'Oncologists Can Feel Optimistic,' Says NCI Director

CHICAGO — Spontaneous applause from a packed hall greeted the announcement of $10 million in new funding for clinical trials here at American Society of Clinical Oncology (ASCO) 2018.

"The majority of this funding will be used to augment per patient reimbursement rates at 180 sites that treat adult or pediatric cancers," director of the National Cancer Institute (NCI), Norman Sharpless, MD, told the audience of oncologists and related health care professionals.

Large clinical trials are largely supported through the National Clinical Trials Network (NCTN) and similar groups, such as the NCI Community Oncology Research Program (NCORP).

"One of the major challenges for these networks over the past few years has been a rapid increase in the per patient costs for patients on trials," Sharpless commented. "NCI appreciates the problems that these skyrocketing costs have caused for NCTN trials, and today I am announcing that we are going to help."

"Every one of today's standard-of-care therapies is available because of a past successful clinical trial," he noted.

The $10 million in new funding was welcomed by ASCO.

"This new investment of funds will be a pivotal beginning to improving reimbursement rates and expanding clinical trial access to more patients," commented ASCO President Bruce Johnson, MD, in a statement.

"We need to give even more patients the chance to participate in these trials," he said, because they are "fundamental to making continued progress in cancer treatment and prevention."

Support From Congress

Sharpless also highlighted "the strong, bipartisan support from Congress" that the NCI and that National Institutes of Health (NIH) has enjoyed in recent years.

"For the fourth year in a row, we have seen budget increases for the NIH and NCI," he noted. "The fiscal year 2018 Omnibus spending bill passed in March 2018 provides a $275 million dollar increase to the NCI budget, as well as continued full funding for the Cancer Moonshot."

One consequence has been an increase in funding of investigator-initiated science, for example through the the funding of the Research Project Grants (the RPG pool).

"This year, I have dedicated an additional $127 million into investigator-initiated science," Sharpless told the audience, again to applause. "This is the largest increase to the RPG pool since 2003 and is possible thanks to significant increases in our congressionally appropriated budget over the past few years."

"Oncologists Can Feel Optimistic"

After a quick review of the rapid progress made in oncology in recent years, Sharpless commented that "with new discoveries, successful treatment approaches, continued research progress and additional funding, as a community, oncologists can feel a lot of optimism."

As a community, oncologists can feel a lot of optimism. Dr Norman Sharpless

"The potential for breakthroughs has never been greater than it is right now," he added. "Almost every day we learn of new discoveries, advances, and approaches that show promise. We have options. We have treatments…. There is enormous optimism in our field."

However, he also touched upon how to communicate that optimism to patients, and to the rest of the world, and even used the "C word" that most oncologists go to great lengths to avoid.

"An almost overarching worry of the cancer doctor today has become the management of expectations: We don't want to overpromise and give people — especially patients — false hope."

"But I am worried we have been losing the point," he told the audience full of cancer specialists. "I think we have become scared to tell our patients that we hope to 'cure' them, and it may be time to re-examine how we communicate our efforts in this area."

At the beginning of his speech, Sharpless reminisced about the early days of his medical career, when he was an oncology fellow at the Dana-Farber/Partners Cancer Care and attending his first ASCO meeting. "I was barely done with residency, and I was called upon to provide care for some sick and often desperate patients," he recalled.

"As an oncologist, I used to cringe at the notion of 'curing cancer' when talking to a patient," he said. "What if I told them they were cured, but then the cancer actually came back?"

Now, after years in cancer research, "I especially know why the notion of 'cure' makes so many of us uncomfortable," he said.

"Curing cancer, making it go away and never come back, is really hard, much harder than initially conceived, and the word 'cure' should not be thrown around lightly with vulnerable patients present," he commented.

Nevertheless, the fact is that "we are curing patients now, and more people than ever, even some people with really bad cancers, at very advanced stages," he emphasized. "I never thought I'd see some of the results that we are now seeing in metastatic lung cancer and melanoma."

But he also emphasized another point, throwing down the gauntlet.

"Even if the idea of curing cancer makes us uncomfortable, it is what our patients, and our funders, expect. They don't just want extended progression-free survival or enhanced quality of life, or reduced costs, or whatever other surrogate marker we might pick."

"They expect us to deliver," he said.

American Society of Clinical Oncology (ASCO) 2018. Presented June 2, 2018. No abstract

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