Genomics and personalized medicine are transforming approaches to cancer therapy, but continuing federal budget cuts threaten to derail progress in cancer treatment, according to an annual report issued by the American Society of Clinical Oncology.
The report, "Clinical Cancer Advances 2013: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology," was published online Dec. 10 in the Journal of Clinical Oncology (doi:10.1200/JCO.2013.53.7076) and represents the 9th year in a row that ASCO has documented the successes and challenges facing oncology.
"The insights described in this report, such as how cancers hide from the immune system and why cancers may become resistant to targeted drugs, enable us to envision a future in which cancer will be even more controllable and preventable," ASCO President Clifford A. Hudis said in a message accompanying the report.
In good news, overall cancer-related death rates declined 1.5% per year from 2000 to 2009. Cancer is still the second-leading cause of death, however. In 2013, there will be 1.6 million new cancer cases in the United States, and cancer will claim 580,000 American lives, according to the report’s executive summary. The incidence of cancer is declining in men, stable in women, and on the rise in African American and Hispanic children.
The report highlighted the work of The Cancer Genome Atlas (TCGA) research network, launched in 2009 by the National Institutes of Health, and its role in charting genomic changes in more than 20 different cancer types, including reporting results of comprehensive molecular analyses of kidney and endometrial cancers as well as acute myeloid leukemia. Additionally, results from the federally funded Lung Cancer Research Consortium gave rise to genomic testing that matches lung cancer patients with the most appropriate therapies.
The approvals of nine new cancer therapies – and expanded indications for six existing therapies – by the Food and Drug Administration through Oct. 2013 reflect the agency’s efforts to bring cancer drugs to market quickly, the report said.
Yet "our position as a world leader in advancing medical knowledge and our ability to attract the most promising and talented investigators are now threatened by an acute problem: Federal funding for cancer research has steadily eroded over the past decade, and only 15% of the ever-shrinking budget is actually spent on clinical trials," Dr. Hudis said in his accompanying message. "This dismal reality threatens the pace of progress against cancer and undermines our ability to address the continuing needs of our patients."
On top of continuing cuts to the NIH budget, automatic budget cuts known as sequestration went into effect in March. Those across-the-board cuts were required by the Budget Control Act of 2011, and are due to continue through 2021, unless Congress can come up with an alternative way to reduce the deficit.
The National Cancer Institute cut its budget by 6%. According to the ASCO report, "the number of new grants supported by NIH is at its lowest level since 1998, with only one in six highly ranked grant proposals currently receiving funding." At institutions that rely on NCI funding, employees are being laid off, there are delays in translational research, and clinical trials are being postponed. Based on an August survey of ASCO members, 75% who responded said that the funding crunch is curbing their ability to do research.
ASCO is petitioning for increases in the NIH and NCI budgets for 2014, for more funding for the NCI National Clinical Trials Network, and to exempt the agencies from sequestration.
The Cancer Advances report was developed by an 18-person editorial board of prominent oncologists who reviewed peer-reviewed research published in journals or presented at major scientific meetings from Oct. 2012 to Sept. 2013. A group of expert advisers provided an additional round of review within their practice specialties. The report features 76 studies, covering prevention, screening, treatment, patient and survivor care, biomarkers, tumor biology, and cancer disparities.
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