<i>Cancer Research</i> Celebrates the 50th Anniversary of the National Cancer Act and a Future of Hope
Authors: Chi Van Dang
Journal: Cancer Research (2021)

As an everlasting holiday gift, President Richard Nixon signed the National Cancer Act into law on December 23, 1971, to strengthen the United States National Cancer Institute (NCI) and to catalyze life-saving discoveries. This year, we celebrate the 50th anniversary of the Act as the holiday season brings a time for reflection and reasons for hope. The galvanization of the cancer research community has led to discoveries that have tangibly improved the lives of many patients with cancer and survivors. Cancer Research published many of these discoveries through landmark papers, which have culminated in strategies that benefit patients. We witness in awe the progress made for patients with cancer, and at the same time, we are humbled by the complexity of cancer biology, human variability, and the many remaining unmet clinical needs. Despite recent research advances, cancer still kills about as many Americans each year as the COVID-19 pandemic to date. Cancer claims over 600,000 U.S. lives annually, that is 600,000 entire worlds as gleaned from the Talmud adage: “…whoever saves a life, it is considered as if he saved an entire world.”The National Cancer Act authorized the NCI with the wherewithal to stimulate cancer research as a national priority. With concerted efforts championed by the NIH, the completion of the human genome sequence consequentially enabled implementation of The Cancer Genome Atlas. The NCI supported cancer research that generated tangible changes in the course of cancer in patients. The development of tamoxifen, the identification of new DNA-damaging therapeutics, and the discovery of oncogenes have led to the development of targeted therapeutic strategies that result in lasting responses in chronic myelogenous leukemia and prolonged survival in patients with lung and breast cancer. Over 35 oncogenic kinase inhibiting cancer drugs have been approved by the FDA. The discovery of BRCA1 and BRCA2 as guardians of the genome resulted in PARP inhibitors that have substantial clinical benefits. The innovation of human papillomavirus vaccines culminated in effective cancer prevention. Recently, the remarkable clinical advances in immunotherapy with drugs, antibodies, and cell therapies such as expanded tumor-infiltrating lymphocytes and chimeric antigen receptor engineered T cells have generated durable clinical remissions that oncologists could now describe as “cures” without trepidation. It is also notable that these advances have been catapulted by philanthropic support for cancer research, such as that of Stand Up To Cancer, for which the American Association for Cancer Research (AACR) is the scientific partner, and Cancer Research UK, among other private and institutional philanthropists.To further advance cancer research, the National Cancer Act also established the NCI Cancer Centers program to support institutions leading the way in the prevention, diagnosis, and treatment of cancer. While funding was initially allocated for the establishment of 15 cancer research centers and local cancer control programs, there are now 71 NCI-designated cancer centers across the country. These centers have been at the forefront of basic, translational, and clinical discoveries, and they serve as the point of care for numerous patients with cancer.Since the establishment of the National Cancer Act in 1971, notable landmark findings have been published in Cancer Research, for example, the identification of free circulating DNA in patients with cancer (1), establishment of estrogen receptor status as a prognostic marker for breast cancer (2), creation of one of the first in vivo prostate cancer models (3), discovery of TP53 loss of heterozygosity in colorectal cancer (4), detection of high expression of the hypoxia-inducible factor in human cancers (5), documentation of the hypermethylation profile of human cancer (6), elucidation of the tumor-promoting role of cancer-associated fibroblasts (7), and description of arginase-producing myeloid cells (myeloid-derived suppressor cells) that suppress antitumor T-cell function (8). As a result of these and other advances, we now have over 17 million (5.1% of the population) cancer survivors in the United States compared with 3 million (1.4% of the population) in 1971. To commemorate the 50th anniversary of the National Cancer Act, Cancer Research has highlighted some key NCI-funded research published in the Journal with commentaries (https://cancerres.aacrjournals.org/).The tangible accomplishments from the 1971 National Cancer Act provided legislative proof of concept that further catalyzed additional budgetary inflection points. The funding of the 21st Century Cures Act in December of 2016 was a notable development. The Cancer Moonshot, as part of the Cures Act, is funding transformative cancer research to drive accomplishments in 5 years that would usually take over a decade. This effort, launched under the direction of former Vice President Joe Biden, resulted in tangible outputs, such as the Human Tumor Atlas