In the midst of a major funding crisis for cancer research in the United States, more than 21,000 cancer researchers convened in Washington, D.C., less than two miles from the Capitol. At the biggest-ever meeting of the American Association for Cancer Research, scientists presented their latest advances in more than 6,500 research presentations – and stood together, literally, in opposition to proposed cuts for scientific research in the federal budget.
Fred Hutch News Service was on the ground at the 110th annual meeting of the AACR. Here are five top highlights from the conference:
Progress toward precision prevention strategies in cancer
We’re not all at equal risk for cancer. As cancer researchers develop more and more tailored treatments for cancers, could we personalize preventive strategies as well?
Throughout the annual meeting, the clear answer was: yes.
Dr. Ulrike Peters of Fred Hutch spoke at the meeting on how tools to study molecular changes in tissue samples can be integrated into epidemiologic research. Her focus is colorectal cancer, and she is leading efforts to develop precision-prevention strategies for this cancer based on integrating data on genetics and lifestyle risk factors.
“It’s really amazing how much progress has been made in identifying new drug targets in colorectal cancer,” Peters said. But even bigger lifesaving gains can be made in prevention, she said. “We really need to do more on the cancer-prevention side, by learning more about underlying mechanisms and taking targeted prevention approaches.”
Many cancers pass through a precancerous state — colon cancer, for example, typically arises from growths called polyps, and while most polyps are benign, some can become cancerous. Over the past couple years, several groups of researchers have called publicly for the development of an effort to characterize precancers’ genomics. The idea is that understanding the molecular changes involved in the development of precancers into cancer would open the door to precision approaches for preventing cancer and spur better methods of early detection. The call was picked up last year by the Cancer Moonshot Blue Ribbon Panel, which submitted its recommendations for the Moonshot in October.
The proposal is often called a Precancer Genome Atlas, or PCGA, named after the impactful national effort to characterize tumor genomes known as The Cancer Genome Atlas, or TCGA.
“It’s absolutely clear that the time is right for a PCGA,” said outgoing AACR president Dr. Nancy Davidson in her Presidential Address on Sunday. “It could galvanize cancer prevention like TCGA has advanced the development of targeted therapies.”
An entire session at the meeting was devoted to the concept, highlighting work by scientists like the Hutch’s Dr. Brian Reid. Reid studies a condition called Barrett’s esophagus that can lead to esophageal cancer, and he has mapped out the dynamics of many of the molecular changes involved in its progression. This summer, Reid and other leaders in the call for a PCGA will meet with the National Cancer Institute to further explore the idea.
Other presentations at the conference reported on new preventive strategies for cancer in development. These included experimental vaccines designed to train high-risk patients’ immune systems to stop the development or advance of malignancies like colon cancer or brain tumors, much like a measles vaccine trains your immune system to activate in case of exposure to the virus.
Health disparities
And yet, even as cutting-edge new methods for preventing cancers are developed, we already have effective ways to prevent many cancers, or catch them early when they can be more easily treated. Millions of people in the U.S. and around the world are at increased risk of developing or dying from cancer because they experience barriers in accessing care or are more likely to have environmental or lifestyle risk factors, like smoking. The conference held its first-ever President’s Select Symposium on Cancer Health Disparities, which featured presentations that illuminated these disparities in cancers like colon cancer and prostate cancer and efforts to overcome them.
In her closing address, Davidson showed a county-by-county map of cancer death rates in the United States, which was published by Seattle researchers in 2017. Counties with the lowest cancer death rates were colored dark blue and those with the highest rates were red.
“We’d like to have a United States that’s — in this case — all blue,” said Davidson, who is also the senior vice president and director of the Clinical Research Division at Fred Hutchinson Cancer Research Center and holds its Endowed Chair for Breast Cancer Research.
Genomically driven personalized medicine for cancer treatment
As genetic sequencing technology has become faster, cheaper, and more accessible, the movement toward therapy personalized to a tumor’s genomic profile is accelerating.
At the meeting, the gene known as HER2 was in the spotlight. Having extra copies of this gene can cause breast cancer to grow aggressively, and treatment for patients with this aberration typically includes a HER2-targeted drug. A few HER2-targeted therapies are currently approved by the FDA for treating certain breast and gastric cancers. But these aren’t the only cancers that are sometimes linked to aberrations in HER2 or related genes, and research groups at the meeting presented the results of trials exploring targeted, experimental drugs in other malignancies, including cancers of the colon, cervix, and bladder.
And new trial designs are emerging that align with our increasingly molecular definition of cancers. One of the HER2-targeted trials presented at the meeting was a Phase 2 trial known as SUMMIT that enrolled patients with 21 different types of cancer in many different parts of the body — but all of which bore mutations in HER2 or related genes. Basket trial designs are a hallmark of a new, personalized approach emerging in cancer treatment — in which the biological characteristics of a cancer are as important, if not more, than the organ in which it appears.
