AACR CANCER PROGRESS REPORT CANCER PROGRESS AACR 615 Chestnut Street, 17th Floor, Philadelphia, PA 19106-4404 2017 AACR CANCER PROGRESS REPORT 2017 Harnessing Research Discoveries to Save Lives AACR.org CancerProgressReport.org #CancerProgress17 For your FREE copy of the full report, go to www.CancerProgressReport.org AACR CANCER PROGRESS REPORT 2017 Harnessing Research Discoveries to Save Lives AACR.org CancerProgressReport.org #CancerProgress17 Please cite this report as: cancerprogressreport.org [Internet]. Philadelphia: American Association for Cancer Research; ©2017 [cited year month date]. Available from http://www.cancerprogressreport.org/. HARNESSING RESEARCH TABLE OF DISCOVERIES TO SAVE LIVES 48 Biomedical Research 48 CONTENTS Progress across the Clinical Cancer Care Continuum 54 Cancer Prevention, Detection, and Diagnosis 54 Simplifying the HPV Vaccination Schedule 54 Enhancing Cancer Detection AACR CANCER PROGRESS and Diagnosis with Technology 54 REPORT 2017 STEERING COMMITTEE iii Treatment with Surgery, Radiotherapy, and Cytotoxic Chemotherapy 56 AACR STAFF iv Improving Outcomes by Combining Existing Treatments 56 Reducing the Adverse Effects of Surgery 56 A MESSAGE FROM THE AACR 1 Tailoring Radiotherapy: Less Is Sometimes More 57 EXECUTIVE SUMMARY 3 Treatment with Molecularly Targeted Therapeutics 57 Cancer in 2017 3 Adding Precision to Treatment for Acute Myeloid Leukemia 61 Targeting Soft Tissue Sarcoma 62 Preventing Cancer: Understanding Risk Factors 4 Increasing Options for Patients with Ovarian Cancer 64 Screening for Cancer Prevention and Early Detection 4 Keeping Breast Cancer Cells at Bay 64 Harnessing Research Discoveries to Save Lives 4 Helping Some Lung Cancer Patients Breathe Easier 69 Looking to the Future 5 Treatment with Immunotherapeutics 72 Working Together to Releasing the Brakes on the Immune System 72 Overcome Cancer through Public Policy 5 Supporting Cancer Patients and Survivors 80 Call to Action 6 Optimizing Quality of Life across the Continuum of Cancer Care 81 A SNAPSHOT OF A YEAR OF PROGRESS 7 Palliating Physical Symptoms 81 CANCER IN 2017 8 Psycho-Oncology 85 Modifying Behaviors to Improve Outcomes 88 Research: Driving Progress against Cancer 8 Cancer: An Ongoing Challenge 8 LOOKING TO THE FUTURE 89 Variable Progress between Types of Cancer Fueling a New Era of Cancer and Stages of Diagnosis 11 Discoveries Harnessing Big Data 89 Disparities in Progress for Distinct Population Groups 11 Greater Effort to Reduce Cancer Health Disparities 92 A Growing Challenge 12 WORKING TOGETHER TO OVERCOME Cancer: A Costly Disease. Research: A Vital Investment 14 CANCER THROUGH PUBLIC POLICY 94 Robust, Sustained, and Predictable COMPREHENDING Funding Increases for Biomedical Research 95 CANCER DEVELOPMENT 18 The Beau Biden Cancer Moonshot: Cancer Development: Influences inside the Cell 18 Toward “Ending Cancer As We Know It.” 99 Cancer Development: Influences outside the Cell 20 Enhancing Support for Regulatory Science and Policy Activities at the FDA 99 Cancer Development: Integrating Our Knowledge 23 Developing and Training the Cancer Workforce of Tomorrow 101 PREVENTING CANCER: Policies to Advance UNDERSTANDING RISK FACTORS 25 Patient-centered Research and Care 102 Eliminate Tobacco Use 25 THE AACR CALL TO ACTION 103 Maintain a Healthy Weight, Eat a Healthy Diet, and Stay Active 30 APPENDIX 104 Protect Skin from UV Exposure 33 Glossary 104 Prevent Infection with FDA-approved Therapeutics for Cancer Risk Cancer-causing Pathogens 36 Reduction or Treatment of Precancerous Conditions 108 Limit Exposure to Environmental Risk Factors 37 FDA-approved Therapeutics SCREENING FOR CANCER for the Treatment of Cancer 109 PREVENTION AND EARLY DETECTION 38 Surgical and Radiotherapy Treatments for Cancer 112 What Is Cancer Screening and How Is It Done? 38 REFERENCES 113 Who Should Be Screened, When Should They Be Screened, and Why? 39 INDEX 120 Ryan C. Fields, MD AACR Associate Professor of Surgery Division of General Surgery Washington University School of Medicine CANCER St Louis, Missouri PROGRESS Jonathan L. Finlay, MB, ChB, FRCP Director of Neuro-Oncology REPORT 2017 Nationwide Children’s Hospital STEERING Columbus, Ohio Margaret Foti, PhD, MD (hc) Chief Executive Officer COMMITTEE American Association for Cancer Research Philadelphia, Pennsylvania Philip D. Greenberg, MD Michael A. Caligiuri, MD Head Chair Program in Immunology AACR President 2017–2018 Fred Hutchinson Cancer Research Center CEO and Director Seattle, Washington James Cancer Hospital & Solove Research Institute The Ohio State University Sandra J. Horning, MD Comprehensive Cancer Center Chief Medical Officer and Head of Global Product Columbus, Ohio Development Genentech, Inc. Melissa L. Bondy, PhD San Francisco, California Associate