Clinical Cancer Advances 2015

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ASCO's Annual Report on Progress Against Cancer

ASCO developed the Clinical Cancer Advances report, now in its 10th year, to document the important progress being made in clinical cancer research and to highlight emerging trends in the field. This report serves to outline to the public progress achieved against cancer by reviewing the major advances in clinical cancer research and care each year. As a whole, this document attests to the current state of the science and envisions future directions of cancer research.

Click on the links below to navigate through Clinical Cancer Advances 2015. The report features:

 

The content of Clinical Cancer Advances was developed through a peer-review process, under the direction of an editorial board led by Co-Executive Editors Gregory A. Masters, MD, FACP, FASCO, and Jyoti D. Patel, MD, comprising prominent oncologists with expertise in a wide range of oncology subspecialties. The editors reviewed research published in peer-reviewed scientific and medical journals and presented at major scientific meetings over a 1-year period (October 2013 to September 2014). The research reviewed in this report covers the full range of clinical research disciplines.

A Message From the President

Ten years ago, the American Society of Clinical Oncology (ASCO) first announced the year’s biggest cancer research advances in the inaugural issue of Clinical Cancer Advances. Looking back at a decade of reports, it is exciting to see how transformative those years have been. Clinical Cancer Advances has documented the dawn of precision cancer medicine, the advent of effective new cancer prevention strategies, major improvements in the management of treatment adverse effects, and many other critical advances.

Although all research achievements in this annual report are important, it often seems that one rises above the rest, whether because of its tremendous impact on patient care, its pioneering science, or its cross-cutting significance. So, as Clinical Cancer Advances enters its second decade, we are highlighting the year’s standout achievement with a new feature: ASCO’s Advance of the Year.

For 2015, ASCO’s Advance of the Year is the transformation of treatment for chronic lymphocytic leukemia (CLL).

CLL is the most common adult leukemia, and it disproportionately affects the elderly. Yet, until the past year, many older patients were without treatment options, because existing therapies caused severe, even life-threatening, adverse effects for those who were frail or had other major health problems. But 2014 brought stunning new possibilities with the introduction of four new drugs that are both highly effective and far easier on patients. These therapies have filled a major unmet need for those with newly diagnosed or resistant disease, making treatment—and remission—possible for more patients than ever.

This advance also speaks to the importance of value in cancer care. Value is a major focus for ASCO, because clinical benefit, toxicity, and cost must all be factored into shared decision making to determine the best treatment options for patients. ASCO is working to develop a physician-guided tool that will help patients evaluate new treatment options such as those highlighted in this report.

Another big change with this year’s report is that clinical research advances are ordered thematically, rather than by disease area. And within each thematic section, the report not only highlights recent advances, but identifies emerging trends as well.

Clinical Cancer Advances also continues its emphasis on the unique and vital role of federally funded cancer research. In this year’s report, almost a third of the studies featured were supported by federal research dollars. One featured study revealed one of the biggest survival gains ever observed in men with advanced prostate cancer. Another found a simple, affordable new way to preserve fertility for women with early-stage breast cancer, while others helped deliver new therapies for hard-to-treat diseases like brain cancer. For more than 60 years, the National Cancer Institute has funded many more clinical studies like these, answering critical cancer care questions that might otherwise have been ignored.

Despite these achievements, federal investment in research has stagnated over the past 10 years, resulting in a 23% loss in purchasing power for the National Institutes of Health. In practical terms, this means promising research is going unfunded, new studies are being scaled back, fewer patients have the opportunity to participate in clinical trials, and future meaningful advances against cancer may be few and far between—unless our nation renews its commitment to fighting cancer.

Advances in health information technology (IT)—including projects like ASCO’s CancerLinQTM—can help overcome some of these challenges. Such technologies will enable us to capture data and learn from every patient, ultimately helping make clinical trials faster and smarter. But we cannot count on health IT alone.

As with any major anniversary, we are reminded that history judges us by our achievements. In oncology, Clinical Cancer Advances documents a decade of remarkable research advances, with progress building on progress over time. Now is the time to increase our nation’s investment to ensure we can build on these advances well into the future.