“We’ve seen a tremendous uptake in this study as [genetic] sequencing really comes into the community setting,” said study leader Dr. David Hyman of Memorial Sloan Kettering Cancer Center.
Immunotherapy drugs to treat more cancers in more ways
The standard of care for cancers like advanced melanoma and certain lung tumors has been transformed with the approval by the Food and Drug Administration in recent years of immunotherapy drugs. Such drugs, called checkpoint inhibitors, block tumors from shutting down cancer-killing immune responses, freeing patients’ immune cells to kill cancer cells.
A flood of studies at the conference explored the potential in experimental drugs with new mechanisms of action, new combinations of immune-modulating drugs, and new indications for existing drugs, including for notoriously aggressive and treatment-resistant cancers like ocular melanoma and triple-negative breast cancer.
“It’s clear that immune checkpoint treatment has joined the ranks of surgery, radiation, and chemotherapy as a pillar of cancer treatment,” said Dr. Padmanee Sharma of MD Anderson Cancer Center, who studies these drugs.
There was buzz around the skin cancer Merkel cell carcinoma, or MCC, an usual spotlight for a tumor so rare that it is diagnosed in only about 2,000 Americans a year. Investigators presented promising one-year follow-up data from a pivotal trial of a newly approved immunotherapy for this cancer, and another group of investigators presented the first reports of the experimental use of an approved drug called nivolumab (Opdivo) in MCC. And Dr. Aude Chapuis of Fred Hutch hinted at “very encouraging” results of a combination of checkpoint inhibition and immune-cell therapy in treating this cancer, which she’ll present in full this June at the American Society of Clinical Oncology annual meeting.
The investigators who conducted some of the landmark studies in the field — which led to the approval of checkpoint inhibition therapies for treatment-resistant, advanced non-small cell lung cancer, and melanoma — presented long-term follow-up data that demonstrate the potential for these therapies to boost long-term survival in patients with few other options.
For example, in the lung cancer trial, after five years of follow up, trial participants had an overall survival rate of 16 percent on nivolumab — which doesn’t seem impressive until you consider that the number is about four times what would be expected in these patients with additional chemotherapy instead of immunotherapy.
“It’s an exciting time, to be able to have long-term survivors to follow up,” said lead investigator Dr. Julie Brahmer of Johns Hopkins.
Unequivocal opposition to proposed cuts to the NIH
Throughout the five days of the conference, speaker after speaker made it clear that that the great advances underway in many types of cancer are seriously threatened by major proposed cuts to the National Institutes of Health budget.
“These proposals would severely damage the progress we’re making right now to prevent and treat cancer,” Davidson said in the conference’s opening session. The breast cancer oncologist called President Donald Trump’s proposed multi-billion-dollar cuts “truly appalling” and “short-sighted.”
“Cancer research funding is not something you can turn on and off like a faucet,” she said and emphasized that sustained funding is required to maintain research teams and ongoing research projects.
The president’s federal budget proposal in mid-March contained a cut of nearly 20 percent for the NIH. And, just last week, the president asked Congress to immediately pull out $1.2 billion from NIH research grants via a reduction in discretionary spending for the current fiscal year.
The proposed cuts were a “terrible shock,” Davidson said, as they came in the wake of 2016’s Cancer Moonshot launch led by former Vice President Joe Biden and last December’s passage of the 21st Century Cures Act, which provided an increase of $1.8 billion for federally funded cancer research. Also surprising, Davidson said, is that the proposals have come at a time when the pace of progress in research is accelerating.
“This is the time to increase investment in the NIH, not retreat,” Davidson said. (Read a statement on the proposed cuts issued March 16 by Fred Hutch President and Director Dr. Gary Gilliland.)
During the opening session, the audience in the airplane hangar-sized plenary hall stood for a photograph that the AACR planned to use in its lobbying efforts against the reduction in research funding. In near silence, hundreds stood to hold up signs bearing messages of support for cancer research: “Support medical research;” “Invest in lifesaving cancer research;” “Cancer research saves lives;” “Make NIH funding a national priority.”
The message was amplified powerfully by social media throughout the meeting. Cell-phone photos of the moment taken by dozens of people in the audience reverberated around Twitter under the conference hashtag, #AACR17, and popped up in slides during scientific talks.
Davidson’s impassioned defense of research funding was echoed by Biden himself, who spoke in a special session on Monday afternoon.
The “draconian cuts” in the proposed budget run “counter to this hope and the progress we’ve made,” the former vice president said.
“This is not the time to undercut progress. This is the time to double down,” he said.
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Susan Keown, a staff writer at Fred Hutchinson Cancer Research Center, has written about health and research topics for a variety of research institutions, including the National Institutes of Health and the Centers for Disease Control and Prevention. Reach her at skeown@fredhutch.org or on Twitter @sejkeown.