Director for Cancer Prevention and Population Sciences Michael V. Knopp, MD, PhD Baylor College of Medicine Vice Chair and Professor Houston, Texas Department of Radiology Ohio State University William S. Breitbart, MD Columbus, Ohio Chair Department of Psychiatry and Behavioral Sciences Joshua M. Lang, MD Memorial Sloan Kettering Cancer Center Assistant Professor New York, New York Department of Medicine University of Wisconsin School of Medicine and Public Health John D. Carpten, PhD Madison, Wisconsin Chair Department of Translational Genomics Patricia LoRusso, DO USC Keck School of Medicine Associate Director of Innovative Medicine Los Angeles, California and Professor of Medicine Yale Cancer Center Graham A. Colditz, DrPH, MD, MPH New Haven, Connecticut Associate Director Prevention and Control Kornelia Polyak, MD, PhD Alvin J. Siteman Cancer Center Professor of Medicine St Louis, Missouri Department of Medical Oncology Dana-Farber Cancer Institute George D. Demetri, MD Boston, Massachusetts Director Center for Sarcoma and Bone Oncology Wendy Stock, MD Dana-Farber Cancer Institute Anjuli Seth Nayak Professor in Leukemia Boston, Massachusetts The University of Chicago Medicine Chicago, Illinois AMERICAN ASSOCIATION FOR CANCER RESEARCH iii AACR STAFF Rajarshi Sengupta, PhD Brandon Leonard Project Lead Assistant Director Senior Project Manager, Cancer Progress Report Government Relations and Advocacy Philadelphia, Pennsylvania Washington, DC Karen Honey, PhD Sarah K. Martin, PhD Lead Science Writer Senior Regulatory Science and Policy Analyst Project Co-lead Washington, DC Senior Managing Editor, Science Communications Philadelphia, Pennsylvania Mary Anne Mennite Executive Editor and Senior Liaison to the CEO Brenna L. Adams Philadelphia, Pennsylvania Lead Designer Special Publications Designer Philadelphia, Pennsylvania Jon G. Retzlaff, MBA, MPA Chief Policy Officer and Vice President Science Policy & Government Affairs Nicholas M. Bashour Washington, DC Manager Science Policy Communications Washington, DC Anna B. Sadusky, PhD Director Regulatory Science and Policy Nicole M. Boschi, PhD Washington, DC Senior Science Policy Analyst Washington, DC Shawn M. Sweeney, PhD Project Advisor Paul J. Driscoll, Jr. Director, Project GENIE Coordinating Center Senior Director Philadelphia, Pennsylvania Marketing and Creative Services Philadelphia, Pennsylvania Mary Lee Watts, MPH, RD Director Thomas Gibbons Government Relations and Advocacy Senior Editor Washington, DC Program Development Philadelphia, Pennsylvania Joshua F. Goldstein Nicolle Rager Fuller Director Illustrator Brand Strategy Communications Sayo-Art, LLC. Philadelphia, Pennsylvania Bellingham, Washington iv AACR CANCER PROGRESS REPORT 2017 A MESSAGE collaborative efforts to generate big data is AACRProject Genomics, Evidence, Neoplasia, Information, Exchange FROM (GENIE). In January 2017, the AACR Project GENIE consortium publicly released nearly 19,000 de-identified genomic records collected from patients who were treated THE AACR at the eight participating institutions. The goal of this data release is to catalyze new clinical and translational research that will significantly enhance the future utility This is an incredibly exciting time for the cancer community. of precision medicine. In the United States, overall cancer incidence and death rates Despite the significant progress made against the many are declining, and an increasing number of people are living diseases we call cancer, there is a vital need for continued longer, higher-quality lives after a cancer diagnosis. This research innovation. This urgency is underscored by the progress has been made possible by individuals working sobering reality that the 5-year relative survival rates for across the continuum of cancer research from basic to U.S. patients diagnosed with some types of cancer, such as translational to clinical and population research who are liver cancer, pancreatic cancer, or the aggressive form of harnessing discoveries to drive advances across the clinical brain cancer with which Senator John McCain was recently cancer care spectrum and save an increasing number of diagnosed, glioblastoma, have not improved significantly lives from cancer. over the past several decades. The AACR Cancer Progress Report 2017 provides a comprehensive overview of the progress we are making Moving forward, we also need to ensure that everyone because of research, much of which is supported by benefits from the groundbreaking advances that are being federal investments in the National Institutes of Health made against cancer. Cancer can strike anyone—no age, (NIH) including the National Cancer Institute (NCI). gender, race, ethnicity, socioeconomic status, or political As highlighted in the report,