Peter Paul Yu, MD, FACP, FASCO
President
American Society of Clinical Oncology

ASCO Calls for Increased Federal Investment in Medical Research Innovation

In testimony submitted to the US Senate Committee on Appropriations, 2013 to 2014 ASCO President Clifford A. Hudis, MD, FACP, urged Congress to step up the need for further investment in medical research:

Federal funding in medical research is needed to study topics that the private sector typically doesn’t pursue, such as comparisons of different but already approved drugs, improving the quality and value of patient care, reducing cancer disparities, and developing cancer screening and prevention strategies.

At the same time, the NIH also takes on high-risk, high-reward research that cannot be done at its earliest stages by industry. This often groundbreaking work is many times picked up by the private sector and translated into lifesaving cures and economic growth.

An important consequence of NIH investment in research is that it is also a driving factor in many local economies. Fully 80% of NIH funding is distributed throughout the United States, and it is estimated that every dollar of NIH grant funding creates $2.21 of spending on jobs and businesses in our communities.

Domestically, declining federal funding for clinical trials, coupled with the rising costs of increasingly complex studies, will severely harm the nation’s clinical research enterprise by limiting opportunities for innovation and demoralizing young clinical investigators. As opportunities to develop and lead trials diminish and institutional pressures to generate research funding and clinical revenue continue to grow, young investigators may leave the field of research, or choose to pursue research opportunities in other countries. Not only does this threaten our progress against cancer, but it also diminishes the overall scientific workforce in America.

Because of the incredible scientific opportunities facing us and the current threats to this opportunity, ASCO urges the Committee to provide the necessary investments to the NIH, NCI, and US Food and Drug Administration in fiscal year 2015 to protect innovation.

Specially, we offer the following recommendations for FY 2015 funding:

  • National Institutes of Health (NIH): $32 billion
  • National Cancer Institute (NCI): $5.26 billion
  • US Food and Drug Administration (FDA): $2.784 billion

Source: ASCO in Action

Executive Summary

Clinical cancer research has yielded tremendous gains, leading to longer survival and better quality of life for the more than half a million Americans diagnosed with the disease each year. Great strides in cancer prevention have further decreased the burden of the disease. Cancer death rates in the United States have declined 20% from their peak in 1991 (215.1 per 100,000 population) to 2010 (171.8 per 100,000 population).1 Today, there are a record 14.5 million cancer survivors alive in the United States.

Now in its 10th year, the American Society of Clinical Oncology’s (ASCO’s) report, “Clinical Cancer Advances 2015: An Annual Report on Progress Against Cancer,” for the first time identifies ASCO’s Advance of the Year. Other new features in this special anniversary issue include: A Decade in Review, which recounts the biggest changes in cancer care since this report’s introduction; The 10-Year Horizon, which previews trends likely to shape the next decade of cancer care; and a special series of research, which highlights exciting new leads for treatment of rare cancers.

In keeping with this report’s tradition, we explore the clinical advances of the prior year that stand to make the biggest impact on improving cancer prevention, treatment, and care. The following is a summary of some of the most exciting trends and developments.

Advance of the Year: Gains in the Treatment of Chronic Lymphocytic Leukemia

In just over a year’s time, treatment for chronic lymphocytic leukemia (CLL), the most common form of adult leukemia, was transformed through the approval of four new therapy options. All the new treatments are easier to tolerate than prior therapies, making treatment possible for more patients than ever—especially elderly patients who account for the majority of patients with CLL and had urgently needed new, less toxic options.

For previously untreated patients who were unable to tolerate the adverse effects of standard CLL treatments, the two different immunotherapy drugs, obinutuzumab and ofatumumab, given in combination with the standard chemotherapy chlorambucil, delay disease progression by roughly a year.

And there is also good news for patients with previously treated CLL that has become resistant to standard treatment or relapsed. New targeted drugs, ibrutinib and idelalisib, which block different molecular pathways that control leukemia growth, are the first effective therapies for these patients. According to striking early clinical trial results, these drugs have the potential to transform CLL therapy, potentially eliminating the need for chemotherapy, the adverse effects of which are too difficult to bear for many elderly patients with CLL.

Precision Medicine Research Brings New Therapies Targeting Immune System and Cancer Cells

Once a distant goal, precision medicine—an approach where treatments are matched to the genetic makeup of the patient and his or her tumor—is a common strategy for many patients with cancer today. Precision medicine allows for better treatment outcomes and fewer adverse effects compared with other approaches, such as chemotherapy. This new reality is the fruit of decades of dedicated research on the biology of cancer.

