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What were the key legislative actions taken by the Trump administration to support childhood cancer research from 2017 to 2021?
Executive Summary
The Trump administration from 2017–2021 advanced several discrete legislative and programmatic steps that materially affected childhood cancer research, most notably the RACE for Children Act [1], the Childhood Cancer STAR Act [2], and continued federal initiatives such as the Cancer Moonshot and related National Cancer Institute (NCI) investments. These actions increased pediatric drug development obligations for manufacturers, expanded biospecimen and survivorship research authorities, and sustained Moonshot-funded pediatric research networks, while broader budget proposals and health-policy moves created tensions with those investments [3] [4] [5].
1. How a single FDA law reshaped pediatric oncology drug development
The most concrete legislative change during the period was the RACE for Children Act, enacted as part of the FDA Reauthorization Act of 2017, which gave the FDA authority to require pediatric studies of adult oncology drugs whose molecular targets are relevant to childhood cancers. This law materially altered industry incentives and regulatory requirements: after passage, the FDA compiled lists of molecular targets and guidance and the statute was implemented fully by August 2020, leading to a substantial rise in pediatric investigations tied to adult cancer drug development. Advocates credit the RACE Act with moving the pipeline from “a handful” of pediatric-relevant trials toward a much larger, target-driven program of pediatric drug studies, reflecting a regulatory lever aimed directly at increasing therapeutic options for children with cancer [3].
2. The STAR Act: a broader, bipartisan statute to strengthen data and survivorship work
In 2018 Congress enacted the Childhood Cancer STAR Act, signed into law in June 2018, which authorized expanded collection of pediatric biospecimens, strengthened surveillance and registry capabilities, and directed federal agencies to study survivorship and late effects. The law tasked the National Cancer Institute and National Institutes of Health with new authorities to support pediatric biospecimen repositories and survivorship research, and empowered the Centers for Disease Control and Prevention to expand state registry capacity. Implementation continued across administrations and the statute’s reauthorization in 2023 extended its provisions; within the Trump term, STAR represented a legislative commitment to infrastructure that supports long-term pediatric oncology research and population-level surveillance [4].
3. Moonshot continuity: federal funding channels and pediatric-focused consortia
Although the Cancer Moonshot began before 2017, the Trump administration maintained and directed Moonshot resources into pediatric-relevant efforts, with the National Cancer Institute reporting near‑term investments and the creation of specific pediatric consortia such as the Pediatric Immunotherapy Discovery and Development Network and the Fusion Oncoproteins in Childhood Cancers Consortium. These Moonshot-era activities focused on accelerating data sharing, building research networks, and funding discovery programs aimed at childhood cancers with poor outcomes, and by 2021 the Moonshot had supported hundreds of projects and public-data commitments that benefitted pediatric research infrastructure and collaborative science [5] [6].
4. Budget proposals versus congressional appropriations: mixed signals on support
The administration’s public budget proposals frequently recommended cuts to NIH and the National Cancer Institute, creating friction with the oncology community, even as Congress repeatedly rejected those cuts and approved increases in NCI funding in multiple fiscal years. The Trump White House approved a targeted FY2019 increase for NCI success rates and the FY2020 spending bills included new childhood-cancer funding lines; the practical result was a patchwork where statutory and programmatic initiatives advanced, while broader administration budget priorities sometimes threatened their scale. This dynamic explains why advocates describe legislative wins alongside concern over sustainability and the need for bipartisan congressional funding to realize authorized programs [7] [8].
5. What advocates and critics emphasized — and what gaps remained
Advocacy groups and pediatric oncologists praised the RACE Act and STAR Act as structural wins that address drug development, biospecimens, and survivorship, yet they continued to press for greater funding, implementation detail, and operational access to specimens and data. Critics pointed to the administration’s healthcare policy stances and budget proposals as potential obstacles to broad access and long‑term investment, while proponents highlighted sustained Moonshot activity and FDA rulemaking as durable progress. The record from 2017–2021 thus shows substantial legislative and programmatic steps to improve childhood cancer research pathways, but also remaining gaps between legal authorities and the funding and implementation needed to translate those laws into faster cures for children [9] [7] [5].