One item in President Barack Obama's State of the Union address this week overshadowed all the others: the announcement of a massive "moonshot" effort, led by Vice President Joe Biden, to cure cancer. Such a bold proclamation naturally begets a few questions, and the government started answering them today in a call with reporters by the National Institutes of Health (NIH), which includes the National Cancer Institute (NCI).
The biggest question: Why now? The short answer is that the science has progressed radically of late. "A coalescence of events has led to this being a moment where this kind of initiative is particularly compelling," said NIH director Francis S. Collins. "We do, after all, understand cancer at the molecular level in a way that we did not understand it a few decades ago."
As the product of genetic mutations, each person's cancer is a bit different. The cost of a complete gene sequencing for a patient has dropped to about $1,000, so they can now be treated in a customized way, instead of just with the blunt instruments of chemotherapy and radiation that treat everyone's cancer the same. "We are also learning that it's maybe more important to know what mutations are in the cancer cell than what organ system it arises in because that will be the thing that guides us to the right cure," said Collins.
Chemo and radiation may still play a role, he said, but in conjunction with genetically targeted treatments, such as chemicals that block certain malformed proteins and vaccines that get the patient's own immune system to target the cancer cells. "Immunotherapy…has emerged as one of the most exciting developments in cancer of all time," said Collins. This has led to dramatic successes, he said, mentioning President Carter's possible cure of melanoma that had spread to his brain.
But immune therapies have not helped many other types of cancers, and getting them to work will be a big part of future research. The government is in a better position to do this now, said Douglas R. Lowy, NCI Acting Director, because Congress last month gave parent organization the NIH its biggest funding increase in more than 10 years (after a decade of keeping its budget essentially flat).
The NIH/NCI seems to have emerged as the center of the government's cancer moonshot, and it's aiming to better coordinate work among government agencies as well as outside parties like universities. NIH can make sharing of data a requirement of any research grants it awards, said Collins. NCI will also roll out a cloud database to hold anonymized medical records for up to 50,000 cancer patients, so researchers can mine details like their genetic mutations.
The conversation got a bit tense on the subject of private for-profit players, especially the Cancer MoonShot 2020 program by Patrick Soon-Shiong, founder and CEO of biotech firm NantWorks. The program was announced the morning before the State of The Union address at a press conference attended by senior officials from biotech and pharma firms as well as of medical centers including Beth Israel and Columbia University. Several of them had met with Biden, together with representatives from agencies like the NCI and Food and Drug Administration. "Dr. Soon-Shiong is obviously a highly regarded entrepreneur, very interested in this space," said Collins, "but the program he talked about…does not involve the NCI or the FDA in a partnership way."
The original moonshot program took more than a dozen years to get to its target, and no one expects to cure cancer in the year that Biden and Obama have left in office. Their successors could well be Republicans, and the two parties have fought viciously over health care issues.
This time might be different, though. Representative Fred Upton, who chairs the House Committee on Energy and Commerce, tweeted support for Obama's plan during the State of the Union address, and the two parties united on additional funding for NIH last month. House Democrats and Republicans also joined overwhelmingly in July to pass the 21st Century Cures Act, which boosts funding and lowers barriers for moonshot-style medical research. (It hasn't passed the Senate.) "This tradition of bi-partisan support for medical research is longstanding," said Collins. "Everyone is anxious to find answers for cancer."