As we all now know, the start of the sequestration prescribed by the Budget Control Act of 2011 was delayed until March 1, 2013, by the American Taxpayer Relief Act of 2012. With Congress unable to strike a deal, the mandatory reductions in Federal spending were triggered on March 1. Those reductions will actually be spread out over the next decade, but about $85 billion is due to be cut this year, with a major impact on cancer research. The following report details what that impact might entail in the coming months, as addressed by AACR and NCI speakers before the March 1 deadline.
On a sunny day in February, more than 100 Congressional staffers heard foul weather predictions for the future of cancer research if Congress were to go ahead with its proposed sequestration cuts. Jon Retzlaff, MPA, MBA, Managing Director of Science Policy and Government Affairs, American Association for Cancer Research (AACR), opened the briefing by noting that support for cancer research is eroding, with a current $1.5 billion National Institutes of Health (NIH) budget cut tacked on to an overall 20% decrease during the past decade.
“If sequestration goes through, it could mean a potential drop of 1,000 research awards, and total employment supported by NIH awards would fall by more than 20,000. And all this comes at a time when the number of opportunities in cancer research has never been greater.”
He went on to say that although there are now 13.7 million cancer survivors in the United States, about 1.6 million Americans will be diagnosed with the disease this year, and approximately 570,000 will die of it.
‘Engine of Discovery’
Cancer mortality overall has decreased somewhat, but there are still several types of cancer about which almost nothing can be done, said Douglas Lowy, MD, NCI Deputy Director.
He said that the National Cancer Institute (NCI) is an “engine of discovery” in both basic and clinical cancer research. He used as an example the definitive spiral CT scan trial that showed a 20% decrease in mortality for certain types of lung cancer. “It involved 50,000 people and cost $250 million, but it was worthwhile. This is the kind of work that NCI can do more easily when it has increasing budgets.”
Kenneth C. Anderson, MD, Kraft Family Professor of Medicine, Harvard Medical School and Dana-Farber Cancer Institute, does B-cell malignancy research, especially focusing on multiple myeloma. He has developed in vitro and in vivo models to identify novel targets and validate therapies targeting the myeloma cell and its bone marrow milieu.
Importantly, he has translated preclinical studies to the bedside, establishing a treatment paradigm using new therapies that target tumor cells, tumor-host bone marrow interactions, and the bone marrow microenvironment to overcome drug resistance and improve patient outcomes. He helped to lead clinical trials of proteasome inhibitor bortezomib (Velcade) and the immunomodulatory drug lenalidomide (Revlimid). FDA has approved both for treatment of myeloma.
“We need to better understand the microenvironment in which multiple myeloma grows in the bone marrow in order to develop better therapies,” said Dr. Anderson. “So far, we have markedly increased response rates and doubled or tripled patient survival. Indeed, for some patients, myeloma is a chronic disease, and we want to be able to achieve that goal for all of them. Only by supporting research will this be possible, and both patients and their families are counting on us.”
However, said Dr. Lowy, with flat budgets, new projects can be started only if existing projects are reduced or phased out.
Despite sequestration going into effect, the NCI is still seriously considering major endeavors such as the RAS project. Mutations in the RAS gene occur in about 30% of all patients with cancer, and the push now is to develop targeted treatments based on understanding the oncogenic mechanisms by which RAS contributes to cancer.
M. Robert Carr, a former Democratic Representative from Michigan and currently Adjunct Professor of Political Management at George Washington University—and Dr. Anderson’s patient—described his experience with multiple myeloma and his gratitude for bortezomib, which has put him into complete remission. He noted how lucky he was to have been the recipient of federally funded research—and to have been in a position to have immediate access to bortezomib.
The Cancer Genome Atlas
Anna D. Barker, PhD, is currently Professor and Co-Director of Complex Systems Research at Arizona State University and former NCI Deputy Director and Deputy Director for Strategic Scientific Initiatives. In her former role, she was instrumental in developing and implementing The Cancer Genome Atlas program—now in its eighth year—will map genome changes in 25 different cancers. So far, it has completed comprehensive sequencing, characterization, and analysis of the changes in glioblastoma multiforme, ovarian cancer, colon cancer, and breast cancer, and has collected the necessary samples for most of the other cancers. The ultimate goal for The Cancer Genome Atlas is integration of genomic information and patient data to provide an unprecedented multidimensional database that will inform the development of a new generation of targeted diagnostics and drugs.
“Cancer is heterogeneous and represents a large number of different diseases—which makes it very difficult to predict the response of individual patients. We do know that know that the cost of treating cancer is staggering, and the number of cases of cancer is expected to rise significantly (estimates approach 30%) in the next decade. These increases, combined with the costs of other chronic diseases, represent a looming health-care and economic crisis.”
She added that the data compiled as a result of completion of the Human Genome Project in 2003, allowed the NIH to undertake TCGA. As with the Human Genome Project, the level of complexity and cost of TCGA could only be accomplished through support from the federal government. Undoubtedly, TCGA will contribute in both known and unknown ways to our future efforts to understand and control cancer. Therefore, said Dr. Barker, it is imperative that Congress continue to fund critical projects such as TCGA and sustain our nation’s support for cancer and biomedical research. ■