More targeted treatments and efficient clinical trials are needed to speed the progress in finding better cancer treatments, a recent report says.

In a report released 40 years after the start of President Nixon's "War on Cancer," the American Society of Clinical Oncology (ASCO) pinpoints specific areas that need improvement to advance the cause of "personalized" cancer care.

"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," said Neal Meropol, MD, one of the three executive editors of the report. "We have a clear opportunity to accelerate the path of progress."

Assessment Of Progress

Tremendous progress has been made against cancer since President Nixon signed the National Cancer Act in December 1971, said ASCO President Michael Link, MD. That includes a record number of cancer survivors, a childhood cancer cure rate of 80% and a drop in death rates for many types of cancer.

Still, said Dr. Link, a pediatric oncologist at Stanford University, "We have a long way to go."

Researchers have learned that certain cancer drugs work very well in one person, but not in another because of differences in the genetic makeup of the tumor, among other factors.

One hopeful scenario outlined in the report: An oncologist tells a patient he has kidney cancer. Instead of determining treatment based on where the tumor is located, 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 in this specific situation.

The Way To Improvement

Though researchers are working to make those sorts of advances possible, progress is being hindered by a difficult-to-navigate regulatory maze and "years of under-funding" research, according to the report. Drug companies also lack incentives to share data and collaborate on research.

The blueprint recommends improvements in several key areas.

First, there's a need for developing new therapies based on a better understanding of cancer based not just on where it's located in the body, but by the characteristics of the tumor itself and the "environment" the cancer is growing in, or the tissue around the tumor.

"We need to identify and prioritize molecular targets that have the greatest promise for improving survival," said Dr. Meropol, chief of hematology and oncology at University Hospitals Case Medical Center & Case Western Reserve University, Cleveland.

Better Clinical Trials

Second, more participants for clinical trials need to be recruited and more collaboration needs to occur between the research and industry communities to develop new combinations of drugs that could target multiple pathways at once.

The medical community needs to focus on "smarter, faster clinical trials so that we can move quickly to find out if new treatments are effective," Dr. Meropol said.

Patients for clinical trials should be selected primarily based on the molecular characteristics of their tumors, said John Mendelsohn, MD, co-director of the Institute for Personalized Cancer Therapy at MD Anderson Cancer Center in Houston.

Finally, the system needs to take advantage of innovations in health information technology such as electronic medical records as well as "rapid learning systems," that, among other things, could alert physicians and patients to relevant trials, Dr. Meropol said.

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