Confronting Cancer Now
In 1971, Congress passed the National Cancer Act and thereby committed the United States to a major assault on cancer. In that year, there were three million American cancer survivors; today, there are more than nine million. But, by the end of 2003, three million new cases of cancer have been diagnosed in the United States, and cancer continues to kill an average of 1,500 Americans every day.
The implication of these numbers-the continuing tragedy of cancer and the impressive strides that have been made in controlling it-lay behind "Confronting Cancer Now," a conference convened by the Division of U.S. Studies and Friends of Cancer Research at the Wilson Center in November. Oncologists, scientists, academicians, pharmaceutical company representatives, senators, and other policymakers convened to educate each other and discuss the potential for better diagnosis, prevention, and treatment of cancer.
Turning a Dream Into Reality
Dr. Andrew von Eshenbach, director of the National Cancer Institute (NCI) and himself a cancer survivor, stated that NCI's goal is "to eliminate the suffering and death due to cancer by 2015." Such a goal could be made possible by the exponential expansion of scientific knowledge and new, enabling technologies such as genomics, proteomics, metabolomics, molecular imaging, and nanotechnology.
Dr. Susan Desmond-Hellmann, chief medical officer and an executive vice president at Genentech, emphasized the enormous increase in the pace of cancer care discoveries during the last five years, particularly in the area of targeted therapies. According to Dr. Mel Sorensen, vice president of Oncology-MSI, Clinical Development & Medical Affairs at GlaxoSmithKline, many of the details of the mechanisms of cancer have been uncovered during the last 10 to 15 years, allowing exciting new approaches to blocking cancer growth.
Preempting the Disease
Dr. von Eshenbach asserted that the war against cancer could succeed only if the approach to cancer continues to evolve. Dr. H. Kim Lyerly, director of the Duke Comprehensive Cancer Center, noted that cancer is, in fact, many different types of diseases with common clinical characteristics-what Dr. von Eschenbach called a "family of diseases"-which suggests the need for a wide variety of therapies and drugs. The consensus, however, was that the best approach is to stop cancer before it starts, and Dr. von Eshenbach described a shift in cancer treatment from "seek and destroy" tactics to a preemptive strategy of preventing cancer from becoming lethal.
Scientists now view cancer as a disease process, with mechanisms that are vulnerable to intervention. Dr. Desmond-Hellmann described the "Angiogenic Switch," the mechanism that allows small dormant tumors to become vascular tumors with metastatic potential. One challenge is to intervene to stop that process. But steps can be taken even before the process begins, according to Dr. Mark McClellan, commissioner of the Food and Drug Administration (FDA), and prevention is far more important than treatment.
Prevention includes not only medical and genetic strategies but also teaching people that their daily lifestyle decisions, especially in the area of diet, have important implications for cancer prevention. Dr. McClellan suggested partnerships with food-production companies to make the relevant dietary options widely available.
View from the Hill
Three senators participated in the conference, all of whom have advocated for increased research and funding to combat cancer. Senator Edward "Ted" Kennedy (D-MA), one of the originators of the National Cancer Act, had found out just weeks after the legislation passed that his son, Teddy, had osteosarcoma in the leg. Following a clinical trial, leg amputation, and years of intense treatment, Teddy survived and lives a full life today, recounted his father.
Greater government funding for research and treatment is crucial, the senators agreed. Senator Kennedy said much has been done at the national level to increase funding for cancer research and Congress continues its bipartisan effort to develop legislation that would expand research.
"Families in this country are entitled to have their priorities reflected in the national budget," Senator Kennedy declared.
But, as Senator Arlen Specter (R-PA) commented, it is difficult to secure additional funding for NIH and for such promising techniques as stem cell research. He explained that huge amounts of money are needed for research into the treatment of cancer, as opposed to efforts aimed at less costly and more immediately responsive diseases; another is the current emphasis on the financial demands of the war on terrorism.
Senator Ted Stevens (R-AK), a cancer survivor, applauded the recent doubling of the NIH budget but asserted that it still is not nearly enough funding. He called not only for greater government investment in medical research but also for: Medicare and private insurance coverage of cancer-related diagnosis and treatment, including participation in clinical trials; increased funding for other governmental agencies (e.g. the National Science Foundation, the Department of Defense, the Department of Energy) that are involved in cancer-related research; and broader NIH authority to fund multi-disciplinary and multi-institution research.
Hopes and Hurdles
Dr. von Eschenbach and Dr. McClellan made the first public announcement of two new programs designed to increase the pace and efficacy of cancer research. The first, in the field of information technology, is a joint effort by FDA and NCI to develop clinical trial management software that will put cancer researchers around the country in electronic communication with the FDA and accelerate the regulatory review process for new cancer drugs. The second, the Cancer Fellowship Training Programs initiative, will enable doctors and scientists from around the country to work with cutting-edge therapies in clinical oncology programs at NCI. These initiatives will bring NCI and FDA into even closer collaboration.
But the roadblocks to fighting cancer are numerous, and include bureaucracy and territoriality. Dr. Nancy Davidson, professor of oncology at the Johns Hopkins University School of Medicine, spoke of the lengthy time required to secure approval of clinical trials, due to the many regulatory agencies that must consent. One reason for the delays, according to Dr. Gerard Thomas Kennealey, Astra-Zeneca's director of Global Products for Faslodex, may be the number of divisions with inconsistent agendas and procedures that exist within the FDA.
Dr. Sorensen noted that only 3 out of 10 marketed cancer drugs will produce a profit that will match or exceed the average research and development costs needed to create those drugs. Dr. McClellan also pointed out that fewer than one out of two Phase Three clinical trial drugs - those at the end process of the clinical trial procedure - will result in an application to the FDA for marketing approval, indicating that the amount of money and risk involved in such research necessarily affects the activities of private industry.
"For medical progress to continue," said Dr. McClellan, "we need to find better, less expensive, more predictable ways to develop new treatments, to reduce costs, and to improve access to better care." Only then might we realize the NCI's goal of eliminating new cancers by 2015.