Progress Against Cancer
Conquest - Spring 2007
By Gabriel N. Hortobagyi, M.D.
The recent announcement that cancer death rates among Americans had dropped for the second consecutive year represents a positive trend. I’m especially encouraged because the continuing decline in cancer mortality has been achieved despite our growing and rapidly aging population.
As president of the 25,000-member American Society of Clinical Oncology, I’m often asked to assess progress against cancer. There are many factors responsible for the decreasing mortality, including earlier detection and improved therapies for multiple cancers plus the good news that we’re preventing more cancers caused by tobacco use, poor diet and excessive sun exposure.
The thread throughout our progress is the payoff for the investment made in cancer research during the past 35 years. Those of us involved in translational research over this period have been confident that research would yield new knowledge to understand the molecular basis of cancer, treat it more effectively and eventually prevent many types of the disease. So I’m heartened that we’re now realizing measurable results from the investment stimulated by the National Cancer Act of 1971. But I also want to emphasize that we need a strong new commitment and sustained funding to assure we’ll accelerate translating scientific discoveries into life-saving clinical applications.
At the same time, we must act quickly to avert a serious crisis due to the predicted shortage of oncologists to treat many more Americans living long enough to develop cancer while caring for the steadily increasing number of cancer survivors. After a study commissioned by ASCO recently estimated a possible shortfall of at least 4,000 oncologists by the year 2020, I appointed a committee to recommend solutions.
On the positive side, a few weeks before the American Cancer Society announced the declining mortality rate, ASCO issued its annual report outlining major research advances in cancer treatment, prevention and screening. These six major advances were identified from a list of more than 30 notable achievements among 10 cancer types:
- U.S. Food and Drug Administration approved the first vaccine (Gardasil®) to prevent human papillomavirus infection that causes cervical cancer, which is diagnosed in almost 500,000 women worldwide each year. The U.S. Centers for Disease Control says more than 25% of American women are infected with this virus.
- Two targeted treatments for kidney cancer — the first in more than 20 years — were shown to improve survival rates. The investigational drug temsirolimus (Torisel™) increased survival when given as a first-line treatment for individuals with advanced, high-risk kidney cancer, while sunitinib (Sutent®) increased progression-free survival and response rates when administered as a second-line therapy for advanced disease.
- The addition of lapatinib (Tykerb®) to chemotherapy produced better control of cancer growth than chemotherapy alone for women with advanced HER2-positive breast cancer that had progressed after treatment with the targeted agent Herceptin.® An estimated 20% to 25% of patients have this aggressive, hard-to-treat breast cancer.
- FDA approved dasatinib (Sprycel™) for chronic myelogenous leukemia patients following a phase I clinical trial demonstrating that 92.5% of CML patients who could not tolerate or had become resistant to imatinib (Gleevec®) had no evidence of disease after taking dasatinib.
- Cetuximab (Erbitux®) became the first FDA-approved new treatment for head and neck cancer in 45 years. A large international study showed this targeted therapy combined with high-dose radiation slowed cancer growth and prolonged survival in patients with locally advanced head and neck cancer, thus providing better results than radiation therapy alone.
- A novel gene profiling test, called the lung metagene model, was developed to predict which patients with early stage non-small cell lung cancer would have disease recurrence and should be treated most aggressively. This accomplishment illustrates the increasingly important field of personalized medicine that uses genetic information to design tailored approaches to prevent and treat cancer and other diseases.
Both the declining cancer death rates and advances cited in the ASCO report are the result of many years of productive translational research led by M. D. Anderson and other major institutions.
While I’m pleased about these and other achievements on the immediate horizon, I’m also deeply concerned that we’ll lose our momentum unless the current yo-yo manner of supporting research is changed.
Despite increases in the National Institutes of Health budgets, the fact is we’ve had a net decrease in overall research funds over the last few years. Right now, only one in every 10 high-quality, peer-reviewed research grants is funded, producing a disastrous roller coaster for critical translational research, particularly for some of our brightest young scientists whose creative ideas can’t be pursued.
ASCO will continue working diligently to raise awareness of the dire need for a stable and predictable form of federal funding. Our 2006 report proposes a minimum annual funding increase of 5% for future NIH budgets. Such a formula should be adequate to keep up with inflation and avoid losing any more ground, but higher increases will be needed to assure we can convert our emerging opportunities into tangible and practical applications for cancer diagnosis, treatment and prevention.
Many people don’t realize that at least 75% of all cancers are diagnosed in individuals 55 and older and that this age group is growing faster than any other. The report, forecasting a shortage of oncologists, notes the number of Americans diagnosed with cancer is expected to rise from 11.7 million in 2005 to 18.2 million in 2020.
Simultaneously, the study predicts U.S. cancer survivors — now more than 10 million — will increase by 81%. This escalation can be attributed to treatment advances that are turning cancer into a chronic and controllable disease. As encouraging as this trend is, I’m worried we won’t have nearly enough oncologists to provide state-of-the-art therapies to so many new patients while properly caring for all of the survivors.
That report showed more than one-half of the current 10,400 practicing oncologists are older than 50, meaning many of them will retire in the foreseeable future. Although about 500 new oncologists enter the field each year, there won’t be nearly enough to replace those retiring and meet the demands for increasingly complex care. In fact, we could face a shortage of 4,000 or more oncologists by 2020.
The complete report will be presented at ASCO’s annual meeting in June, but I already have asked a group of academic training program directors and several leading oncologists to begin developing bold recommendations on what actions we should take concerning the projected shortage.
Besides the lack of oncologists and the unreliable funding dilemma, another problem involves access to human biospecimens. These samples of tissues and blood taken from patients during surgeries, biopsies and routine tests are vital for scientists to study the molecular characteristics of cancer cells. Another recent ASCO report emphasized the need for specific guidelines to standardize biospecimen collection, storage and use, and called for creation of a national database to enable sharing information and expertise among researchers.
Despite these deficits, I’m more excited than ever about the future of cancer research. At our annual meeting, we expect to hear hundreds of reports on promising translational research, including more effective targeted therapies for many cancers and difficult-to-treat subtypes. The investment in cancer research made over the past three decades definitely is paying off with the development of newer, smarter treatments and the initial steps toward personalized medicine.
The Man Behind the Commentary
Patients throughout the world benefit from the pioneering contributions made by Gabriel N. Hortobagyi, M.D., to improve the outlook for breast cancer. His landmark translational research during the last three decades includes proving the effectiveness of preoperative chemotherapy to reduce the size of previously inoperable breast tumors so they could be removed and conducting numerous clinical trials that have led to better therapy for patients with all stages of breast cancer.
Hortobagyi joined the M. D. Anderson faculty in 1976 following a two-year fellowship in medical oncology. He chairs the Department of Breast Medical Oncology, directs the Multidisciplinary Breast Cancer Research Program and holds the Nellie B. Connally Chair in Breast Cancer. He also is principal investigator on the Specialized Programs of Research Excellence grant for breast cancer.
In June 2006, Hortobagyi began a one-year term as president of the American Society of Clinical Oncology. He is the first M. D. Anderson faculty member elected to head ASCO, the world’s leading professional organization representing physicians who treat people with cancer.
Conquest - Spring 2007
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