National Cancer Act prompts 50 years of progress

Since a “war on cancer” was declared half a century ago with the National Cancer Act of 1971, scientists and clinicians the world over, including those at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James), have made big gains against a formidable foe. But the war rages on.

RP: In 1971, many people equated a cancer diagnosis with a death sentence. Only one of two people diagnosed with cancer in this country could expect to live five years, compared to two of three people diagnosed today. Cancer in its many forms bore such a stigma that some people wouldn’t even say the word. Physicians were sometimes wary of discussing a cancer diagnosis with their patients. Today, although cancer is still widely feared, we know much more about the disease and are more open to addressing it, thanks to continual advances helping us better understand, prevent and treat it. The American Cancer Society and the National Cancer Institute estimate there are some 17 million cancer survivors in the United States and that the number will rise to over 22 million by 2030.  

RP: Perhaps the most significant overall advance is a more thorough understanding of molecular genetics. Discoveries in this discipline have illuminated biological changes that can cause normal cells to become cancerous. Cancer fundamentally arises from the body’s failure to properly regulate cell growth, so it’s critical to know how normal cells function and what goes awry within the cell to cause cancer. Specifically, I’d say some of the most critical basic-science advances of the past half century include: the discovery of oncogenes, which when mutated or overexpressed can cause cancer; the discovery of how blood vessel formation can sustain tumor growth and proliferation; the development of targeted therapeutics that, unlike chemotherapy, can more precisely attack the molecular causes of cancer and cause fewer toxic effects; and the development of immuno-oncology – which harnesses the body’s innate defenses against cancer – as another major modality for treating cancer in addition to the earlier modalities of surgery, systemic therapies (such as chemotherapy and hormonal therapy), precision or targeted therapies, and radiation therapy. We’ve seen substantial improvements in each of those modalities as well, along with better methods of diagnosing and preventing cancer. 

RP: There’s an unending list of individuals and research teams at Ohio State who’ve helped improve the cancer care landscape. Just a few examples are our work to develop drugs called Bruton’s tyrosine kinase inhibitors that have led to substantial gains in treating chronic lymphocytic leukemia; our pioneering studies of microRNAs that have opened a spectrum of new targeting agents that are making a difference in patient outcomes; and our groundbreaking work in the study of colorectal, prostate, lung, breast and brain cancers, as well as advances we’ve made against sarcomas and oral cancers. We have also done important work involving patients with Lynch syndrome (LS), an inherited condition that predisposes to several cancers. Our efforts have helped elucidate the genetic derangement underlying LS and have led to the establishment of an Ohio-wide screening program to identify individuals within family groups who may be vulnerable to LS-related colorectal cancer and other malignancies. Another major achievement we’re known for is the 1980s development of pentostatin as one of the first agents to secure durable remissions for patients with hairy cell leukemia (HCL), a disease first identified and described by scientists here in 1958. Pentostatin changed the natural history of HCL. 

RP: With 350 researchers and the third-largest cancer hospital in the nation, the OSUCCC – James integrates research with patient care more closely than ever. We rank 15th in National Cancer Institute (NCI) funding and are striving to reach the top 10. We’ve made substantial investments in immunotherapy through the 2019 opening of our Pelotonia Institute for Immuno-Oncology. We also have ambitious goals for developing a Center for Monoclonal Antibodies – the next frontier in immuno-oncology and precision medicine – as well as for expanding artificial intelligence and machine learning to align with university-wide priorities, and for enhancing cancer prevention strategies, early-detection efforts and treatment options among underserved populations. 

RP: As our understanding of cancer biology expands, many more forms of the disease will prove to be modifiable using increasingly less toxic approaches. Ultimately, I anticipate that a majority of cancers will be curable in most patients or at least controllable as chronic diseases, rather than the aggressive malignancies with unfortunately high likelihoods of lethal outcome that we still see all too often today.

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Raphael E. Pollock, MD, PhD, is a surgical oncologist and researcher who also directs The Ohio State University Comprehensive Cancer Center. His clinical specialty is treating patients with soft tissue sarcomas. Dr. Pollock is a professor in the Division of Surgical Oncology at Ohio State, where he holds the Klotz Chair in Cancer Research and directs the Sarcoma Research Laboratory. He has authored or co-authored hundreds of research articles and more than 20 books.