The remarkable progress in medical research—primarily supported by federal investments in the National Institutes of Health (NIH) and the National Cancer Institute (NCI)—over the past 3 decades, coupled with advances in cancer prevention and early detection, has led to a 33% reduction in cancer mortality, averting an estimated 3.8 million cancer deaths, according to the American Association for Cancer Research (AACR) Cancer Progress Report 2023: Advancing the Frontiers of Cancer Science and Medicine. As a result of NCI-funded clinical trials, since 1980, in the United States, patients with cancer have collectively gained nearly 14 million years of life. The reduction in overall cancer mortality is attributed to declines in the death rates from lung, colorectal, prostate, and female breast cancers and melanoma, as well as steady decreases in death rates from leukemia and kidney cancer.
Of note, overall cancer death rates in children and adolescents declined by 70% and 64%, respectively, between 1970 and 2020, largely driven by improvements in treatment. As a result, the number of cancer survivors has risen from 3 million in 1971 to more than 18 million today.
Included in this year’s report is a spotlight on cancer immunotherapy—the fourth pillar of cancer care. The report also addresses the persistent challenges in cancer research, including cancer disparities; the slow progress against difficult-to-treat cancers, such as pancreatic and uterine cancers; and the ongoing physical, psychosocial, and financial hardships cancer survivors face.
Recent FDA Approvals; Trends and Advances in Cancer Care
Listed here are highlights from the AACR Cancer Progress Report 2023:
- From August 1, 2022, to July 31, 2023, the U.S. Food and Drug Administration (FDA) approved 14 new anticancer therapeutics, including a new gene therapy–based immunotherapeutic for certain patients with bladder cancer; a first-in-class antibody-drug conjugate for patients with ovarian cancer; and four new T-cell–engaging bispecific antibodies for a variety of hematologic malignancies.
- During this time frame, the FDA also approved two new imaging agents and expanded the use of 12 previously approved cancer therapeutics for additional cancer types, including an immune checkpoint inhibitor for pediatric and adult patients with a rare type of sarcoma.
- Since 2011, the FDA has approved 11 immune checkpoint inhibitors, many of which are approved for multiple cancer types, making this therapy an option for 20 cancer types and any tumor with certain specific molecular characteristics.
- Since 2017, the FDA has approved six chimeric antigen receptor (CAR) T-cell therapies to treat various hematologic malignancies.
- Immunotherapy research is expanding, with researchers combining the power of other cells in the immune system with recent advances in gene editing to develop more personalized and effective versions of adoptive cell therapy for solid tumors; developing mRNA-based vaccines and therapeutics to treat cancer; and targeting the gut microbiome to increase the efficacy of cancer immunotherapy.
Ongoing Challenges in Cancer Care
Despite these advances, the report recognized the persistent challenges remaining in cancer care, including an estimated nearly 2 million new cancer cases that will be diagnosed this year and more than 608,000 people who will die of the disease. Other challenges include the following:
- Ongoing cancer disparities in racial and ethnic minority patients as well as other medically underserved populations shouldering a disproportionally higher burden of cancer. These patients are also less likely to receive standard-of-care treatment. Although advances have been made in identifying, understanding, and addressing some of these disparities, according to the report, more research and policy solutions are urgently needed to ensure equitable progress against cancer.
- Uneven progress made against different cancer types—for example, pancreatic cancer and glioblastoma, which carry extremely low 5-year survival rates
- Increasing incidence rates for some cancers, including young-onset colorectal cancer, pancreatic cancer, and uterine cancer, in part because of the rising rates of obesity
- Rising financial toxicity for cancer survivors. According to the report, in 2019, patients with cancer paid an estimated $16.2 billion in out-of-pocket cancer care costs and lost an additional $5 billion in “time costs.”
Call to Action
To overcome these challenges, the AACR Cancer Progress Report 2023 calls on Congress to support robust, sustained, and predictable annual funding growth for the NIH and NCI by providing increases of at least $3.465 billion and $2.6 billion, respectively, in their fiscal year (FY) 2024 base budgets. According to the report, from 2010 to 2019, NIH funding contributed to the development of 354 of 356 new drugs, including many cancer drugs, approved by the FDA.
The AACR is urging Congress to take the following steps:
- Provide $1.7 billion in dedicated funding for Cancer Moonshot activities in FY 2024 across the NCI, FDA, and the Centers for Disease Control and Prevention (CDC), with the assurance that Cancer Moonshot funding will supplement—rather than supplant—NIH funding in FY 2024.
- Designate at least $472.4 million in FY 2024 appropriations for the CDC Division of Cancer Prevention to support comprehensive cancer control, central cancer registries, and screening and awareness programs for specific cancers.
- Allocate $50 million in funding for the Oncology Center of Excellence at FDA in FY 2024 to allow regulators to have the necessary staff and tools to conduct expedited reviews of cancer-related medical products.
“This 13th unveiling of the AACR Cancer Progress Report continues a tradition of trying to raise awareness of the advances and progress that we are making in cancer research and delivering that to patients …to save the lives of patients with cancer,” said Philip Greenberg, MD, FAACR, President of the AACR, during a press briefing announcing the findings in the report. “The progress that has been made is a consequence of federal investment in the NIH, NCI, FDA, and the CDC and is a [testament] of just how effective and critical NIH funding is.”
Formation of the AACR Cancer Centers Alliance
During the press conference, Margaret Foti, PhD, MD (hc), Chief Executive Officer of the AACR, announced the formation of the AACR Cancer Centers Alliance, which aims to bring together the nation’s cancer centers with the goal of markedly expanding the scope and impact of world-class cancer institutions to benefit all patients with cancer. The initiative will seek to accelerate the pace of discovery by providing an ongoing mechanism for transferring new knowledge; sharing resources; developing national demonstration projects; and driving innovation that impacts cancer science, cancer care delivery, and science and health policy. An article outlining the Alliance’s initial plans was published in Cancer Discovery and will be published subsequently in ACCR’s nine other peer-reviewed journals.
The Alliance will initially focus on four main areas of collaboration:
- Basic and translational research
- Clinical research, clinical trials, and regulatory science and policy
- Education; training; professional advancement; and diversity, equity, and inclusion
- Speaking with a unified voice.
“The AACR Alliance, we believe, will become a powerful…force driven by the AACR, and it is an organization and an infrastructure and a collaborative alliance that we as cancer center directors have sought for many years,” said Cheryl L. Willman, MD, Executive Director of the Mayo Clinic Cancer Programs, Director of the Mayo Clinic Comprehensive Cancer Center, and subgroup Chair of the Alliance, Speaking With a Unified Voice. “We are so honored to be able to work with the AACR to truly achieve that vision.”
