Veterans of the nation’s long, difficult slog against cancer are watching closely as Vice President Joe Biden visits the University of Pennsylvania Friday to launch a campaign that — as President Obama put it in his State of the Union address Tuesday — “cures cancer once and for all.”
As Biden starts shaping the “cancer moonshot” — inspired by his son Beau’s death from brain cancer last spring — leaders of the cancer research community are wondering whether the project will be a truly bold leap forward, or just business as usual, bringing, at most, incremental progress. Here’s what the experts said, in interviews this week, they will look for:
1. Is the science establishment calling for his head?
Fran Visco, the founder and president of the National Breast Cancer Coalition, is more than five years ahead of Biden. In 2010, she launched an audacious effort to end — really end — breast cancer. She intends to do this by organizing and securing funding for research to discover, by 2020, both a preventive vaccine and a way to eliminate breast cancer deaths, which almost always occur after cancer metastasizes from the original site.
Critics called her Artemis Project (named for the Greek goddess, twin sister of Apollo, as in NASA’s lunar missions) “harmful to public trust,” “long on aspiration and short on scientific detail,” and impossible. Some of the scientists Visco approached to be part of Artemis “thought we were nuts,” she said. If Biden’s program doesn’t upset some people, she added, that will be an indication it’s just doing more of the same rather than reaching for the heavens.
“The same” has certainly made significant advances lately, as drugs that take the brakes off the immune system seem to cure some patients’ melanoma and non-small cell lung cancer, for instance. And with gene-targeted therapies, “90 percent of patients with chronic myeloid leukemia are cancer-free forever,” said Dr. Brian Bolwell of the Taussig Cancer Institute at the Cleveland Clinic. But targeted therapies, overall, are falling short of their promise, there is essentially no treatment for cancers that spread beyond the tumor’s original site, and the only preventive vaccine is for virus-caused cervical cancer.
Early on, said Visco, “we realized that the most important thing is to identify people who are willing to put aside their own agenda [for their pet research ideas] and are capable of responding to a bold challenge. We figured out that if you keep going to the same scientists and the same thought leaders, nothing is going to change: they’re very invested in continuing to do what they’ve been doing.” A cancer moonshot will have to make some people mad.
2. Is there a real deadline?
John F. Kennedy set one for the original moonshot — “We choose to go to the moon in this decade,” he said in 1962. “If you’re going to call it a moonshot, at least be historically accurate,” said pharma consultant Frank Calzone, a former science director at biotech giant Amgen and an advisor to Artemis. “You need a deadline and milestones.”
Those make academics “very uncomfortable,” he said, “since in academia you never reach the end — you’re always supposed to ask more questions — and if deadlines are missed, you risk causing the perception that [you] failed.” But without setting out a plan to accomplish X by one date and Y by another, there is less sense of urgency and curing cancer becomes a never-ending quest.
3. Is Biden’s moonshot at least doing the easy things?
Determining tumors’ genetic profile in order to find a drug that targets the cancer-driving genes has been far from a home run (or moon landing, to stick to the metaphor of the moment), though it does help some patients. One reason is that few patients get their tumors tested. The trouble is, Medicare and many private insurers generally don’t cover tumor genetic profiling.
“One of the things the vice president could usefully do is talk to people at [Medicare] and make sure they’re doing their utmost” to expand such coverage, said Dr. Harold Varmus, who stepped down as director of the National Cancer Institute last year and is now at Weill Cornell Medical Center in New York. “The vast majority of cancer patients are not getting genetic testing of their tumors, but doing so would really move things forward.”
It might not have an instant clinical payoff — one 2015 study questioned the whole premise of matching tumor mutations to drugs — but would accelerate discoveries in gene-to-drug matching. Private payers generally follow Medicare’s lead.
4. Is it not duplicating what’s already being done?
Is the moonshot doing things that aren’t already being done in academic, pharma, and biotech labs? Cancer research has undeniably led to meaningful progress, so much so that physicians and scientists are sometimes willing to use the fraught word “cure.” “What we should worry about is if [Biden’s program] just spends more money on the kind of research that’s already happening,” said Calzone. “That’s not a moonshot.”
5. Does the program emulate venture capitalists?
Venture capitalists figure that nine out 10 investments in startup companies will fail but one will return a zillion-to-one payout. “Back in 2010, people who thought immunotherapies would work against cancer were all in the crazy room at scientific meetings,” Calzone said. They struggled to get government funding, and the National Cancer Institute still rejects most funding requests for high-risk research, though the agency says it’s getting less risk-averse.
NCI “would never fund something like Artemis,” said cancer geneticist Yaniv Erlich of Columbia University, who is part of that project. “But you need crazy ideas and radical thinking if you want to reach ambitious goals.” For instance, Artemis participant Stephen Johnston of Arizona State University is developing a vaccine to prevent breast cancer. It’s such a long shot that NCI rejected his grant proposal twice.
With support from Visco, who helped get him funding from the Pentagon’s breast cancer research program, Johnston has identified 21 antigens (molecules on the surface of cancer cells that the immune system targets) “found on any breast tumor that might arise,” he said. If the vaccine works, the immune system would target these antigens and destroy the very first malignant cell long before it multiplies out of control and produces a tumor.
Johnston will test the vaccine in 700 healthy dogs starting this spring. “I can’t guarantee you this will work, but I can’t see any scientific reason why we shouldn’t try it. Fran [Visco] wants to eradicate cancer and I do, too. A prophylactic vaccine is the only way to do that. This country should be able to afford support for research that has the potential for an enormous payoff even if there’s a risk it won’t work.”
6. Does the program bang heads together?
Biden talks a good game about collaboration and breaking down silos, so it will be telling to see if that happens. The lack of true collaboration, where researchers share data before they publish, or try to patent, discoveries, “is a real barrier to progress,” Visco said. “We made it clear to everyone that that wasn’t going to happen [in Artemis]. If they weren’t going to share, they weren’t going to participate.”
Artemis parted ways with scientists at one institution who were more concerned about claiming priority, and possibly patents, than with pushing the research ahead as fast as possible. And a number of experts said leading cancer centers that do DNA profiling of their patients’ tumors hoard data on how those patients fare, slowing progress.
7. Does it involve scientists outside cancer biology?
Artemis has virologists, and microbiologists, and computer scientists, and more. “By getting people from different domains and putting them together, you get creative ideas,” said Columbia’s Erlich. Or as Visco put it, “you need a process, and you need people, that allows for wild-ass ideas.”