March 11, 2019 — The latest advances in liquid biopsy and immunotherapy promise to revolutionize the way cancer is detected, treated, and cured. Yet there are both technical and systemic hurdles to overcome before realizing the possible benefits. At SXSW, in Austin, TX, on March 9, 2019, members of a panel discussion titled, “Frontiers of Cancer: Racing Toward A Cure” (#FrontiersOfCancer) shared insights from the medical researcher, pharmaceutical, and foundation perspectives.
Topics of discussion included investment; cancer research startups; novel discoveries in cancer and their impact on patient care;’ and how the collective cancer-care community can accelerate science and the rate at which advances translate into patient impact.
The panel was moderated by Amy Puliafito, director of product marketing, Freenome, an AI genomics company. The panelists were: Hillary Theakston, executive director, the Clearity Foundation; Bobbie Rimel, MD, director, Gynecologic Oncology Clinical Trials, Cedars-Sinai Medical Center; and Karl Handelsman, investment director, Roche Venture Fund.
The panel opened citing news that 2018 was a banner year for cancer breakthroughs:
- FDA drug approvals hit an all-time high—59 new drugs were approved in 2018, including 18 new cancer therapies. There was also an expanded use of 10 previously approved treatments to include new types of cancer.
- There was an expansion of cancer-relevant, at-home personal genomic tests, including FDA approval of direct-to-consumer DNA testing.
- The National Institutes of Health (NIH) launched the “All of US” Research program to collect relevant health data from at least 1 million Americans to accelerate research for, not just cancer, but across multiple disease areas.
- Enabled by genetic tests, the TAILORx trial found that most women with early breast cancer do not benefit from chemotherapy.
- Liquid biopsy companies attracted record investment based on the promise of better treatment-response prediction and early detection.
- Traditional pharma companies have been seeking out and acquiring precision oncology firms. For example, Roche acquired Flatiron Health and Foundation Medicine.
- After more than 10 years of stagnant funding, Congress passed four annual consecutive NIH and National Cancer Institute (NCI) funding increases. Most recently, lawmakers passed a $2 billion (5.4%) NIH funding increase for fiscal year 2019.
The panel also noted that momentum in cancer research, solutions, and patient results is building:
- The number of cancer survivors in the United States is growing. Today, 15.5 million Americans—nearly one in 20—are cancer survivors. Experts estimate this population will grow to 26 million by 2040. Death rates have declined by 27% since a peak in 1991.
- People with cancer are living longer. About 64% of U.S. patients diagnosed with cancer in 2005 have lived 10 years beyond diagnosis, compared with 35% of those diagnosed in 1975.
- More treatments are available for patients. More than 130 new cancer drugs and therapies have been approved by the FDA since 2006.
- Cancer research is accelerating. The number of medical journal articles with the word “cancer” in the title quadrupled in the last decade, from about 28,000 in 2007 to 120,000 in 2017.
- Still, a one-third increase in new cancer cases is expected over next decade, according to ASCO Clinical Cancer Advances Reports 2018 and 2019 and AACR 2019 forecasts.
However, even with all of this momentum, it was revealed during the panel discussion that it typically takes 17 years from the point at which an idea for a cancer solution is proposed to the time it is actually practiced by oncologists. Clinical approval, testing, evaluation, commercialization, and broad awareness in the cancer community all take time.
At the conclusion of the panel, Freenome’s Puliafito asked each panelist: “How close are we to a cure?” Each panelist said that cures for some, but not all, cancers may very well be found in their lifetimes.
Questions from the audience generated lively conversation about using AI and machine learning to better connect the cancer-care community to enhance and accelerate research. The good news is that in a survey conducted by Puliafito, the majority of oncologists are positively open to using AI and machine learning to aid their work.