By: The Mesothelioma Cancer Alliance and Cancer Mission 2020
A little more than a year ago, former President Barack Obama announced his desire to help cancer patients throughout the United States – and the world – by expediting cancer research. In his State of the Union speech before Congress, President Obama said he wanted to double the rate of progress toward finding a cure for cancer by accomplishing ten years’ worth of research in only five years.
Over the course of the rest of the year, former Vice President Joe Biden worked to establish and organize the moonshot effort, creating a task force. In the remaining months of his tenure, Biden, whose son passed away in 2015 due to brain cancer, steered his task force in the direction of building collaborative efforts between governmental agencies, research universities, nonprofit organizations, private companies, and others to set up a range of endeavors that would accelerate the important work of finding cures (or at least vastly more effective treatments) for various types of cancer. This includes not just the most common types of cancer that many people know about, but also relatively rare cancers that get very little attention, such as mesothelioma and various sarcomas.
The work done throughout 2016 has paid off. The Cancer Moonshot Task Force keeps a running list of milestones, and moonshot effort’s Blue Ribbon Panel Report presented to President Obama in November listed several areas of progress:
Technology: The development of the Cancer Treatment/Therapy API allows developers, researchers, and others to review and visualize cancer patient data in new ways, such as by combining them with other datasets to identify new data-driven insights. Another technological approach being taken as part of the moonshot is a project being led by the Department of Defense to implement an AI interface that can process cancer datasets and potentially find new (and more efficient) avenues for cancer research and development.
Prevention: Not all cancers are preventable, but medical professionals know that the risk of developing many types of cancer can be reduced by changing certain lifestyle and environmental factors. Educating the public and implementing programs about preventative measures, such as radon testing or asbestos abatement, are a big part of this effort. Another avenue of prevention is vaccinating people against viruses that increase the risk of certain types of cancer, such as human papillomavirus (HPV) and Hepatitis B virus (HBV), and finding new vaccines.
Treatment: There are many potential avenues for treatment research, including both looking for a cure, as well as developing new forms of palliative care to ease the physical and mental discomforts caused by cancer. As part of the Cancer Moonshot, the National Cancer Institute is helping to fund studies that address all of these varied approaches to cancer therapy, from new technologies like particle beam radiotherapy, immunotherapy drugs like Keytruda (pembrolizumab) and Avastin (bevacizumab), and managing stress and anxiety through art therapy.
Public-Private Partnerships: In addition to the more medically focused efforts mentioned above, the moonshot has helped encourage private companies to partner with public agencies and assist in the effort. Companies like Microsoft and Amazon are collaborating with researchers by providing cloud services and processing power. Even the ride-sharing services Uber and Lyft have gotten into the effort by developing plans to give free rides to cancer patients in low-income areas.
Given all of this institutional and organizational progress, we wanted to hear what what some of the people closest to the front lines of the fight against cancer had to say about the Moonshot Initiative.
Ira S. Pastor
The largest “unspoken” challenge in 2017 is that the cancer research system, within its moonshot thinking, continues to base its drug development model on two concepts of tumors that every day become more and more obsolete – these are the concepts that:
- The sole drivers of tumors are somatic mutations in various growth control/proliferation centers of the genome
- Tumors are homogeneous in their composition
Both of these concepts have led to a flood of “targeted” therapeutics which work extremely well in the short term, in small groups, but fail rapidly thereafter. That has brought us to where we are today, with many treatments, but few real cancer cures.
Emerging knowledge from scientific literature points to the facts that even with the current “silver bullet” model of the moonshot we are still heading down a path that will continue to give us incremental advances in survival. Most mutations may be only “permissive” of cancer, not “causative” of it, and tumors are heterogeneous baskets of cells, with potentially many different transcriptional regulatory states in one (which can easily reconstitute each other). There is a small but growing research base that is beginning to challenge this old model.
Marlon Garzo Saria, PhD, RN, AOCNS, FAAN
The effects of the Cancer Moonshot have not yet trickled down all the way to the front lines. Three nurses were appointed by former President Barack Obama to working groups tasked to provide recommendations to the Cancer Moonshot Blue Ribbon Panel. Additionally, one of those three nurses was appointed to the Blue Ribbon Panel itself. Outside of the National Institute for Nursing Research at the NIH, nurses have not been historically represented at these high level public policy and decision-making bodies.
