“Cancer Moonshot” takes shape with NCI input

Sept. 22, 2016
In his State of the Union address delivered last January, President Barack Obama asked Vice President Joe Biden to lead a major effort, a “Cancer Moonshot” to find new diagnostics, treatments, and, to the extent possible, cures for the complex of diseases that we call cancer. “I’m putting Joe in charge of Mission Control,” the president said. “For the loved ones we’ve all lost, for the families that we can still save, let’s make America the country that cures cancer once and for all.”

The Obama administration—which has been a good one for scientific research, sometimes in the face of appallingly shortsighted political opposition—will come to an end in a few months. Let’s hope that the next administration continues this valuable work.

Just after Labor Day, the Cancer Moonshot got a shot in the arm when a blue-ribbon panel of the National Cancer Institute (NCI) recommended ten scientific approaches that the project might consider. The list was presented to the vice president’s task force. Among some of its most interesting elements:

  • A proposal to create a national tumor profiling network to which patients
    contribute their data and register for studies based on the profiles
  • A plan to set up a clinical trials network devoted to immunotherapy-based
  • An increased emphasis on testing for hereditary cancers
  • A renewed focus on identifying therapeutic targets to overcome cancer drug
  • The development of new technologies to treat cancer, including implantable
    devices that deliver targeted chemotherapy
  • Attempts to better understand the role of fusion oncoproteins in pediatric cancer
  • The creation of dynamic 3-D maps of human tumor evolution.

Along with these and other broad approaches, the NCI “road map” includes specific projects. These include “a demonstration project to test for Lynch syndrome, a heritable genetic condition that increases risk of several types of cancer, to improve early detection and prevention; the establishment of a nationwide pediatric immunotherapy clinical trials network to enhance the speed with which new immunotherapies can be tested in children; exploring patient-derived organoids; and “microdosing” devices to test drug responses in living tumors.”

Reading the list, I can’t help but be impressed by the presence of terms that would have had little practical meaning, even for the research community, only a few decades ago: tumor atlases, immunotherapy, drug resistance mechanisms, national [information sharing] ecosystem, fusion oncoproteins and inhibitors, retrospective analysis, 3-D mapping of tumor evolution, genetic lesions and cellular interactions, and tumor characterization.

Comprehensively, the orientation toward genomics and proteomics, molecular diagnostics and precision medicine, and population health management seems strikingly modern. It resonates with the way cancer is being understood now, and creates hope for significant advancements in the near future.

The “road map” also may lend impetus to efforts to win funding from the U.S. Congress to make these big ideas realities. As MLO contributor Larry Altshuler, MD, wrote in the August 2016 issue, referring to the “Moonshot” as well as the administration’s proposed Precision Medicine Initiative, “they are enormous undertakings and will require substantial resources, which may wax and wane depending on the progress observed and the priorities of political leadership” (MLO. 2016;48(8):56). Indeed, will the next Congress, particularly if it remains under Republican control, look with favor on a program championed by a President whom it sought to block at every turn while he was in office? It’s a fair question, particularly in the light of the lack of interest, bordering on downright hostility, that the Republicans have shown toward science in general in recent years.

It is to be hoped that politics is put aside, and that the necessary funds are provided for such a worthy project, regardless of the results of next month’s national election. The energy provided by the NCI panel’s list must not be allowed to dissipate.

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