies approved by the FDA in the past 2 to 3 years, hundreds of drugs fail in clinical trials. Further, those approved carry an estimated cost of $2.6 billion.

Among the commission’s recommendations is the need for an overhaul of the drug discovery process so that projects can be discontinued earlier in the clinical development phase, and to transform how academia, industry and clinical groups collaborate to vastly improve efficiencies.

“These are, in some cases, less sexy than cutting-edge, high-technology scientific advances, but they represent the actual implementation of our scientific progress,” Hudis said. “It is obvious that making advances without a clear ability to deploy them where they are needed is only half of the battle.”

With patients living longer with cancer as a chronic condition, guidelines must be developed to address the long-term health care needs of patients undergoing therapy and for survivors, the report said.

As HemOnc Today previously reported, a Harris poll of more than 4,000 adults indicated that Americans support an expanded federal role in cancer research and would support higher taxes and deeper deficits to accomplish the goals of the Moonshot initiative, Hudis said.

“We have a rare moment of unity [in which] our political forces and our general public are aligned behind the goal of the Moonshot effort, and what we have to do is deliver,” he said. – by Chuck Gormley

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