Network and the Immuno-Oncology Translational Network that aim to define therapeutic vulnerabilities of cancers through deep dives into the tumor microenvironment and immunity down to the single-cell level. These efforts among others should provide the foundation for understanding therapeutic resistance and tumor heterogeneity. Real-world cancer care issues are also addressed by the Moonshot initiative that supports research in early detection strategies and implementation science. Overall, the Moonshot has made tangible progress on over 240 research projects to advance our options for preventing, diagnosing, and treating cancer.Even with all the progress achieved since 1971, there remains a great sense of urgency for dealing with therapeutic resistance in both more responsive cancers such as melanoma and deadly cancers that are largely refractory to therapy, such as glioblastoma and pancreatic cancer. Likewise, there is an urgent need to catalyze additional breakthroughs for childhood and rare cancers. These challenges are cause for redoubling our efforts for another inflection point in cancer research. We collectively cheer the establishment of the National Cancer Act 50 years ago and now look into the future with great hope that additional cures will come from increased investment in cancer research. New ideas are welcomed to meet the urgency of patients with cancer waiting for cures, such as the establishment of the Advanced Research Projects Agency for Health (ARPA-H), modeled after the Defense Advanced Research Project Agency (DARPA) that was designed for high-risk high-gain research and development of projects to serve the needs of the Department of Defense.DARPA efforts accomplished remarkable advances such as catalyzing the creation of the internet and global positioning system, engineering unmanned aircrafts, and creating stealth technology for military aircrafts. Likewise, it is envisioned that ARPA-H will have resources to deploy through mechanisms orthogonal to the traditional NIH peer-reviewed funding mechanisms. Unlike DARPA, ARPA-H's key stakeholder should be the patient with cancer rather than serving the needs of the government. Nimbleness and the willingness to take risks should be the driving mantra of ARPA-H if we are going to make breakthroughs in cancer research at an unimaginable scale. We need a concerted effort to enhance real-world cancer care and prevention through standardizing and collecting cancer data as a national mandate. With standardized cancer clinical data in a national database from electronic health records, we can begin to track cancers in real-time and glean unforeseen clues to improve cancer care and therapies. Not only will cancer health impacts be realized through advanced computational power and use of artificial intelligence, but economic impacts will also materialize through data-guided use of expensive cancer drugs and the ability to intercept cancer development early. This data warehouse will provide the foundation for a nimble coordinated national clinical trial infrastructure that enables the efficient and rapid testing of pipeline drugs generated in many laboratories and companies. Enhanced incentives through innovative regulatory and budgetary practices should be provided for private-public collaborations that augment cancer patient–centric interests and diminish self-serving goals while meeting the interest of shareholders.As we celebrate the past 50 years of cancer research, we look forward to the next 50 years of collaborative research efforts and risk taking for the sake of patients with cancer. Specifically, we look forward to assessing conceptual gaps in the understanding of cancer biology and renewed efforts to fill these gaps by developing new technologies. We also anticipate advances in the identification of patient and tumor-specific vulnerabilities to targeted medicines and technologies enabling high-throughput preclinical functional genetic screening for cancer dependencies in vivo. Computer science is expected to enrich our understanding of drug sensitivity and resistance, to innovate drugs against previously untargetable oncoproteins, and to identify approaches to reactivate dysfunctional tumor suppressors. We anticipate that generation of novel engineering platforms, including the creation of tumor-on-a-chip, and predictive mathematical models of cancer immunity and the microbiota will improve drug discoveries. New imaging technologies are expected to be developed that predict and monitor therapeutic responses as well as facilitate early detection. At the population level, there is a great need to elucidate behavioral and pharmacologic disease modulators, to fight obesity as a major cancer risk factor, and to detect cancer at its earliest stages to increase early disease intervention.Looking back with a sense of pride, we celebrate the 50th anniversary of the National Cancer Act and all the advances it facilitated. To help realize a hopeful future for patients with cancer, Cancer Research is poised to catalyze innovative research and to disseminate research reports that continue to advance our knowledge of cancer.No disclosures were reported.