NCI Director’s Message: Fiscal Year 2024 Annual Plan & Budget Proposal
NCI Acting Director Dr. Douglas R. Lowy
For much of the past 50 years, a melanoma diagnosis was essentially a death sentence. Today, thanks to advances in cancer research, the outlook for people with melanoma—and several other cancers—has dramatically improved.
Over the course of my career, I have seen countless examples where cancer research has given hope to people who might once have had none. With the scientific opportunities available to us today and the right investments, we can create many more reasons for hope.
The extraordinary progress we have seen was made possible by decades of investments in basic, translational, clinical, and implementation research. Thanks to these advances, I am confident that we can end cancer as we know it—not only for a lucky few, but for all.
For instance, efforts to develop drugs that target mutant forms of KRAS, which drive more than 30% of cancers and were long considered undruggable, hit a major milestone in 2021: the first approval of a KRAS inhibitor. And more such drugs are on the horizon. Meanwhile, although lung cancer is still one of the leading causes of cancer death, its toll has dropped more rapidly in recent years, thanks to the combination of tobacco prevention and cessation, screening, and an explosion of Food and Drug Administration approvals for new drugs—including targeted therapies and immunotherapies—since 2010.
As a young cancer researcher decades ago, I could not have imagined the incredible scientific resources available to today’s researchers thanks to NCI support across the cancer research enterprise. For instance, many scientists supported by NCI grants conduct their research at state-of-the-art facilities, such as the 71 NCI-Designated Cancer Centers, with access to sophisticated technology that would have seemed like science fiction not long ago. Researchers are taking advantage of resources such as NCI’s National Cryo-Electron Microscopy Facility, Patient-Derived Models Repository, and Cancer Research Data Commons. Others are embarking on their careers through a wide array of NCI training programs and support for early-stage investigators.
Despite research advances that have led to steady—and, in some cases accelerating—declines in cancer death rates since the early 1990s, far too many people still face cancer’s devastating effects. We can do so much more. We can prevent more cancers. We can diagnose cancers earlier. We can develop more effective—and less toxic—therapies. We can unravel the mysteries of even the rarest and most treatment-resistant cancers. And we can ensure that these advances are available to all.
NCI will pursue many scientific opportunities that have the potential to greatly accelerate progress. In this Annual Plan and Budget Proposal, we highlight four examples:
- Multi-cancer detection tests: The ability to screen blood or other body fluids for multiple types of cancer simultaneously in symptom-free people would represent an extraordinary advance, particularly for cancers like pancreatic, ovarian, and brain, for which no screening tests exist.
- Cell therapy to treat cancer: Therapies that use a patient’s own immune cells to kill cancer cells have been approved for patients with certain blood cancers. Cell therapy could offer a treatment option for solid tumors, which comprise about 90% of all cancer diagnoses.
- Persistent poverty and cancer: We need to better understand how persistent poverty impacts different populations, as this is a multigenerational, population-level problem that exacerbates cancer.
- “Undruggable” cancer targets: Drugs that target cancer-driving proteins that have eluded all attempts to stop them could result in new strategies to target almost any abnormal protein and lead to medicines for more patients.
The Cancer Moonshot℠, initially launched in 2016, has helped NCI unleash many more opportunities for cancer research. The Cancer Moonshot has established important networks of scientists who collaborate on a greater scale. The Pediatric Immunotherapy Discovery and Development Network, for example, has made advances such as improving the cancer-fighting ability of CAR T cells.
The Cancer Moonshot has also enabled NCI to build infrastructure with the unprecedented capabilities to share cancer data across the research community. For instance, the Human Tumor Atlas Network's three-dimensional cancer atlases will help researchers understand and intercept tumor growth at any stage. Additional investments outlined in the Professional Judgment Budget Proposal will ensure that we build on the Cancer Moonshot’s successes thus far and further catalyze progress to achieve the bold goals put forth by President Biden.
This Annual Plan and Budget Proposal describes the resources needed to ensure that the cancer research enterprise remains strong, delivers on the opportunities before us, and transforms what it means to have cancer. Because fundamental scientific discovery is the backbone of cancer research, we must make strong investments in investigator-initiated research aimed at unlocking cancer biology and increasing the pipeline of new, less toxic drugs for cancer prevention, interception, and treatment.
NCI will also continue to expand and modernize clinical trials to reach more people, so that everyone benefits, no matter their demographics. Through implementation science, NCI aims to better understand how to ensure current and new standards of cancer care reach all patients equitably. All of these efforts depend on a cancer research workforce that reflects the populations we serve. To that end, NCI will expand its efforts to recruit more early-stage investigators from diverse backgrounds, further leverage existing programs that train members of underrepresented groups, and drive cultural change at the institution level that embraces equity, inclusion, and diversity of thought.
As I consider what we can achieve through cancer research, I am humbled by the advances made possible by the many people with cancer who have participated in research, and I am filled with hope. What once seemed so far off is closer than ever. By harnessing the incredible talent and dedication of the cancer research workforce, building on decades of scientific discovery, and taking advantage of today’s cutting-edge technology, we can truly transform what it means to have cancer so that far more people live longer, healthier lives.