President Obama’s Cancer Moonshot 2020 Initiative: How Big Is the Challenge?

Apollo rocket blasting offWhen President Obama’s White House Task Force meets for the first time this week, it faces a lofty charge: “Let’s make America the country that cures cancer once and for all.” His proposed Cancer Moonshot 2020 initiative will provide much needed funding for research, will encourage collaboration between industry and academia, and will undoubtedly lead to important advances in our understanding of cancer and how to treat it.

Although this initiative is noble and well intentioned, calling for a “cure for cancer” oversimplifies the challenge and is based on an outdated understanding of the disease.

The public needs to understand that cancer is not one disease; it’s hundreds of different diseases, and it’s more complex than anyone imagined back in 1971 when President Nixon first declared war on cancer. Those involved in cancer research know that conquering cancer, in all its varied forms, is truly a global endeavor that will require a sustained commitment for decades to come. While a challenge to be the “country that cures cancer” stirs our patriotic spirit and conviction that American biomedical know-how can render cancer irrelevant in our lifetime, the reality is that meaningful progress will require international collaboration.

Are we, as a nation, prepared to take on that challenge and lead such a charge? The President has taken the first step, appointing Vice President Joe Biden to lead the White House Task Force. But now the difficult work begins. Can we balance competing priorities and sustain both our political will and financial commitment for the many years that such an effort will undoubtedly take?

The good news is that we’re much closer to achieving cures in 2016 than we were in 1971. In the early 1970s, we understood very little about what causes cancer or how to treat it. The best weapons we had available were highly toxic chemotherapy and radiation.

Now, in the 21st century, we understand how mutations in dozens of critical genes lead to uncontrolled growth of cancer cells, and we have the technical ability to rapidly sequence the genomes of cancer cells and dissect what makes them malignant. The pharma industry has also developed hundreds of targeted small molecules that can seek out, with laser precision, the molecular defects that trigger uncontrolled growth and at least partially turn off the switch.

But perhaps the most exciting development in the last decade is an understanding of how to awaken and energize the patient’s own immune system, turning it into a cancer killing machine.

For decades, cancer researchers have sought ways to stimulate the patient’s immune system to fight their disease—but with limited success. A few patients with melanoma or kidney cancer can be cured with immunotherapy, while the vast majority fails to respond. The problem is that cancers can shut down the immune response and keep it at bay. But an important breakthrough occurred when researchers discovered a new approach to prevent cancers from stifling the immune response. These so-called immune checkpoint inhibitors unleash the full potential of the immune system against the tumor. Currently, these agents are the hottest topic in cancer research, and they’re transforming the treatment of melanoma, lung cancer, and many other forms of cancer.

The Cancer Moonshot 2020 initiative will advance this research by promoting collaboration between biotech and large pharma companies, academic cancer centers, and community oncologists. It will bring together the best available technology, such as next-generation sequencing of cancer genomes, precision medicine, and novel immunotherapy combinations.

Most importantly, it refocuses our mission on finding cures. For too long, we’ve been content with developing new treatments that marginally slow tumor growth or extend survival by just a few months. While those therapies play an important role, we have to say, that’s not good enough!

Although cure can often be achieved when cancer is diagnosed at an early stage, that goal becomes increasingly difficult when the disease has spread to other organs. The problem is one of evolution. Cancers are living organisms with the ability to adapt and evolve, and they often find ways to thwart our best efforts to destroy them. In some cases, we may have to settle for converting cancers that are incurable today into manageable chronic diseases, but at the same time, we can’t stop looking for cures.

A wise clinician and researcher recently reminded me of an important point: in science and in life, we tend to find what we’re looking for. If we’re actually looking for cures, we’re more likely to find them. Success will depend on harnessing the best technology and getting the best minds in medicine from around the world to work together in close collaboration. Let’s hope we can maintain the political will and lead the sustained international effort necessary to achieve success.

 Jeff Riegel, PhD, combines his scientific expertise in molecular biology with 20 years of global healthcare agency experience guiding medical and regulatory communication strategies for biopharma companies. Jeff helps clients prepare for FDA Advisory Committee meetings and directs publications planning and execution in oncology and other therapeutic areas. Connect with Jeff on LinkedIn.