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Cancer death rate continues to decline amid progress, challenges, researchers report

The Philadelphia-based American Association for Cancer Research's annual report on progress against the disease says immunotherapy and precision medicine continue to drive the field forward.

Bill McCone’s advanced head and neck cancer disappeared just months after he went on a breakthrough immunotherapy drug
Bill McCone’s advanced head and neck cancer disappeared just months after he went on a breakthrough immunotherapy drugRead moreVera LaMarche, courtesy of the AACR

When his head and neck cancer spread to his lungs, Bill McCone was given a year to live.

The Gilbertsville, Pa., resident also enrolled in a clinical trial of Keytruda, the immune-boosting drug made by Merck.

Today, three years later, he has no evidence of cancer. And Keytruda, originally approved in 2014 for advanced melanoma, is proving the power of personalized, precision medicine. In May, the U.S. Food and Drug Administration approved Keytruda to treat any solid tumor cancer that has specific genetic features. That makes it the first drug to target cancer based on genetic markers, without regard to the organ where the malignancy originated.

Keytruda and McCone are highlighted in the annual cancer progress report issued Wednesday by the Philadelphia-based American Association for Cancer Research.

The 2017 report hails the 25 percent fall in  U.S. cancer death rates from 1991 to 2014, while five-year survival rates for all cancers rose from 49 percent in the mid-1970s to 69 percent in 2013.

Moreover, in the past year, the FDA has approved nine new cancer drugs and expanded the approved uses for eight more. Two of the new drugs are in the revolutionary class of immunotherapies, called "checkpoint inhibitors," that includes Keytruda. (And the report was finalized just before the Aug. 30 approval of the world's first genetically engineered immune therapy, Novartis Pharmaceuticals'  T-cell treatment for pediatric leukemia, which was pioneered at the University of Pennsylvania and Children's Hospital of Philadelphia.)

"Since I was in medical school in the late 1970s, I have seen a transformation in cancer care," AACR president Michael A. Caligiuri says in the executive summary. "This change is a result of tremendous advances in basic and applied research."

Of course, it's not all good news. More than 600,000 people will die of cancer this year, and the burden falls disproportionately on certain groups, including the poor, the elderly, and racial minorities, the report says.

Soaring drug prices are a huge, unresolved issue, with newer drugs like Keytruda costing more than $100,000 a year. And "some individuals continue to expose themselves to preventable causes of cancer," including  smoking, obesity, and tanning devices, the report says.

Although Congress has increased funding for the National Institutes of Health in recent years, discretionary budget caps threaten to prevent "robust, sustained, and predictable growth of the NIH budget," the report says.

Another ongoing challenge is boosting childhood vaccination rates against the human papilloma virus. HPV causes cervical cancer as well as rarer malignancies including head and neck cancers like McCone's. Merck's leading HPV vaccine came on the market in 2006, yet "most U.S. adolescents have not received the full HPV vaccine course."

A neck lump led to McCone's diagnosis of an HPV-driven cancer that began on a tonsil. "It was a total shock," McCone says in the report. " I knew that my two daughters had received the HPV vaccine, but my son had not. Right away, we got him vaccinated."

McCone's cancer spread despite radiation and a molecularly targeted anti-cancer drug. Only two slots were left in the Keytruda trial when he signed up at Fox Chase Cancer Center. Within months, the drug wiped out his lung tumors by removing a immune system brake, or checkpoint, that cancer exploits to evade the body's natural defenses.

"It is miraculous what it did, so let's keep the funding going and get this thing knocked out of the way," McCone urges.