Abrahams E.,Personalized Medicine Coalition |
Foti M.,American Association for Cancer Research |
Kean M.A.,Cambridge Healthcare
Clinical Cancer Research | Year: 2015
Significant progress has been made in the past 50 years across the field of oncology, and, as a result, the number of cancer survivors in the United States is more than 14.5 million. In fact, the number of cancer survivors continues to grow on an annual basis, which is due in part to improved treatments that help people with cancer live longer, and improvements in early detection that allow doctors to find cancer earlier when the disease is easier to treat. However, in spite of this progress, innovation in cancer research and care is at risk as the rise in health care spending is leading to significant pressure to contain costs. As the oncology community seeks to ensure that innovation in cancer research and care continues, it is imperative that stakeholders focus their attention on the value that the research and care continuum provides. Over the past several years, the Turning the Tide Against Cancer initiative has worked with the cancer community to accelerate the delivery of patient-centered, high-quality cancer research and care, while addressing value and cost. This article highlights policy recommendations that resulted from the convening of an expert working group comprising leaders from across the oncology field. Of the recommendations, the coconveners have identified several issue areas that merit particular • Support FDA's efforts to modernize its framework for bringing new medicines to patients, through facilitating and implementing innovative approaches to drug development and regulatory review. • Ensure that cancer clinical pathways or similar decisionsupport tools are transparent; developed through a physiciandriven process that includes patient input; and meet minimum standards for clinical appropriateness, timeliness, and patient centeredness. • Support oncology decision-support tools that are timely, clinically appropriate, and patient centered. • Build on existing efforts to convene a multistakeholder committee and develop a report on ways to define and measure value in oncology care, taking into account many of the complex dynamics associated with measuring value, including the interests and needs of patients, as well as the importance of committed and ongoing support for innovative research. These policy options are intended to further the national dialogue and represent meaningful and actionable steps toward supporting cancer research and care that is innovative, efficient, and focused on the patient. © 2015 AACR. Source
For many of the 18,000 people who were in New Orleans last week for the annual meeting of the American Association for Cancer Research, the highlight came when US vice-president Joseph Biden took the stage. Biden heads the US National Cancer Moonshot Initiative, which aims to double the pace of cancer research. He has consulted with hundreds of cancer researchers during his ‘listening tour’ to lay groundwork for the programme. Biden seems to have been paying attention. He ran through a list of familiar obstacles posed by what he called “cancer politics” — the difficulties in conducting interdisciplinary research and sharing data, and the lack of incentives to reproduce published results, among others. But it was when he made a joke about how long it takes to get a federal grant — “It’s like asking Derek Jeter to take several years off to sell bonds to build Yankee Stadium,” he said, referring to a famous baseball player — that it really hit home. The audience laughed and clapped; a few even gasped in surprise. The realization struck: the vice-president was clued up. Biden made it clear that he was not the only one who was listening. At a recent nuclear-security summit with heads of state gathered round, US President Barack Obama began by noting that many of them had asked about Biden’s cancer initiative. Several countries, Biden said, then joined with the United States in a memorandum of understanding about how they could work together to fight cancer. Are they right to be so enthusiastic? Certainly the flaws in Biden’s plan — not least the name — should not distract from its potential. His National Cancer Moonshot Initiative could yet receive US$1 billion in funding: not enough to ‘cure’ cancer, obviously, but perhaps enough to make significant changes in how cancer research is done if scientists help to target the money properly. And yes, the implications could yet spread beyond US borders — particularly if international researchers weigh in with their thoughts about how best to accelerate the pace. The US National Cancer Institute has made it clear that it wants to hear recommendations from the community, and has a website dedicated to stimulating participation (see go.nature.com/cc5crk). This participation need not be restricted to US researchers: international scientists and clinicians should submit recommendations, too. And, if the US project is as well received elsewhere as Biden claims, then scientists in those nations should look for ways to band together and marry their unique resources. Some countries have meticulous databases of health outcomes; others may have unique computing power or long-running longitudinal studies. And researchers in all countries face similar challenges of data sharing, reproducibility and interdisciplinary research. These topics are also not cancer-specific: researchers in other fields have much to offer — and to gain. Biden said that after Obama’s State of the Union address, in which he appointed Biden head of the moonshot initiative, one of the first people to contact him was the US energy secretary Ernest Moniz. The Department of Energy has supercomputing power that could aid cancer researchers, the secretary said. Researchers from other fields can bring fresh perspectives to and reap the rewards of a coherent cancer-research strategy. In a US Congress that is paralysed by partisan bickering, the fight against cancer should find common support from lawmakers. Researchers can come together and show them the way.
