What history can teach us about cancer innovation

As one of 30,000 oncology professionals attending the 51^st American Society of Clinical Oncology (ASCO) meeting, I am excited about the future of cancer care but I’m also concerned. As a researcher, I welcome the opportunity for scientific exchange at what is the most important oncology research gathering of the year. But as a physician, I’m concerned that the current focus on costs will jeopardize future progress and access to life-enhancing therapies – or even cures – for the patients who need them.

We have come so far in the fight against cancer in the last half-century, with some cancers now being managed as chronic diseases, and some others that are even curable. However, most of these advances did not come in leaps and bounds, but in small steps building on each other – something we call “continuous innovation.”

{mosads}Granted, cancer progress can’t come fast enough. But there’s an old adage: “Study the past to define the future” (Confucius). Could the history of cancer research hold clues to future discoveries? We looked for a historical database of cancer research but none existed, so we spearheaded the creation of one.

The result is a massive database and analysis tool – the Continuous Innovation Indicators™ or CII, developed by PACE (Patient Access to Cancer care Excellence), a global policy network formed to help ensure that more patients get access to the most effective cancer care, and that the policy environment for innovation against cancer improves.

Created with and for partners from the research, policy, payer, and patient advocacy communities, the tool takes a retrospective approach, examining thousands of pieces of evidence for progress against 12 specific cancers across all treatment types in the last half century.

The end products are a dozen big cancer stories, as well as smaller stories on: subtypes of cancer or specific patient groups; how treatments combine to produce better results; why progress tends to cluster in certain areas; and what policy changes might do to encourage progress in areas that have seen few steps forward.

Here are a few CII takeaways:

1. 1.  Cancer treatments evolve over time, often far beyond their initial indications. It is importantto avoid short-sighted decisions regarding the clinical utility of a new cancer treatment.  Evidence for trastuzumab’s utility has increased over the past 15 years. While it originally demonstrated benefit in the treatment of HER2-positive metastatic breast cancer, it later showed similar results in the treatment of HER2-positive gastric cancer. Within breast cancer, trastuzumab has also demonstrated additional uses, such as in combination with other treatments for breast cancer, including docetaxel and paclitaxel, as well as in additional treatment contexts, such as adjuvant therapy following surgery.
2. 2.  Quantifying and visualizing progress illuminates unmet needs and points to better solutions. While there is much talk about the increase in five-year survival for breast cancer, the outlook for women with metastatic breast cancer remains grim, with the five-year survival rate at 25.9 percent. The CII show that having more or better disease-tracking biomarkers for breast cancer could inform individual treatments, for example, by identifying which patients diagnosed with early breast cancer actually have more advanced disease and therefore would benefit from more aggressive therapy.
3. 3.  Continuous innovation is actually responsible for curing testicular cancer. The textbook storyline for testicular cancer points to four or five major innovations on the path to a successful cure. In fact, the CII illustrate that there were a total of 25 unique innovations that contributed to a cure, including the development of new anti-cancer agents, new drug combinations, and combinations with better results or improved side effect profiles.
4. 4.  Continuous innovation is also responsible for advances in immunotherapy. The CII show that long-term survival after application of immunotherapies dates back to the ‘80s, and that the future of immunotherapy in melanoma and indeed most cancers will likely involve combination therapies, including immunotherapy, chemotherapy, radiation and surgery.
   

There are countless other stories from the CII, most of which have yet to be written. We invite those who make cancer care decisions to use the tool, write those stories, and draw conclusions to inform cancer innovation policy. To learn more about the CII, visit: https://pacenetworkusa.com/continuousinnovation.php.

Gaynor is senior vice president of product development and medical affairs for Lilly Oncology.