On the eve of the 40th anniversary of President Nixon's "War on Cancer," the American Society of Clinical Oncology (ASCO) released a report that identifies specific areas that need improvement in order to advance cancer care and increase survival rates. More targeted treatments and streamlining clinical trials are necessary to accelerate our progress and win the war, they say.

"If we begin to make the needed changes, we believe that cancer research and patient care can become more targeted, more efficient and more effective," Dr. Neal Meropol, one of the three executive editors of the report. "We have a clear opportunity to accelerate the path of progress."

We have made great progress against cancer since Nixon signed the National Cancer Act in December 1971--including a record number of cancer survivors, a childhood cancer cure rate of 80 percent and a drop in death rates for many types of cancer. But, we have a long way to go.

More Targeted Treatment

We now know that certain cancer drugs may work well in one person, but not in another because of differences in the genetic makeup of the tumor or other factors. The oncologists’ report says research should focus on identifying the molecular pathways and biomarkers that determine who will respond best to a particular therapy, and how to best identify those patients.

So, instead of determining treatment based on where the tumor is located, which has been the standard practice, the oncologist runs a genetic test on the patient and the molecular characteristics of the tumor to determine how likely the cancer is to spread, and which of the available medications will work best.

According to the report, advances in genetic testing are being hindered by a regulatory maze and "years of under-funding" research. Drug companies also lack incentives to share data and collaborate on research.

The report outlines improvements needed in several key areas:

• Define cancer based on the characteristics of the tumor itself and the "environment" the cancer is growing in or the tissue around the tumor--not just on where it's located in the body.
• Develop new therapies based on a better understanding of cancer biology.
• Identify and prioritize molecular targets that have the greatest promise for improving survival.
• Increase participation in clinical trials and foster collaboration between the research and industry communities to develop new combinations of drugs that could target multiple pathways at once.
• Focus on "smarter, faster clinical trials so that we can move quickly and find out if new treatments are effective. This means avoiding "me-too" trials that don't have the potential to lead to major new advances in survival.
• Choose patients for clinical trials based primarily on the molecular characteristics of their tumors.
• Take advantage of innovations in health information technology such as electronic medical records as well information sharing systems that could alert physicians and patients to relevant trials.

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