National Cancer Institute director details bridge to the future of cancer care

The director of the National Cancer Institute said that now is a golden age of cancer care with consistent and meaningful declines in cancer mortality, new treatments, and steady progress in prevention measures. However, more work is needed.

President Biden has stated that he wants to end cancer “as we know it,” said Norman E. Sharpless, MD, which means that many of the biggest challenges are still ahead.

The American Association for Cancer Research Annual Meeting 2021 welcomed Sharpless on Sunday, April 11, to hear his blueprint for building a bridge for cancer success.

Making strides

Since becoming NCI director in 2017, the FDA has issued more than 240 new supplementary or biosimilar approvals for drugs and biologics for oncologic indications, including more than 80 new medicines. Many of these new products deliver long-lasting benefits or even cures, he said.

“This progress is a testament to the work of people like you, the members of AACR,” Sharpless said.

To continue this work, Sharpless asked for continued public support for cancer research, especially this week as President Biden releases his proposed budget for fiscal year 2022. This budget includes a proposed total increase in funding to the National Institutes of Health (NIH) of about $9 billion, including $2.5 billion to the institutes of the NIH, of which NCI is the largest.

This funding, Sharpless said, is key to increasing pay lines for grant applications.

“Investigator-initiated science is how we make progress for our patients,” he said.

Future progress

Using that funding, Sharpless hopes to work towards the President’s goal of ending cancer as we know it. Sharpless knows that eradicating all cancer is unlikely, but he hopes ending cancer as we know it means ending the tragedy of cancer.

Sharpless said that progress would require solid metrics, including looking at age-adjusted cancer mortality. For example, a goal could be cutting age-adjusted cancer mortality in half from its peak in the 1990s at 215 deaths per 100,000 of the population. Currently, it is at about 150 per 100,000 population, Sharpless said, which represents a 30-percent decline over three decades. Meeting this goal by 2026 requires an average reduction in cancer mortality of about 4 percent a year, which would be a faster reduction than has ever been achieved before.

Bridging this distance will require a “concerted effort with lots of complex parts coming together,” he said.

Sharpless offered suggestions for the path forward, including a large national trial or trials of multi-cancer blood-based cancer screening tests to detect cancer early in healthy adults, devoting resources to government-sponsored clinical trials, and a new commitment to drug discovery through accelerated approaches to structural biology and chemistry.

Importantly though, all of this new work must be done along with intensive efforts to improve health equity.

“We can’t leave huge proportions of society behind and expect to make meaningful progress against cancer,” Sharpless said.

He closed by recommending a book called The Bridge by Gay Talese, which tells the story of the people who built the Verrazano bridge connecting Brooklyn to Staten Island.

The story, he said, is not really about the bridge, but the people who made that great achievement possible.

“The important part of our story will be about all of us who work on cancer, our patients, and their loved ones,” Sharpless said. “The key moments will be about meetings like this where we come together and talk about what works and doesn’t work, frankly, and slowly or not so slowly together make progress against malignant disease.”