Cancer research booms, cancer mortality declines, NCI director says

Cancer death rates are dropping. Government funding for cancer research is increasing. And the past few years have seen record numbers of cancer drugs approved for clinical use.

In short, “it’s a really special time to be in cancer research in the United States,” National Cancer Institute Director Norman Sharpless, MD, told an audience Jan. 10 at Stanford’s Frances C. Arrillaga Alumni Center. He was introduced by Steven Artandi, MD, PhD, the Laurie Kraus Lacob Director of the Stanford Cancer Institute and the Jerome and Daisy Low Gilbert Professor of Medicine and Biochemistry.

Sharpless’ talk came just days after the American Cancer Society announced that the United States in 2017 saw the biggest single-year drop in cancer mortality ever reported.

That “brisk decline” tracks with government data and, along with slowly shrinking disparities related to race and ethnicity, are cause for celebration, Sharpless said. 

However, he cautioned that the pace of the decline has been uneven among cancer types, and that mortality rates for some cancers related to obesity have improved only slightly, or worsened. Growing disparities between people in rural and urban settings also are cause for concern, he said: “Since 1990, those curves have been separating every year for reasons we don’t understand.”

Reductions of the mortality rates from lung cancer and melanoma are particularly notable, Sharpless said. Between 2012 and 2016, melanoma mortality dropped an average of about 5% a year for both men and women, and death rates from lung cancer fell an average of 3.1% annually for women and 4.3% annually for men, according to the American Cancer Society.

Lung cancer deaths projected to drop by half

Projections paint a still rosier picture for the future, he said, with lung cancer death rates estimated to drop about 50% for both men and women between 2020 and 2040. 

“What it shows,” Sharpless said, “is when you have an effective therapy, added to good prevention and good screening, you can really make a difference in these cancers.”

News also is positive for researchers seeking NCI funding, he said. The 21^st Century Cures Act, which was signed into law in late 2016, pumped an extra $1.2 billion into the institute’s budget from fiscal year 2017 to 2020, and the recent Childhood Cancer Data Initiative will add another $50 million a year for the next decade. That initiative supports the collection, analysis and sharing of childhood cancer data to improve treatments and outcomes.

Sharpless said many members of Congress tell him that cancer research is a good investment. “There’s a real sense of patients doing better,” he said. “They’re hearing from constituents that things are improving, and so I think that translates into really good support for the NCI.”

The $6.4 billion appropriated for the institute for fiscal year 2020 also includes more than $200 million to prioritize competing grants in cancer research and sustain commitments to continuing grants, he said. This is an important step, as the number of grant applications increased by about 50% between 2013 and 2019, Sharpless said. He added that he expects the earmarked money to increase success rates for NCI research project grant applications from about 11% to about 13%.

“Everybody wants to be in cancer research because we’re making so much progress and it’s going so well,” he said. “The last thing in the world we want to do is discourage those investigators from bringing their great ideas and great science to the [National Institutes of Health].”

‘Dominant’ player in pharma revenue

Sharpless said he observed further evidence of the cancer research boom during a stint last year as the acting commissioner of the Food and Drug Administration. Between April and October, 19 new cancer drugs and supplements were approved, he said; meanwhile, 2018 was a record year for cancer drug approvals, with more than 50. 

A possible reason for this growth, Sharpless said, is that over the past two decades, the percentage of pharmaceutical companies’ revenue coming from cancer drugs has climbed to about 28%, while the share from drugs for psychiatry and cardiovascular conditions fell dramatically.

“Cancer was sort of modest player,” Sharpless said, “but now it’s dominant.”

Going forward, he said, the NCI plans to focus on four key areas: emphasizing basic science research; developing the next generation of cancer researchers; increasing data aggregation and interpretation; and optimizing the design, administration and analyses of clinical trials.

A problem Sharpless hopes to address is the issue of undisclosed support — that is, researchers neglecting to report funding from industry or foreign countries. Most scientists want to follow the rules, but it can be confusing, he said. The institute is working with journals and professional organizations to explore options for a centralized database for the information.

“I want to reiterate that I think collaboration both with industry and foreign countries is wonderful. It’s absolutely essential, and we really want to support that,” Sharpless said. However, he added, “if you’re not telling us about funding you’re receiving, that’s against the rules and has been for 40 years.”