HILADELPHIA — On Friday, Vice President Joe Biden will make a University of Pennsylvania cancer center the formal launching pad for the Obama administration’s cancer “moonshot.”
For Dr. Robert Vonderheide, a leading cancer researcher here, and many of his colleagues, Biden’s kickoff tour and discussion at Penn Medicine’s Abramson Cancer Center will be the culmination of a long journey from the fringe to the mainstream.
Vonderheide joined Penn in 2001 because he said it was one of the few places that took cancer immunology seriously. Back then, the area wasn’t a focus for much of the broader medical community, even though it had been first floated a century earlier.
At the time, immunology proponents “didn’t have the clinical results to support their contentions at all,” Vonderheide said. He had an intense interest in it, though, and he said Penn was one of the few institutions where he interviewed that shared that enthusiasm.
Now, the cancer center’s work has earned it a place in the national spotlight as Biden gets his project underway. A Biden aide said that the vice president picked Penn for Friday’s visit because of “the cutting edge immunotherapy work done there.” Immunotherapy uses the human body’s immune system to fight cancer cells.
Penn is a short drive (or train ride) from Biden’s beloved home in Delaware, and his eldest son, Beau — who died last year of brain cancer, making the cancer fight a personal one for the vice president — earned his undergraduate degree there.
But personal connections aside, it’s the center’s work with immunotherapy that caught Biden’s attention. In his Medium post announcing this national commitment to curing cancer, Biden singled out immunotherapy as one of the developing treatments that could be “revolutionary.”
Beau reportedly was treated by surgery, chemotherapy, and radiation after his diagnosis. As Dr. Daniela Bota, a neuro-oncologist at the University of California, Irvine, noted at the time of his death, immunotherapy is emerging as one of the most promising avenues for treating the most aggressive kinds of brain cancer.
Penn has been at the forefront of the field.
“There are a couple of those places that are notorious for pushing things forward,” said Dr. Elizabeth Jaffee, a top oncologist at John Hopkins Medicine. “They’re one of them.”
Shortly after arriving at Penn, one incident convinced Vonderheide he’d made the right choice.
“I needed quite a bit of cash” for an expensive piece of equipment, he recalled in an interview with STAT, sitting in his corner office in the colossal glass complex that houses much of Penn Medicine, the downtown Philadelphia skyline looming out the window.
Vonderheide had a lengthy set of arguments ready to go, expecting a fight. He found his supervisor in a hallway and started making his pitch on the spot.
The cancer center’s scientific director didn’t hesitate. “Sure,” the director said — confirming to Vonderheide that he was among people who saw the same potential for immunotherapy that he did and would do what it took to realize it.
‘Everybody’s talking about it’
At the Abramson Cancer Center on Thursday, there was little outward sign that the vice president of the United States would arrive the next day to formally launch a national effort that he has compared to putting a man on the moon.
People whispered in waiting rooms. Patients in gurneys were wheeled down the hallways. Every once in a while, there were small reminders of the stakes of this fight. “So stressed,” said one patient in a wheelchair.
But behind the scenes, things were “very hectic,” said Dr. Chi Van Dang, the cancer center’s director. Speakers needed to be sorted out; everybody wants a seat at the table when the vice president is on the stage. Vonderheide said the staff was abuzz about the visit: “Everybody’s talking about it.”
Vonderheide lauded the vice president’s focus on cancer research, describing him as “sincere and authentic” in his interest. He singled out Biden’s lobbying for a $264 million boost in federal cancer research funding approved last month, the largest in more than a decade.
“That was amazing,” he said, and it comes “at a time that that money can be applied to these potentially monumental types of new therapies.”
So by proxy, Penn and its peers will also help bear the burden of the immense expectations that Biden and Obama have set. Biden has said he wants to “end” cancer. And in Tuesday’s State of the Union address, Obama said he wants America to be “the country that cures cancer once and for all.”
Some aren’t comfortable with that kind of rhetoric. Cancer is many diseases, not one, and scientific progress is usually incremental. Dang is sympathetic to those concerns — “We as scientists are very leery of word choices” — but he also wants his team and peers to feel inspired by such goals.
So Dang has actually taken the NASA analogy one step farther. He has been walking around campus the last few days telling his staff that they’ve already been to the moon — and that “we want to go to Mars.”
“We’ve cured some cancers,” he said. “The moon was easy. It’s a lot harder to go to Mars.”
The promise of immunotherapy
Vonderheide isn’t surprised that Biden chose Penn for the kickoff event. “That’s why I came here,” he said. “Immunology is now part of the fabric of cancer biology.”
“Twenty years ago, people would say, ‘You’re just guessing. You don’t have anything to really try.’ But now we do,” Vonderheide said. “The clinical results we’ve seen with immunotherapy are absolutely unprecedented. We can now, hand on heart, honestly have discussions with patients about, ‘We might be able to cure you.’”
After five years of human testing, Penn researchers led by Dr. Carl June said last year that they continue to see high remission rates among advanced blood cancer patients who had been treated with the therapy. June and some of his colleagues created a pharmaceutical company, Tmunity Therapeutics, to produce new treatments for a range of diseases using the technique. This week, the company announced that it had raised $10 million, including an investment from Penn Medicine itself.
The challenge for researchers now is to figure out how to apply what they’ve learned to other diseases. For example, Vonderheide said, an immunotherapy that works for melanoma doesn’t work for pancreatic cancer. But add a vaccine, and it might.
The hurdles are numerous: scientific, regulatory, and cultural. But there is a real optimism that the nation’s leaders can help inspire the revolution that so many are waiting — and have died waiting — for.
Obama and Biden also aren’t the first government leaders to declare war on cancer. It all started in 1971 with President Richard Nixon. But Vonderheide said this time might be different, thanks to the decades of work that has already been done. Holding his hand level and then thrusting it skyward, he said that medical science is at an “inflection point” where monumental breakthroughs are now possible.
Many cancers, as Dang alluded to, have already in effect been cured. Skin and breast cancers are much less lethal, now that early detection is so emphasized. But for patients with advanced, metastasized cancer, the outlook is often still dire. That’s what the immunotherapy has the potential to totally change.
“We haven’t been able to have this hope of cure in the past,” Vonderheide said. “But now, for the first time, as cautiously optimistic as we should be with our patients and the public, we nevertheless have that hope.”
Penn is not only at the cutting edge of medical science, but it has also taken some more bureaucratic steps that align with Biden’s vision. The vice president, his staff, and researchers they’ve met with have talked again and again about breaking down the “silos” in the cancer research field that prevent scientists and institutions from working well together and speeding along their progress.
It is already a point of emphasis internally at Penn, Dang said, but more could be done. The cancer center is currently in talks with peer institutions in New York and Baltimore to enter into the kind of partnership that would help eliminate those barriers.
One common problem: intellectual property. A lot of money is at stake when researchers are developing new therapies, which might discourage cooperation with peers. The partnership under discussion would try to fix that by giving each institution equal buy-in.
“Whoever wins, we divide the pot,” he said. “It’s just like the Powerball.”
In Vonderheide’s laboratory, there is a hallway lined on both sides with more than a dozen refrigerators that hold genetic samples, known as a “freezer farm.” He gestured toward the tens of thousands of samples that might be of use to some other researcher working across the country. He explained that he would have to clear a lot of bureaucratic hurdles to get it to them.
The implication was clear: There has to be a better way.