Molecular profiling allows clinicians to identify the molecular and genetic signatures that help to deliver treatments that are highly specific to a tumor. This tool has made possible a number of advances in the past year that are improving care for patients with gastrointestinal cancers. In recognition of this progress, ASCO has named Molecular Profiling Driving Progress in Gastrointestinal Cancers as the Advance of the Year in Clinical Cancer Advances 2021.
The report was also published by Sonali M. Smith, MD, FASCO, and colleagues, in the Journal of Clinical Oncology.1
This ASCO report on annual progress against cancer—now in its 16th year—also catalogs a year’s worth of significant research advances, highlights areas of research opportunities, and reinforces the importance of federal funding for cancer research.
Sonali M. Smith, MD, FASCO
This year’s report includes a special section that examines the need for health equity in cancer research and explores potential strategies to achieve it.
“If clinical trials don’t represent the individuals we treat, including those from racial, ethnic, and other minority populations, the state of science suffers, and patients with life-threatening conditions may not receive the best—perhaps only—treatment option for their condition,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO.
In addition, the report includes pivotal research on a range of therapies for breast, lung, prostate, liver, and blood cancers, among others. In many cases, these advances have resulted in newly approved therapies.
Lori J. Pierce, MD, FASTRO, FASCO
“Progress in cancer treatments over the past year provide improved therapy for cancers like breast and lung,” said Dr. Smith, Editor-in-Chief of Clinical Cancer Advances 2021. “We also saw new treatment options for patients with difficult-to-treat cancers, such as bladder and nasopharyngeal cancers.”
This progress could not have come about without federal support for clinical cancer research.
The Clinical Cancer Advances report not only identifies the major advances of the past year, but also looks forward, highlighting areas where progress is most promising in ASCO’s list of Research Priorities, which identifies areas of unmet needs and research opportunities in cancer care.
Advance of the Year
Gastrointestinal cancers account for 26% of the global cancer incidence and 35% of all cancer-related deaths, according to a report published by Melinda Arnold, PhD, and colleages in Gastroenterology.2 The ability to molecularly profile a gastrointestinal tumor has expanded the treatment options for patients with gastrointestinal cancers—extending survival, while minimizing adverse effects.
“Molecular profiling tools such as next-generation sequencing give us the ability to identify specific molecular- and genomic-targeted treatments that are likely to benefit an individual patient. Personalized medicine is becoming a reality,” said ASCO Board Chairman Howard A. “Skip” Burris III, MD, FACP, FASCO.
Howard A. “Skip” Burris III, MD, FACP, FASCO
In the past year, research has shown that targeting human epidermal growth factor receptor 2 (HER2) improves survival in gastric cancer and shows promise for patients with HER2-positive colorectal cancer. Therapy is now approved that targets specific BRAF gene mutations in metastatic colorectal cancer. These advances are moving the treatment of gastrointestinal cancers closer to personalized medicine.
Achieving Equity in Cancer Research
The report includes an examination of health inequities in cancer care and clinical research. National and global events of the past year have highlighted health inequities as one of the greatest challenges currently facing medicine and society more broadly. Disparities in cancer outcomes are rooted, in some respects, in the development of novel diagnostics and therapeutics—the clinical research that demonstrates the efficacy and safety of new cancer treatments.
The underrepresentation of minority groups in cancer research contributes to disparities in cancer care and outcomes by failing to provide the evidence that clinicians need to safely treat minority patients with cancer. The report outlines strategies and actions that can be used to lower the barriers to clinical trial participation and thereby increase the diversity of trial participants. Such strategies include broadened trial eligibility, expanding trial geographic availability, and financial assistance, among others.
Research Priorities to Accelerate Progress Against Cancer
This year, ASCO added artificial intelligence (AI) and deep learning in cancer research to its list of Research Priorities to Accelerate Progress Against Cancer. AI has the potential to drive diagnostic, therapeutic, and translational cancer research. In particular, research should focus on the use of AI in diagnosing cancer based on biospecimen analysis; enhancing and improving radiographic imaging, interpretation, and reporting; and integrating large amounts of clinical data to aid clinical decision-making and measurement of clinical outcomes.
The full list of priorities, in no particular order, are to:
- Develop and integrate AI and deep learning in cancer research
- Identify strategies that predict response and resistance to immunotherapies
- Optimize multimodality treatment for solid tumors
- Increase precision medicine research and treatment approaches in pediatric and other rare cancers
- Optimize care for older adults with cancer
- Increase equitable access to cancer clinical trials
- Reduce adverse consequences of cancer treatment
- Reduce obesity’s impact on cancer incidence and outcomes
- Better identify potentially malignant lesions and predict when treatment is needed.
“While clinical research has resulted in longer survival and better quality of life for many patients with cancer, we can’t rest on our laurels. With ASCO’s Research Priorities to Accelerate Progress Against Cancer, we continually evaluate and highlight critical gaps in cancer prevention and care that we believe to be most pressing and where opportunities for rapid progress are greatest. These priorities are intended to guide the direction of research and accelerate progress,” said Dr. Burris.
Progress in a Pandemic: Cancer Research Funding at Risk
The COVID-19 public health emergency threatens to reverse years of momentum in cancer research. Laboratories conducting cancer research have closed, or space has been redirected to COVID-19 research. Clinical trials have halted or slowed, creating a costly loss in research progress and delays in patient access to potentially life-saving treatments.
The National Institutes of Health and the National Cancer Institute need emergency funding—on top of a robust annual increase to their baseline budgets—to mitigate disruptions caused by the pandemic and get the nation’s biomedical research enterprise up and running again. Even minor funding cuts can have a major impact on cancer research.
Richard L. Schilsky, MD, FACP, FSCT, FASCO
“Stable, predictable funding increases will allow our nation to continue to build on the promise of today’s research and improve outcomes for all patients with cancer,” said Richard L. Schilsky, MD, FACP, FSCT, FASCO, Chief Medical Officer and Executive Vice President of ASCO.
Disclosure: For full disclosures of the report authors, visit ascopubs.org.
References
1. Smith SM, Wachter K, Burris HA, et al: Clinical cancer advances 2021: Report on progress against cancer. J Clin Oncol. February 2, 2021 (early release online).
2. Arnold M, Abnet CC, Neale RE, et al: Global burden of 5 major types of gastrointestinal cancer. Gastroenterology 159:335-349, 2020.
© 2021. American Society of Clinical Oncology. All rights reserved.
