This is an exciting time, as reports of major news impacting oncology research are emerging, it seems, on a daily basis. Just recently, the National Cancer Institute (NCI) announced it had assembled a blue ribbon panel made up of cancer leaders, scientific experts, and patient advocates. The panel will influence NCI’s goals and direction for Vice President Joe Biden’s $1 billion National Cancer Moonshot Initiative, which will provide funding to promote finding new methods of detecting and treating cancer. Our government has also indicated its commitment to modernizing our research infrastructure through such proposals as 21st Century Cures and the president’s Precision Medicine Initiative.

The National Cancer Moonshot aims to forward progress through the enhancement of data access and facilitation of collaboration between doctors, researchers, philanthropies, patients and their advocates, and pharmaceutical and biotechnology companies. The Moonshot’s goal is to achieve a decade worth of advancement in 5 years, improving our ability to prevent cancer and detect it earlier, while making more therapies available to more patients.

The blue-ribbon panel will function as a working group under the presidentially appointed National Cancer Advisory Board. Its goal is to provide scientific guidance from cancer community thought leaders.

Members of the panel come from a variety of scientific disciplines, such as immunology, biology, diagnostics, genomics, bioinformatics, and cancer prevention/treatment. The panel also comprises investigators who have expertise in cancer health disparities and clinical trials. Significantly, cancer advocacy groups along with biotechnology and pharmaceutical companies will also be represented on the panel and its working groups.

Unfortunately, there are no radiation oncologists on the blue-ribbon panel.

In addition, funding for research in radiation oncology has been dwindling, and remains well below the level of other therapeutic areas. According to an analysis by the American Society for Therapeutic Radiology and Oncology (ASTRO), spending on radiation oncology awards represented only about 2.2 percent of the NCI’s budget for fiscal year 2015.

Over the next several months, the panel will consider how to advance the themes that have been proposed for the initiative. These themes include the development of cancer vaccines, advances in immunotherapy and combination therapies, single-cell genomic profiling of cancer cells, enhanced data sharing, and new approaches to the treatment of pediatric cancers.

Of the themes listed above, the development of radiation- driven personalized systemic therapy—involving radiation therapy, surgery, chemotherapy, and one of my personal interests, immunotherapy&mdash;may provide the best treatment options for many cancer patients. For those familiar with some of my publications on the area, radiation-driven immunotherapy (RDI) coupled may improve outcomes for our patients. Indeed, the deeper dive into how radiation influences systemic changes in vivo, in humans, is critical to understanding which patients are most appropriate for immunotherapy.

Building a collaboration of the best scientists in the cancer field is laudable; including radiation therapy and supporting the development of existing and adoption of powerful new combination therapies, equally so.

To promote advances in cancer care using radiation therapy, there must be consistent funding to expand the field. Providing specific input and funding for radiation oncology will ensure a stable future for the best minds as they set out to shoot for the moon...and beyond.

Articles

This is an exciting time, as reports of major news
impacting oncology research are emerging, it
seems, on a daily basis.

Shooting for the Moon…and Beyond

I recently had the opportunity to be involved in something truly special.

With more than 70,000 people in attendance, and potentially millions more watching on television, the 45th Annual Battlefrog Fiesta Bowl, held on Jan. 1, 2016, in Glendale, Arizona, filled the University of Phoenix Stadium with not only Ohio State and Notre Dame fans, but also with cancer survivors and people whose lives have been touched by cancer.

To honor those cancer survivors, as well as patients and caregivers—and to continue raising awareness of the importance of knowledge and education in cancer care&mdash;I had the privilege of being deeply involved with the 

) as its team blanketed the field with a 40’x40’ cancer care stadium flag prior to the national anthem that kicked off the event.

Additionally, all fans in attendance were asked to write the name of a loved one affected by cancer on a 

 placard before standing and displaying these cards as they participated in a moment of silence to honor and remember those individuals.

