AACR Progress Report Highlights New Drugs Along With Disparities, Challenges of Obesity, Aging Population

This article was originally published by The American Journal of Managed Care.

According to American Association for Cancer Research (AACR), the past year has brought plenty of good news: 8 new anticancer therapies, 10 new uses for existing drugs, and 2 new diagnostic imaging agents. More people than ever in the United States are living after being treated for cancer—18 million. The rate of cancer mortality continues to fall, tumbling 2.3% between 2016 and 2019.

Yet, as noted in AACR’s annual Cancer Progress Report, cancer remains a top killer, claiming more than 600,000 lives each year in the United States. Disparities in who gets cancer—and who gets access to the best care—remain “a pervasive public health problem,” according to the report released Wednesday, which covered data from August 1, 2021, to July 31, 2022.

This year’s report came with a new warning: the Supreme Court decision and subsequent actions by states to restrict reproductive rights will have “serious detrimental effects” on health care that could affect patients with cancer. A statement released with the report warns that cancer treatments could be withheld if they might affect a pregnancy, causing disease to progress, “making it more difficult to treat and more likely to threaten the life of the woman.”

Failure to prevent cancer or ensure that equitable treatment exacts a toll, both in human and economic terms, the report states. Direct medical costs for cancer care in the United States “were estimated to be $183 billion in 2015, the last year for which these data are currently available; this cost is projected to increase to $246 billion by 2030.”

Despite all the advances in treating cancer, AACR said the need to prevent disease is urgent, as the cancer burden will rise with an aging population. There’s been tremendous progress in reducing smoking and increasing breast cancer screening, but there are troubling signs: uptake of vaping by teens and suboptimal rates of lung cancer screening.

Based on current trends, the report states, the number of new cancer cases each year will reach 2.3 million by 2040, with 80% occurring among those 55 or older. The report highlights the vulnerability of those living HIV if they develop cancer as they age. More than half (57%) will occur among those at least age 65, and this segment of the population will grow from 54.1 million in 2019 to 81 million in 2040, according to the report.

Support for research and regulatory activity. Overall, the report connects the long-term, bipartisan Congressional investment in cancer research with the remarkable advances in treatments and improved outcomes. AACR leaders call for continued funding for basic research, not only to develop therapeutics but also to expand use of artificial intelligence (AI) in cancer detection, and to do more to understand the physical, psychosocial, and financial effects of cancer on survivors. AACR called on Congress to consider tax policies that encourage philanthropic support for cancer groups.

“Basic research discoveries have driven the remarkable advances that we’ve seen in cancer medicine in recent years,” AACR President Lisa M. Coussens, PhD, FAACR, said in the report. “Targeted therapies, immunotherapy, and other new therapeutic approaches being applied clinically all stem from fundamental discoveries in basic science. Investment in cancer science, as well as support for science education at all levels, is absolutely essential to drive the next wave of discoveries and accelerate progress.”

Among the therapeutic advances AACR highlighted:

• FDA approval of belzutifan for cancers associated with von Hippel-Lindau disease;
• FDA approval for a new immune checkpoint inhibitor, relatlimab-rmbw, to treat melanoma;
• FDA approval of asciminib, an inhibitor of the BCR/ABL oncogene to treat chronic myelogenous leukemia;
• FDA approval of zanubrutinib, which inhibits an enzyme necessary for proliferation of B cells, to treat Waldenström macroglobulinemia and marginal zone lymphoma.

In a “Call to Action” section, AACR praised the relaunch of the Cancer Moonshot and sought specific appropriations in number of areas, including reauthorization of the Childhood Cancer STAR Act ($30 million), Childhood Cancer Data Initiative ($50 million), CDC Division of Cancer Prevention and Control ($462.6 million), and FDA’s critical regulatory science efforts, increase of $318 million ($3.653 billion total).

Disparities. The report notes that overall progress in survival is uneven, and some types of cancer are on the rise, especially those that appear to be related to obesity such as kidney, pancreatic, and uterine cancer; fatty tissue in women who are overweight is known to release estrogen that can increase the risk of uterine cancer. Between 2000 and 2018, the report states, the greatest increased incidence in pancreatic cancer was seen among women aged 15 to 34 years. Cases of colorectal cancer among young adults are also on the rise.

Cancer disparities are sharp between certain US populations, “including racial and ethnic minorities and several other medically underserved groups, [who] have not benefited equally from the advances against cancer,” the report states. Social determinants of health, such as lack of housing, income differences, lack of education, and inadequate or lack of health coverage all serve as barriers to receiving the best available care. For example, AACR called for reducing barriers for children on Medicaid by ensuring they can see an out-of-state pediatric specialist.

The report also highlighted passage of laws to improve diversity in clinical trials, including the DIVERSE Act to improve enrollment of minority populations in clinical trials, and the DEPICT Act, which requires FDA to issue rules for drug sponsors to meet enrollment targets that match the population of the disease the therapy will meet.

Challenges Remain. AACR’s report concludes with an overview of the work ahead. “Despite the major progress that is being made against cancer…there are several areas in cancer research and patient care that need to be addressed in order to provide opportunities for further advances,” the report states.

“Racial and ethnic minorities and medically underserved population groups in the United States continue to shoulder a disproportionate burden of cancer. The epidemic of obesity in US adults and youth, and that of e-cigarette use in the US youth, continue to threaten the progress made against cancer. Awareness of and adherence to routine cancer screening continue to be suboptimal. Participation and diversity in clinical trials that are reflective of the US cancer burden continue to be minimal.

“Financial burden of a cancer diagnosis on those directly affected by it, as well as on the US economy, continues to be substantial. And while cancer screening and clinical trials—both of which were severely impacted by COVID-19—are returning to prepandemic levels, the full impact of the pandemic on cancer research and patient care remains to be seen.”