NEW ORLEANS — Colorectal cancer has been linked to a number of risk factors, such as inactivity, smoking and eating a lot of red meat. Now, a new study suggests a slightly more surprising risk factor: long legs. Compared with people who had shorter legs, those with longer legs had a 42 percent higher risk of developing colorectal cancer, according to the new study presented here today (April 19) at the American Association for Cancer Research's annual meeting. Evidence from previous studies has suggested that taller people in general are more likely to develop colorectal cancer, said Guillaume Onyeaghala, a graduate student in epidemiology at the University of Minnesota and the lead author of the study. Researchers have two hypotheses that may explain the association between height and cancer risk, Onyeaghala told Live Science. [Top 10 Cancer-Fighting Foods] One idea is that because taller people have longer colons (and therefore, more surface area within the organs where colon cancer could develop), they have more chances to develop the condition, Onyeaghala said. The other suggestion is that increased levels of growth hormones — which affect leg length in particular — are also the driving factor for colorectal cancer, he said. (The growth hormone "insulin-like growth factor 1" is elevated during puberty, and has been shown to be a risk factor for colorectal cancers at high levels, the study said.) The researchers looked at data on participants in the Atherosclerosis Risk in Communities Study, a long-running cohort of more than 14,500 men and women. Specifically, the new study examined three aspects of the participants' height: overall height, torso height and leg length. Researchers also looked at how many participants developed colorectal cancer over the nearly 20-year study period. The only factor that was linked to people's colon cancer risk was their leg length; the researchers did not find a significant link between people's overall height or torso height and their cancer risk, Onyeaghala said. [10 Do's and Don'ts to Reduce Your Risk of Cancer] Because sex is related to height, the researchers also looked at men and women separately. Results showed that in men, those with the longest legs (an average length of 35.4 inches, or 90 centimeters) had a 91 percent greater risk than those with the shortest legs (an average length of 31.1 inches, or 79 cm), Onyeaghala said. In women, there were no statistically significant differences in risk. Because leg length was more strongly associated with colorectal cancer risk than were sitting height or overall height, these results support the hypothesis that the growth factors that drive bone growth in the legs are a risk factor for the disease, Onyeaghala said. (However, the idea that a longer colon is to blame cannot be ruled out based on these results.) The findings have not been published in a peer-reviewed journal. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
The recent launch of multiple major US cancer initiatives has infused cash into immunotherapy, one of the most promising new methods of cancer treatment. But researchers warn that the money may be wasted without concrete plans to coordinate the programmes. “There’s a lack of overt leadership, and in the absence of a logical strategy we have a tendency to throw plates of spaghetti against the wall and hope it sticks,” says Ira Mellman, vice-president of cancer immunology at the biotechnology company Genentech in South San Francisco, California. The broadest programme is the US government’s National Cancer Moonshot, which hopes to receive US$1 billion by next year for 8 areas of cancer research. Immunotherapy, which recalibrates the body’s own immune defence against cancer, is among them. It “is poised to be a critical part of our nation’s anticancer strategy”, the project’s leader, US vice-president Joe Biden, said last week at the annual meeting of the American Association for Cancer Research (AACR) in New Orleans, Louisiana. An advisory panel will release more-detailed plans for the government programme in June. Meanwhile, three privately funded immunotherapy research projects are gearing up: the $250-million Parker Institute for Cancer Immunotherapy, funded by Sean Parker, co-founder of the music-file-sharing company Napster, and announced on 13 April; a $125-million Immunotherapy Center at Johns Hopkins University in Baltimore, Maryland, unveiled in March; and the Cancer MoonShot 2020 Program, announced in January by biotechnology billionaire Patrick Soon-Shiong. This sudden proliferation of cancer initiatives is reminiscent of the spate of brain-research projects launched in the past few years — some of which have foundered through poor leadership. Europe’s Human Brain Project, for instance, almost ran aground after a series of top-down decisions alienated the neuroscience community. By contrast, the US BRAIN Initiative set priorities after consulting with neuroscientists, and awarded grants through a conventional peer-reviewed process, ensuring community acceptance. Now cancer researchers are left wondering how their moonshots will proceed. At the AACR meeting, Biden said that he had met representatives of many cancer-funding projects. “Why is all of that being done separately?” he asked scientists in the audience, noting that progress is accelerated by collaboration. The privately funded initiatives are more concerned with meeting their own goals — and satisfying their funders — than with coordinating efforts in the field. “I don’t see my role as trying to answer this larger question about how does this all fit together,” says Jeffrey