NCI Leaders Optimistic about Meeting President’s Goal

In February, President Joe Biden set an audacious goal for the cancer community: Cut the number of deaths from cancer in half within the next 25 years.

“You don’t need to necessarily be a physician or even a scientist to think that that’s a big change. That’s huge,” said David Tuveson, MD, PhD, of Cold Spring Harbor Laboratory in New York and outgoing president of the American Association for Cancer Research (AACR), during the organization’s 2022 annual meeting, taking place April 8–13 in New Orleans, LA. “So instead of 600,000 people in our country, we’re going to lose 300,000 a year from cancer. That will take a lot of effort.”

However, both NCI Director Norman “Ned” Sharpless, MD, and Principal Deputy Director Douglas Lowy, MD, are optimistic that the goal can be met.

The two met with reporters at the AACR meeting to discuss the state of cancer research in the United States and answer questions about Sharpless’s announcement last week that he will step down as director of agency at the end of April, concluding a 5-year stint at the agency. Lowy will fill that role until Biden names a permanent successor.

“I think if you look at the pace we’ve been going at, we’ll need to accelerate that to meet the president’s goal. But I think that’s doable,” remarked Sharpless. “I think it’s a very achievable goal.”

Since the early 1990s, the cancer death rate has been declining, and the decline has been accelerating over the past several years thanks to tobacco control measures, greater use of mammography and increased screening, vaccinations against cancer-causing human papillomavirus (HPV), and targeted drugs and immunotherapies.

Additional opportunities could move the needle more quickly, Lowy said. He pointed to cancer screening and prevention, noting for example that eliminating hepatitis C infection through vaccination could spare tens of thousands of patients from liver cancer death.

Advances against RAS, a gene that is mutated in 25% to 30% of serious cancers, could have a significant effect on survival as well. “Ten years ago, it was an intractable problem,” Lowy noted. KRAS^G12C inhibitors have now been approved to treat certain lung cancers, and now the technology is available to develop inhibitors against KRAS^G12D, which is commonly found in pancreatic cancers, which is “where we haven’t been able to move the needle.” But, he added, “RAS is no longer an undruggable target.”

Researchers’ efforts to discover more biomarkers will also pay off, Sharpless and Lowy predicted. As well, genomic testing will increase, pointing patients to targeted therapies. Building on the success of monotherapies, the use of combination therapies will grow.

Where funding will come from to make further advances, however, hasn’t been clear. Biden’s proposed budget for fiscal year 2023 cuts nearly $200 million from the NCI. Funding for the first Cancer Moonshot, launched in 2016, is nearing its end, and Biden made no mention of funding for the second Moonshot that he announced in February. However, Sharpless noted that Congress controls the purse strings and that they have, in a bipartisan fashion, demonstrated strong financial support for the NCI. In addition, Congress just appropriated $1 billion to form the Advanced Research Projects Agency for Health to drive significant breakthroughs against diseases like cancer and Alzheimer disease.

As for the leadership transition, Sharpless said that Lowy is a “tremendously popular person” at the NCI and has served as acting director on two other occasions, most recently for 7 months in 2019 while Sharpless served as acting FDA commissioner. Lowy also developed a strong relationship with Biden when the two worked to launch the Cancer Moonshot under President Barack Obama. “He’s the ideal person to take over at this time,” Sharpless commented.

Lowy said he is looking forward to his “new” job and will embrace it. He quipped: “I am very enthusiastic about having my third once-in-a-lifetime opportunity” to lead the NCI. –Suzanne Rose