The Initiative gives focus to very important components of the research to find the cure for cancer. It is not just about developing a drug. Drugs are ineffective in patients who do not take them. One of the reasons patients are non-adherent with therapy is inappropriately managed side effects, but one of the recommendations of the Blue Ribbon Panel is to minimize cancer treatment’s debilitating side effects
We must continue to advocate for federal research funding. Every new administration will have a new set of priorities, so until Congress secures sustainable funding, we will experience many uncertainties about the future of the moonshot efforts.
Dr. James Weese, VP Aurora Cancer Care
The Cancer Moonshot Initiative has positively impacted the way that Aurora Cancer Care continues to help people fight the battle against cancer. I was fortunate enough to be in Washington D.C. for the event and have had ongoing communication with other attendees as we share data and key learnings of different types of treatments. Collaboration is the key to winning the battle.
I believe the concept is a very good idea to have various types of data collected from institutions across the nation to really see what might be working that would be beneficial to our patients. The philosophy is all about how can we as a coalition of cancer fighters become more valuable to each other and ultimately provide better care to our patients.
I’m excited to see the continued progress, and see how institutions that many might view as competition are working together to find a cure. This puts the patient’s best interest at the heart of the journey, which is what we’re all here for, to help people. The moonshot concept can help to eliminate redundancies, increase efficiencies and ideally improve the way we’re able to deliver care. It’s an exciting time to see how we might be able to bring new treatment methods and drug to patients who previously may not had the same type of access.
There’s always work to do, and the biggest thing in my mind is we need to continue to ensure the program is supported financially by government groups and the National Cancer Coalition. We need to be sure that momentum is not lost and that new treatments being developed are available for all patients. By having the best access to the type of data and findings that the Moonshot brought us, we as the cancer coalition will be able to do more to better match molecular based drugs with patients with tumors with similar molecular profiles, for example.
The advantage of getting funding by congress before President Obama will help, but time will tell if complementary activities will continue to be funded. Certainly with a new administration now in place, a challenge we may see is potential change in priorities and this could impact the future of the initiative to move forward. I believe it’s a major priority for our nation to bring the best and brightest together as we battle cancer, though time will tell. This challenge could lead to loss of time in the battle and a lack of funding.
Dr. Ritu Trivedi-Purohit
As a clinical psychologist working within the practice of oncology, I have not been directly involved with the initiative. Currently, from the medical community, oncologists conducting research and providing care in community hospitals are directly involved with the initiative. Allied service professionals, such as psychologists, are indirectly involved. Many of my patients engage in clinical trials around the country and receive immunotherapies. These promising treatments shape patients’ cancer journeys and impact the work I do with them.
The outcomes of the initiative will have a direct impact on survivorship and the quality of life of my patients. Cancer has increasingly become more of a chronic condition and requires ongoing management where it used to be a death sentence for too many.
From my perspective, there is a significant gap in cancer care and it lies fundamentally with the lack of support for patients with the management of side effects, attention to psychosocial issues, and long-term support through survivorship. Many patients survive decades post initial diagnosis, often with lifelong side effects and consequences of toxic treatments. Little attention or guidance is provided to these survivors. This is a critical area that I would like to see more resources aimed at research and program development.
What’s In Store for 2017?
Hopefully, 2017 will bring about more information and more collaboration in the medical industry, which would directly help the Cancer Moonshot Initiative move forward. During the SXSW Conference in Austin, Texas at the beginning of March, former Vice President, Joe Biden, said that he would work with the new president and his administration to keep Cancer Moonshot moving forward. This is a great step in the right direction, but it will only be able to be successful if President Trump and his administration also agree to work with Joe Biden. In the past, there has been more talk than action, and we need action now. In December, Congress passed the 21st Century Cures Act, which over the next seven years, will provide $1.8 billion dollars to Cancer Moonshot, leading the way to keeping this program alive and running.
Joe Biden is very committed to finding the cures for cancer, and while there may be different viewpoints on whether the Moonshot initiative actually helps, one thing is for certain, cancer is continually being discussed, and discussion is key to getting information circulating, and getting people actively involved in finding the cures for cancer. The only way that anything will get accomplished is if there is support from our leaders in Washington. Cancer is not a Republican, Democrat, or Liberal issue, it is a people issue, and this country is losing over 11,000 Americans each week to cancer. The time to stand up and get involved is right now. There are many ways to help—people can call their local government leaders and urge them to get more involved in Cancer Moonshot and cancer research, they can support local programs that help people who are suffering from cancer, they can donate to local charities, and so much more. Everyone has directly or indirectly been touched by cancer, and everyone needs to push our leaders to make finding the cure for cancer a top priority.