Bluestone, chief executive of the Parker Institute. “I’m focused on how to make sure what we do is impactful for patients.” But Douglas Lowy, acting director of the US National Cancer Institute (NCI), which is coordinating the government moonshot, notes an overlap with the leadership of the various projects. Soon-Shiong, Bluestone and leaders of immunotherapy initiatives at Johns Hopkins and the University of Texas MD Anderson Cancer Center in Houston are on the government initiative’s advisory panel. And on 18 April, the Biden moonshot launched a website to solicit research ideas. The aim, Lowy says, is to ensure that research areas recommended by the advisory panel do not duplicate topics being covered by the private initiatives. There is wide agreement on major questions regarding immunotherapy, however. For instance, researchers don’t understand why the approach works in only 15–20% of patients. Combining immunotherapies, and studying what distinguishes patients who respond, could make treatments more effective. Pharmaceutical companies are already developing new drugs and testing therapies in combination. Philip Gotwals, executive director of oncology research at the Novartis Institutes for BioMedical Research in Cambridge, Massachusetts, estimates that industry has spent upwards of $1 billion on the field. But scientists see a lack of basic cancer immunology research, even in the new programmes. “Many of these initiatives are moving forward ideas that are already out there,” says David Raulet, faculty director of the Immunotherapeutics and Vaccine Research Initiative at the University of California, Berkeley, which began in March. Many researchers are looking to the Biden project to make a big investment in basic cancer immunology and to address broader barriers to research, such as data hoarding. Gotwals, for instance, notes that the results of industry-sponsored clinical trials now under way could help other companies to decide which approaches to test, but that results are typically not made public until 9–12 months after a trial ends. Companies are reluctant to share data before then, both to comply with regulatory requirements and to protect their intellectual property. “It’s not trivial to figure out how to make that work,” Gotwals says. Biden seems to be hearing that message. At the AACR meeting, he said that data sharing often comes up when he speaks to scientists about the moonshot. Lowy says that the NCI is already planning to open a Genomic Data Commons in June to host detailed information on cancer patients. Sharing data collected in company-sponsored clinical trials is trickier because patients must give informed consent. In the meantime, the government moonshot faces a major hurdle: its funding is at the mercy of legislators who may be loath to give US President Barack Obama a victory in his last year in office. “It will be very difficult for us to initiate all of the programmes that we’re looking forward to the blue-ribbon panel recommending if there isn’t funding,” Lowy says.
NEW ORLEANS — Eating nuts has been linked to a number of health benefits, such as a reduced risk of obesity, diabetes and heart disease. Now, new findings from South Korea suggest that a nut-rich diet may also reduce a person's risk of colon cancer. The researchers found a reduction in this risk for both men and women, according to the findings, presented here today (April 18) at the American Association for Cancer Research's annual meeting. Eating a serving of nuts three or more times a week appeared to have a big effect on risk, said Dr. Aesun Shin, an associate professor of preventive medicine at Seoul National University College of Medicine in South Korea and an author of the study. In the study, a serving of nuts was considered to be 15 grams (0.5 ounces), Shin told Live Science. That's a smaller amount than what's considered a serving in the United States, she added. (A serving in the U.S. is 28 g, or 1 oz.) Although the researchers included many types of nuts in their analysis, peanuts were the most widely consumed nuts among people in the study. This may be due to the availability of peanuts in South Korea, the researchers said. [6 Foods That Are Good For Your Brain] To examine the relationship between eating nuts and colon cancer risk, the researchers looked at 923 patients who had been diagnosed with colon cancer and compared their diets with those of 1,846 people who did not have colon cancer. The researchers found that men who reported eating three or more servings of nuts a week had a 69 percent lower risk of colon cancer than those who reported eating no nuts. Women who ate three or more servings had an 81 percent lower risk than those who ate no nuts, according to the study. In addition, the researchers looked at several different types of colon cancer, based on the location in the colon where the cancer is found. Nut consumption was associated with a reduced risk across all of the different locations that the researchers examined, Shin said. The study does not prove a cause-and-effect relationship between eating nuts and having a lower risk of colon cancer, the researchers said. However, the researchers hypothesized that some of the compounds, including fiber and antioxidants, found in nuts may help reduce a person's risk of colon cancer. [Top 10 Cancer-Fighting Foods] Shin noted that a limitation of the study is that participants were asked to recall their own nut intake, and it's possible that they may have made mistakes. The findings have not been published in a peer-reviewed journal. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.