Cancer Moonshot: Recommendations for the Blue Ribbon Panel
The NCI Blue Ribbon Panel released their list of recommendations for the Cancer Moonshot Initiative last week. This has been both a tremendous opportunity and effort for and among cancer researchers to rapidly advance cancer care through the infusion of much needed research funds.
The report outlines 10 recommendations from seven working groups that largely focus on patient engagement through inclusion of patient tumor genomics data, creation of national databases to characterize tumor samples and correlate data with clinical outcomes, and develop new technologies to better understand and treat tumors. Click here to reach the executive summary of recommendations. These goals are very ambitious and each could be developed into their own cancer moonshot program. The recommendations are forward leading and futuristic that aim to move the research field forward significantly.
The focus of the cancer moonshot initiative is, however, to accomplish in the next five years what would currently take 10. The recommendations published look to what could be and maybe should be, but are not going to be accomplished within the next five years. If I had almost $1 billion and the opportunity to develop the cancer moonshot, here is what I would do:
1. Address issues of cancer care access.
We have great technology and products that are increasing the survivorship and quality of life for patients now. Unfortunately, not all treatment options are accessible to every patient. Some regions don't have access to the same technology or resources. Some drug prices are too high for patients to afford therefore patients ration or skip treatments. Racial and ethnic disparities in health care exist that results in inadequate care in some parts of our society. These are issues that can and should be addressed so that in the next 5 years patients can improve their survivorship and quality of life from existing treatments.
2. Conduct clinical trials and increase research into combination therapy.
Cancer researchers refer to the 5 pillars of cancer treatment - radiation, chemotherapy, targeted therapy, surgery, and immunotherapy. The image displayed is of a building with 5 pillars supporting the structure. Subliminally this image reinforces the silos that prevents progress. Patients rarely receive just one treatment modality, but instead receive a combination of different therapies that change based on genomics and as the disease progresses. We know a lot about these individual therapies - and conduct clinical trials to understand how well they work - however, we need to do more research in the combination of these 5 pillars so that the best, most effective option, with the fewest side effects are available for patients.
3. Integrate genomics into every aspect of care.
We know that our genes and the environment can alter outcomes. Being tall will prevent you from shopping in the petite section of stores just like having Her2 protein over-expression in your breast cancer cells will change your treatment to include a drug that prevents her2 activity like trastuzumab (trade name Herceptin). Our understanding of genomics is increasing every day. How genes turn on, turn off, get mutated (and what the mutations mean), and how treatment changes based on gene changes are all questions that we understand better with each new scientific paper published. This needs to be fully integrated into patient care, from healthy profiles to disease states. How to do this is still unclear because it involves education of patients, physicians, and researchers on what is important and what can and should be done. Education is the first step. Research into how genomic changes alter combination treatment outcomes needs to continue and be expanded.
4. Provide funds for basic and translational research.
Research is the only way that new technologies, treatments, and drugs will be developed. It is the only way we will understand how to provide them in what combination, in what order, and for how long that produces the best outcome. It is important to continue to explore new ideas and emerging treatment modalities, but to not forsake what has already been developed and learned.
I applaud the efforts of those involved in the cancer moonshot. It is a great idea and it pushes the cancer community to step outside the box, to talk with each other, and to think about things differently. But what is truly the goal? Is it to develop a completely new paradigm or to significantly improve care in the next five years? Personally, I think it is both - think differently about what we have now - and keep innovating and developing for the future. Expectations need to be delineated and set so that the goal can be achieved. We can change cancer care in five years, but need to then focus on what we have right now and how to improve it and increase access to it.
Image: taken from Pixabay.
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