“With millions of people suffering daily from some type of cancer, ongoing education and research continue to be vital in improving patient outcomes, while increasing the control and confidence that cancer patients and caregivers feel throughout their cancer experience,” said Michael Hennessy Jr., president of 

 Media Group. “This initiative, in which we honor cancer patients, survivors, and caregivers at the University of Phoenix stadium, will further increase awareness that knowledge is strength in cancer care, while giving the audience an opportunity to sign up for 

 magazine, which provides the latest information in cancer updates, research and education.”

As a cancer expert and Fiesta Bowl Committee member, I think this was an outstanding initiative to honor those affected by cancer and educate fans on the importance of early diagnosis and education to improve patient outcomes in cancer care. I was truly honored to join 

 magazine on the field to unveil the stadium flag alongside cancer survivors, including prostate cancer survivor Don Meyers, my patient and one of the Fiesta Bowl founders, as well as my own father, prostate cancer survivor Howard Finkelstein.

Furthering the mission exemplified by this heartening experience, we present this, the latest issue of 

, which features three peer-reviewed research articles on the cutting edge of current radiation oncology practice.

An Outstanding Initiative of Honor and Remembrance

For those who think that men can’t die of prostate cancer, they can spend the day with me in clinic and meet some of the bravest men on the planet who are in the fight of their lives and are unfortunately afflicted with advanced metastatic prostate cancer.

Prostate cancer is the most commonly diagnosed cancer, affecting an estimated 220,800 men. In 2015, an estimated 27,540 will die of this disease. Thus, identifying those who have aggressive, potentially fast-growing disease is of paramount importance.

In 2008, there was indeed such an action. The United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening for men over age 75. In 2012, however, USPSTF extended the recommendation against PSA-based screening to all men.

Interestingly, there were no urologists or radiation oncologists on the USPSTF panel. The recommendations were based on the following beliefs: a) the screening process can result in pain, suffering, and a small risk for other complications; b) the screening process can result in a psychological consequence of receiving a false-positive test; and c) the screening process can result in men with prostate cancer receiving overtreatment because of the potential difficulty distinguishing prostate cancers that are life-threatening from those that are indolent. Yet, numerous expert organizations, including the American Urological Association and National Comprehensive Cancer Network, support prostate cancer screening with appropriate education.

For every action there’s an equal and opposite reaction. Fewer PSA draws imply fewer patients being diagnosed with prostate cancer, implying fewer referrals to urologists, implying fewer appropriate referrals to radiation oncologists.

, “Changes in Prostate Cancer Presentation for Radiation Oncology Care in Southwest Florida, 2007-2013,” the authors demonstrate a significant decrease in the volume of prostate patients seen across all radiation oncology and urology clinics in Lee County in Florida. The estimated number of low-risk patients decreased as did the number of intermediate- risk patients.

Although it is difficult to know exactly the reason behind the decrease, what profits wisdom when there’s nothing to be done? The fact is, there is a decrease in the volume of patients with prostate cancer who are seen early in the course of their disease. This occurs in an era in which treatments for prostate cancer have gotten better and better with improved radiation therapy techniques, surgical acumen, and novel agents such as Provenge, Xofigo, Zytiga, and Xtandi, which are defining the metastatic castrate resistant landscape in which a decade ago there was little.

Additionally, diagnostic improvements via available genomic testing and advanced imaging are highlighting more personalized care. Many believe we have been using primitive tools for the screening, diagnosis, and risk grouping of all patients. The introduction of advanced genetic testing for appropriate patients first identified by simple blood tests can potentially identify the patients at real risk of dying from their disease, so that ultimately the screening can be more targeted.

I encourage all who read this to think about what this means for current decision making in our own practices.

For those who think that men can’t die of prostate cancer,
they can spend the day with me in clinic and meet some
of the bravest men on the planet who are in the fight of
their lives and are unfortunately afflicted with advanced
metastatic prostate cancer.

Steven Eric Finkelstein, MD

Articles

Shooting for the Moon…and Beyond

An Outstanding Initiative of Honor and Remembrance

Prostate Cancer: Every Action Has a Reaction