In his keynote address at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium, Norman E. “Ned” Sharpless, MD, Former Director of the National Cancer Institute (NCI), and Professor, Cancer Policy and Innovation, University of North Carolina School of Medicine, Chapel Hill, told attendees that although cancer-related mortality is declining, challenges remain to “end cancer as we know it.” This phrase was recently used by President Biden when he announced new efforts to extend the Cancer Moonshot to address an ambitious new goal: to reduce cancer mortality by at least 50% in the next 25 years. In his presentation, Dr Sharpless discussed the potential impact of this initiative, the progress that has already been made in the fight against cancer, and some of the challenges that lie ahead.
Cancer Research Funding
Dr Sharpless emphasized the fact that cancer research—and adequate funding to conduct that research—is essential for improving patient outcomes. In this regard, he said, “We are doing pretty well, but not well enough. We need to accelerate the success we’ve had.”
NCI funding for cancer research increased from $4.95 billion in the 2015 fiscal year (FY) to $6.913 billion in FY 2022. Although this boost was desperately needed and appreciated, the reality is that the per-year increased funding, which was made possible through the Cancer Moonshot initiative, is a very small proportion of the total NCI appropriations, he said.
The first Cancer Moonshot was funded through the 21st Century Cures Act, which was signed into law in December 2016. Through this act, Congress authorized $1.8 billion in funding to support cancer research over 7 years, beginning in 2017. This funding will sunset at the end of the year. Dr Sharpless said that the next cash infusion to accelerate cancer research must be significantly larger to address issues such as low pay lines and higher research costs.
In December 2022, President Biden signed the FY 2023 omnibus appropriations bill, which will provide an additional $1.5 billion for The Advanced Research Projects Agency for Health through FY 2025 ($500 million or a 50% increase over FY 2022) and hopefully should help to further boost NCI funding.
Mortality Rates Have Declined for Some Cancers, But Not Others
Dr Sharpless explained that over the past 5 years, the FDA has approved numerous drug and nondrug products to fight cancer. The number of these approvals on a yearly basis has ranged from 45 in 2019 to 74 in 2021, not including biosimilars, generics, and devices. The percentage of the drug pipeline dedicated to oncology has also increased steadily, from 26.8% in 2010 to 35.2% in 2019. These advances, in addition to improved screening strategies and tobacco control, have led to a nationwide decline in age-adjusted cancer mortality rates of 30% over the past 3 decades, although state-level variations remain due to factors such as race, socioeconomic disparities, rurality, and differences in access to care.
Although statistics show significant declines in age-adjusted cancer mortality rates between 1994 and 2019 for several types of malignancies, including lung cancer, female breast cancer, and prostate cancer, mortality rates for several other types of cancer increased during the same period. These include liver cancer, pancreatic cancer, and uterine cancer, which are all linked to obesity.
“The obesity epidemic in the United States is something we’re really going to have to deal with if we want to meet the president’s goal [of] ending cancer as we know it,” Dr Sharpless said. “We’ll have to make progress in cancers like pancreatic cancer, where there hasn’t been a lot of progress.”
Additional Factors to Consider
Dr Sharpless went on to say that although statistics show an improvement in cancer-related mortality, much of the data is typically more than 2 years old. Therefore, the aftermath of the COVID-19 pandemic has yet to be assessed. One concern is that cancer screenings declined sharply during the first year of the pandemic and many people postponed their medical appointments. Reports are already suggesting rising rates of late-stage cancer diagnoses, leading to widespread concerns about the impact this will have on outcomes.
Other challenges that need to be overcome to meet the goals set by the Biden Administration include spiraling costs associated with clinical trials and difficulties with the accelerated approval process, which Dr Sharpless said is currently “under attack.”