February 04, 2020
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ASCO names refinement of surgical cancer treatment ‘Advance of the Year’

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Howard A. Burris III, MD, FACP, FASCO
Skip Burris

ASCO has named the refinement of surgical treatment of cancer as the Advance of the Year, recognizing emerging novel systemic therapies that changed the role of cancer surgery.

ASCO’s annual Clinical Cancer Advances report, released today and published simultaneously in Journal of Clinical Oncology, highlighted other advances in cancer research, as well as areas ripe for research opportunities, and emphasized the importance of federal funding for such research.

“It is fair to say that cancer treatment began with surgery, with accounts dating back to ancient times. In recent years, other treatments like systemic therapy emerged, changing the role of surgery in cancer care,” ASCO President Howard A. “Skip” Burris III, MD, FACP, FASCO, president of clinical operations and chief medical officer for Sarah Cannon Research Institute of HCA Healthcare, and an associate of Tennessee Oncology PLLC, said in a press release. “ASCO’s 2020 Advance of the Year recognizes the way systemic cancer therapies have improved the effectiveness of surgery, minimized the extent of surgery required for many patients, and even eliminated the need for surgery for some patients.”

Research successes

Although significant advances in the understanding and development of systemic therapies have been ongoing, their effect on surgical care — such as in reducing the amount of surgery required or eliminating the need for surgery altogether — had not been shown until recently.

In the report, ASCO highlighted the specific cancer types for which advances in systemic therapies have aided in reshaping the role of surgical treatment:

  • Melanoma: Research on the efficacy and safety of neoadjuvant immunotherapy combinations or other targeted treatments has led the way for more successful and less invasive surgery for many patients with locally advanced melanoma, some of whom can avoid surgery.
  • Renal cell carcinoma: Targeted therapy-based approaches for renal cell carcinoma have shown potential as alternatives to immediate surgery for this population of patients.
  • Pancreatic cancer: Preliminary research suggests more patients with pancreatic cancer may be eligible for surgery after neoadjuvant treatment.

ASCO also cited other research successes in the report, such as progress made in cancer prevention, biomarker-driven treatment, and therapy combinations that suggest survival may be extended without increasing adverse events.

Research priorities

ASCO also identified eight research priorities for areas with promising progress and greatest need. These priorities include:

  • identifying ways to better predict response and resistance to immunotherapies;
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  • limiting the magnitude of surgery by optimizing systemic therapy;
  • improving precision medicine research and treatment for pediatric and other rare cancer types;
  • optimizing care for older adults with cancer;
  • increasing fair access to cancer clinical trials;
  • reducing adverse effects of treatment;
  • reducing obesity, a risk factor for various cancer types, and its effect on cancer incidence and outcomes; and
  • better identifying approaches to detect and treat premalignant lesions.
Richard L. Schilsky, MD, FACP, FASCO
Richard L. Schilsky

“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,” Richard L. Schilsky, MD, FACP, FSCT, FASCO, ASCO senior vice president and chief medical officer, said in the release. “These priorities are intended to keep clinicians, patients and other stakeholders abreast of the areas where the opportunity for rapid progress is most promising.”

Federal funding a must

The progress would not have been possible without federal funding for cancer research, the ASCO press release stated.

Nearly 25% of the advances included in this year’s report were funded by NIH and other federal agencies, according to the report. In addition, research funded by the NIH creates almost $74 billion in direct and indirect economic activity annually and more than 433,000 jobs.

During the past few years, Congress has approved annual consecutive increases for the NIH, including a $2.6 billion increase for fiscal year 2020. However, the NCI’s budget remains $1.1 billion less than it would be had funding kept pace with biomedical inflation since fiscal year 2003, according to the report. Further, despite the increases, NCI was able to fund only 12% of new research proposals in 2018.

“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,” the press release states. – by Jennifer Southall

Disclosures: Burris reports no relevant financial disclosures. Schilsky reports research funding to his institution from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Genentech/Roche, Eli Lilly, Merck and Pfizer; and travel expenses/accommodations from Varian. Please see the report for all other authors’ relevant financial disclosures.