The AACR Cancer Progress Report 2021, published on October 13, celebrates the gains made in cancer research since President Richard Nixon signed the National Cancer Act into law on December 23, 1971, especially against such life-threatening cancers as metastatic melanoma and lung cancer.1 The report also recognizes the negative impact the COVID-19 pandemic has had on cancer research and patient care, the disproportionate toll both cancer and the pandemic continue to have on racial and ethnic minorities, and the overwhelming financial burden cancer and the coronavirus are having on the U.S. economy.
According to this year’s AACR Cancer Progress Report, an estimated $200.7 billion of total health-care costs was spent on cancer-related health care in the United States in 2020. And that number is expected to increase to $245.6 billion over the next decade. In addition, these costs do not seem to reflect the additional indirect cost due to lost earnings or lost productivity or the potential negative economic impact of COVID-19 on cancer-related health care.
Progress Against Cancer
The cumulative effect of advances in cancer over the past 50 years has resulted in reducing overall cancer incidence and death rates in the United States and rising numbers of cancer survivors. Here are some of the findings from the AACR’s analysis:
- The age-adjusted overall cancer death rate declined by 31% from 1991 to 2018, a reduction that translates to 3.1 million lives saved. This reduction includes a 2.4% decline between 2017 and 2018, the largest reduction ever seen in a single year.
- From 1971 to 2019, the number of cancer survivors has grown from 3 million to 16.9 million, respectively.
- Efforts to reduce smoking rates have contributed to a 41% decline in lung cancer–related deaths from 1991 to 2018.
- Fueled by research discoveries made over the past 5 decades, molecularly targeted therapeutics and immunotherapeutics have substantially increased the 5-year survival rates for patients with formerly intractable cancers, including lung cancer, from 12.3% in 1975–1977 to 21.7% from 2011–2017; and melanoma, from 18% from 2006–2012 to 30% from 2011–2017.
- The 5-year relative survival rate for all cancers combined has increased to 68% for people diagnosed between 2011 and 2017 from 49% for those diagnosed in the mid-1970s. This trend includes increased 5-year relative survival rates for children and adolescents (up to age 19), from 63% to 84% in the same interval.
Breakthroughs in Treatment
According to the AACR report, from August 1, 2020, to July 31, 2021, the U.S. Food and Drug Administration (FDA) approved a total of 16 new anticancer therapeutics; 11 previously approved anticancer agents, which are now approved for treating new types of cancer; three new diagnostic imaging agents; two new surgery guiding devices; two new multipanel next-generation sequencing liquid biopsy companion diagnostic tests; and one new artificial intelligence–driven endoscopy device.
Breakthroughs in precision medicine include sotorasib, the first FDA-approved therapeutic to successfully target the KRAS oncogene; the first approval of an antibody-drug conjugate, fam-trastuzumab deruxtecan-nxki, for the treatment of HER2-positive gastric cancer; and relugolix, the first oral hormone therapy approved for advanced prostate cancer.
Advances in immunotherapy include FDA approvals of idecabtagene vicleucel, the first approved chimeric antigen receptor T-cell therapy for multiple myeloma; dostarlimab-gxly, a new checkpoint inhibitor for the treatment of recurrent or advanced deficient mismatch repair endometrial cancer; and nivolumab plus ipilimumab in the treatment of mesothelioma.
Call to Action for Continued Federal Investment in Research
Despite the improvements in cancer incidence and mortality in the United States, this year, 1.9 million people are expected to be diagnosed with cancer, and more than 600,000 will die of the disease.2 The report acknowledges that continuing research progress in cancer care will take increased government support and provides a call to action, including the following steps:
- Predictable funding increases to the National Institutes of Health (NIH) and the National Cancer Institute (NCI) by providing increases to their fiscal year 2022 budgets of at least $3.2 billion and $1.1 billion, respectively, for a total funding level of $46.4 billion for NIH and $7.6 billion for NCI.
- Providing at least $10 billion for the NIH in emergency supplemental funding to restart research and clinical trials that have been delayed because of the COVID-19 pandemic.
- Supporting the creation of an Advanced Research Projects Agency for Health designed to prioritize high-risk, high-reward approaches to prevent, diagnose, and cure diseases, including cancer, diabetes, and Alzheimer’s disease.
Addressing Health Inequities
David A. Tuveson, MD, PhD, FAACR
Although the gains made in cancer care over the past 50 years are impressive, the AACR Cancer Progress Report 2021 noted that not all patients are benefiting from these advances equally. “The stark reality is that certain segments of the population, including racial and ethnic minorities and other underserved populations, continue to shoulder a disproportionate burden of cancer,” said David A. Tuveson, MD, PhD, FAACR, President of AACR; Chair of the AACR Cancer Progress Report 2021 Steering Committee; and Director of Cold Spring Harbor Laboratory Cancer Center, during a virtual Congressional briefing on the report. “For many of the same reasons, these populations have also been disproportionately affected by COVID-19. This is unacceptable, and it is imperative that all stake holders in the medical research community work together to better understand and address health disparities.”
Ushering in the Golden Age of Cancer Research
The progress that has been made since the National Cancer Act was signed into law is so extraordinary, it has ushered in the golden age of cancer research, according to Norman E. “Ned” Sharpless, MD, FAACR, one of the speakers at the Congressional briefing.
Norman E. “Ned” Sharpless, MD, FAACR
“As this year’s report reflects, we continue to make remarkable progress against cancer. It’s so remarkable, in fact, I believe we will come to think of this time now, this period we are living in today, as the golden age of cancer research, where cancer mortality rates have been declining since the early 1990s. And that rate of decline has accelerated in the past years,” said Dr. Sharpless. “We’ve also seen a boon in FDA approvals for cancer drugs and devices in recent years and the rate of exciting new technologies that have created new opportunities across the spectrum from prevention and diagnosis to survivorship.”
To ensure that medical research continues to drive progress against cancer, Dr. Tuveson issued a call to action for Congress, the Biden Administration, and the public to make research funding through the NIH a national priority. “The AACR urges Congress to continue to support robust, sustained, and predictable annual growth in funding of the NIH and the NCI and to provide consistent and sufficient annual funding for the FDA and the CDC [Centers for Disease Control & Prevention]. These actions will ensure that we continue on the path of life-saving progress for all patients with cancer in the United States and around the world,” said Dr. Tuveson.
REFERENCES
1. AACR Cancer Progress Report: Discovery Science Driving Clinical Breakthroughs. Available at cancerprogressreport.aacr.org/progress. Accessed October 19, 2021.
2. American Cancer Society: Facts & Figures 2021 Reports Another Record-Breaking 1-Year Drop in Cancer Deaths. Available at www.cancer.org. Accessed October 14, 2021.
