January 19, 2016 | by Sumanta Kumar Pal, M.D.
“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” noted President Barack Obama in his recent State of the Union address.
The statement underscores a plan from the White House to have Vice President Joe Biden lead a “moon shot” program – a massive effort to invest in cancer research with the ultimate goal of eradicating the disease. While a laudable goal, this is not the first time a moon shot has been attempted.
The lesson learned is that while the amount of investment is critical, so too is the way in which funds are applied.
Below are my five tips for Vice President Biden, as he puts forth his own moon shot.
1. Invest in clinical trial enrollment. Nationally, fewer than 5 percent of patients enroll on clinical trials. It’s not for a lack of options – there are thousands of studies listed in our national registry, located at Clinicaltrials.gov. The reasons for poor accrual are manifold. Clinical trials are often housed at academic centers that are out of reach for patients in remote areas. In addition, insurance-related barriers may preclude individuals from participating. A healthy allocation for resources that close the insurance gap or provide for access to specialized centers would certainly help this situation.
2. Don’t put all your eggs in one basket. There may be temptation to invest in a select number of technologies or therapies. Agents such as vaccine therapies and CAR-T cells are red hot right now, and do hold incredible promise. However, a moon shot is an opportunity to invest in earlier stages of research that may lead to the next generation of blockbuster agents. Spreading the funds over a larger and more diverse pool of investigators and projects will ensure that a robust pipeline of agents is maintained.
3. Keep pushing at personalized therapy. It was not long ago that the president included the theme of personalized medicine in a state of the union address. We have made incremental progress in this approach, which entails using a patient’s genes or biologic information to tailor therapy. The barriers to personalized medicine have been twofold: First, a lack of funding for new tests that would aid in characterizing biologic profile, and second, a paucity of clinical trials that rely on personalized medicine for treatment allocation. Both of these could be remedied through increased funding.
4. Harness established networks to speed research. Over the past decades, investigators have worked to develop extensive networks, termed cooperative groups, which bind together academic institutions around the country. City of Hope is a part of one such collective, the Southwest Oncology Group (SWOG), and has led a number of pivotal trials through this mechanism. These large organizations are well equipped to perform large trials in common cancer, such as lung, breast and prostate cancer, but are equally poised to examine key clinical questions in rare malignancies, such as penile and anal cancer. Recently, the American Society of Clinical Oncology (ASCO) has also launched a clinical trial trials program. Collaborative efforts through groups such as SWOG and ASCO will push research to patients faster than any individual organization.
5. Don’t overpromise. Ask any expert in the field, and they are likely to tell you that cancer will not be cured within the next five years. Why? Because cancer is a varied disease, with a biology that differs from one individual to the next. While we are likely to make important strides in a selected array of cancers, the prospect of us eradicating the disease in half a decade is unlikely. At the end of five years, we should do a critical examination of our efforts and identify successes and failures in our strategic plan. This should result in a framework for the subsequent five years of research.
I would guess there are few who would be opposed to a concerted effort to rid the world of cancer, and a moonshot could be an important step toward this goal. However, the devil is in the details – pushing a large pool of funds toward cancer research without a focused (and realistic) strategy will do little to move the field forward.
I'm looking forward to see how the vice president’s plan manifests.
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