From January through October 2014, the US Food and Drug Administration (FDA) approved seven new drugs that target either cancer-driving proteins on the surface of or inside cancer cells or molecules on immune system cells (for more information, view a list of FDA approvals from January - October 2014). Four new uses for previously approved drugs were also approved. The new approvals bring hope for patients with hard-to-treat types of melanoma and lung, stomach, blood, and cervical cancers.

Genomic Discoveries Provide New Leads for Cancer Prevention and Therapy

Modern high-throughput technologies provide extensive molecular information on tumors, which is analyzed to gain a deeper understanding of genetic factors that trigger and sustain cancer growth. This ever-growing knowledge advances patient care in many different ways—from guiding day-to-day treatment decisions for individual patients to steering the direction of new drug development.

Two recent studies brought intriguing new insights, which may have implications for cancer prevention and therapy in the future. In the first study, researchers were able to link known cancer triggers, such as tobacco and sun tanning, to specific sets of genetic changes or mutational signatures in tumor tissue. In another study, similar mutational signatures were sometimes found in entirely different types of cancer. This finding suggests that treatment for a cancer is more dependent on mutations in a tumor than on the organ in which the cancer arises. For example, this may mean that patients with bladder cancer who have a specific mutational signature that is found in lung cancer should be treated more like patients with lung cancer, rather than like other patients with bladder cancer. This potentially has broad applications for our approach to cancer therapy, but more research is needed to confirm this intriguing possibility.

Federal Research Dollars Answer Key Questions in Cancer Care

Much of the progress in this report and in past reports was made possible by federal investment in clinical cancer research. In fact, roughly a third of the advances highlighted in this year’s report were backed in whole or in part by federal funding from the US National Institutes of Health and the National Cancer Institute. Some of the most exciting discoveries include:

  • Adding generic chemotherapy to standard advanced prostate cancer treatment yields one of the biggest survival gains ever seen in this disease
  • Adding a generic, low-cost hormone treatment to standard chemotherapy helps preserve fertility of young women with breast cancer undergoing chemotherapy and extend their lives
  • Combining standard radiation therapy with chemotherapy adds years of life to patients with a class of brain cancers called low-grade glioma
  • Identifying ways to maximize benefits and reduce potential risks from low-dose computed tomography (CT) lung cancer screening
  • New, molecularly targeted drugs help overcome treatment resistance in lung cancer

But despite this record of success, the future of the US federal cancer research enterprise faces critical challenges that must be addressed by policymakers, together with the cancer community, so that this pace of research progress can continue, or even accelerate, for the next 10 years.

About Clinical Cancer Advances

ASCO developed this annual report, now in its 10th year, to document the important progress being made in clinical cancer research and to highlight emerging trends in the field. Clinical Cancer Advances serves to outline to the public progress achieved against cancer by reviewing the major advances in clinical cancer research and care each year. As a whole, this document attests to the current state of the science and envisions future directions of cancer research.

The content of Clinical Cancer Advances was developed through a peer-review process, under the direction of an 18-person editorial board comprising prominent oncologists with expertise in a wide range of oncology subspecialties. The editors reviewed research published in peer-reviewed scientific and medical journals and presented at major scientific meetings over a 1-year period (October 2013 to September 2014). The research reviewed in this report covers the full range of clinical research disciplines: prevention, screening, treatment, patient and survivor care, and tumor biology.

About ASCO

ASCO is the world’s leading professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care. ASCO is unique in that it is the only organization that encompasses all oncology subspecialties, allowing ASCO members to grow from the professional and personal expertise of their colleagues worldwide and across disciplines. With more than 35,000 members in 100+ countries, ASCO is dedicated to providing the highest-quality resources in education, policy, the pioneering of clinical research, and, above all, advancing the care for patients with cancer. For ASCO information and resources, visit ASCO.org. Cancer information for patients, caregivers, and others interested in learning more is available at Cancer.Net.

1. Siegel R, Ma J, Zou Z, et al: Cancer statistics, 2014. CA Cancer J Clin 64:9-29, 2014