Cancer Progress Report 2012

machinery of cells, permitting them to survive when normal cells would die and to multiply uncontrollably and metastasize. In addition, interactions between cancer cells and their microenvironment profoundly affect these same processes. Cancer-influencing factors that comprise the tumor microenvironment include the matrix of proteins outside the cancer cell that support the structure and function of the tissue in which the cancer is growing; the creation of new blood and lymphatic vessels; hormones; nutrients; and the immune system (see Fig. 2, p. 20).

Insight into the importance of inflammation, established by certain cells of the immune system, in promoting cancer progression has increased dramatically in the past few years. Persistent inflammation—for example, that driven by infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), or by continual exposure to toxins like alcohol or asbestos—has been known for some time to create an environment that fosters cancer cell survival, proliferation, local invasion and metastasis. More recently, it has become apparent that chronic inflammation in an organ or a region of the body enables cells in that area to acquire the characteristics needed for cancer formation.

In addition to better understanding the concept of tumor-promoting inflammation, the last several decades of research have also established the importance of the components of the immune system that participate in antitumor defense. That knowledge has stimulated developments of drugs designed to boost patients’ antitumor immunity.

Although we have learned a great deal about the unifying principles that underpin cancer, translating this knowledge into cures remains challenging because of the diversity of cancer types. Currently, many areas of research are rapidly evolving, in part as a result of technological advancements that are increasing our ability to probe the genetic and molecular defects that drive cancer. With continued federal investments, these endeavors will yield new discoveries that improve the ways we prevent, detect, diagnose and treat cancer.

Cancer Research: From Concept to
Patient and Back Again

If cancer research is to be truly successful, it must be an iterative cycle, with observations flowing from the bench to the bedside and back again (see Fig. 3). The participation of patients and their health care providers is essential to this cycle because observations made in clinical trials also help define areas for future study, including the identification of new drug targets and the refinement of treatment. Finally, cancer research does not operate in isolation from other fields of research. Insights into the biology of cancer and the identification of ways to prevent, detect, diagnose and treat its many forms offer new ideas for the conquest of other diseases.

Figure 3: The Virtuous Cycle of Research. For the cancer research enterprise to be efficient and effective it must be an iterative cycle, with observations flowing from the bench to the bedside and back again. Essential to this cycle is the participation of all stakeholders, not only basic scientists, physician-scientists and clinical researchers from a wide variety of disciplines, but also cancer patients and survivors, citizen advocates, philanthropic organizations, government, biotechnology and pharmaceutical industries, regulatory agencies and healthcare payers; (see Fig. 21, p. 79). Adapted from (140, 141).