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May 3, 2016

Obama’s $1 billion ‘moonshot’: is curing cancer realistic?

President Obama recently announced a ‘moonshot’ effort to cure cancer backed by a down-payment of $1bn. Elly Earls takes a deeper look at his hugely ambitious goal and asks whether the funding is being directed to the right places.

By Daniel Garrun

moonshot

In his final State of the Union address, President Obama announced the launch of a new national effort, to be jumpstarted with an injection of $1bn and led by Vice President Joe Biden, to accelerate research towards cures for cancer. And while curing cancer, Obama’s ultimate goal, has been widely agreed to be unrealistic, cancer experts across the country are fully behind the initiative.

The project aims to squeeze ten years of research into five and will direct funding to areas as varied as early detection, immunotherapy and improvements in data sharing. It’s been christened the ‘National Cancer Moonshot’ and has been launched to not only increase public and private resources and to develop new and existing treatments, prevention methods and detection tools, but also to break down silos between the different agencies and experts working in this crucially important field.

Yet, with the hugely ambitious goal of making America "the country that cures cancer once and for all", is the effort doomed to failure from the start?

"With other cancers, though, the thing we should hope for is to be able to treat these cancers and convert them into more of a diabetes model."

For Dr Otis Brawley, chief medical officer at the American Cancer Society, when it comes to curing cancer, a category that is made up of more than 200 different diseases, that’s a yes. But that doesn’t mean it’s wrong to have such an ambitious target.

"A goal of a cure is fine, it’s a great thing to have really," he says. "In fact, were we to have a concerted effort in a very short time, we’d be able to cure a group of cancers. With other cancers, though, the thing we should hope for is to be able to treat these cancers and convert them into more of a diabetes model, where people continue to be treated but have a good quality of life and a much longer life."

Jon Retzlaff, managing director of science policy and government affairs for the American Association for Cancer Research (AACR) agrees. "If we do have this kind of support, we are going to see the rates of cancer decline, we are going to cure some cancers and we are going to extend the lives of many who currently have cancer," he says. "But it’s not a realistic goal that we will be curing cancer once and for all."

A shot in the arm?

But is a $1bn investment even enough to begin progress towards this less ambitious target? Only if it’s sustained, says Retzlaff, adding: "One billion is a shot in the arm, but there must be follow-up on those dollars, there must be robust, sustained and predictable annual funding increases beyond that $1bn."

According to the White House, that’s the plan. While the first batch of funding will contribute to areas including prevention and vaccine development, early detection, immunotherapy and combination therapies, genomic analysis of tumours and surrounding cells and enhanced data sharing, this is only the beginning.

"Together, these investments represent an initial down-payment on the National Cancer Moonshot," the White House’s fact sheet on the initiative reads. "Over the coming months, the administration looks forward to working with Congress to launch the next phase of investments, providing the resources needed to double our rate of progress in this historic fight."

Has the government got it right?

While there’s no question that the government’s initial $1bn down-payment must be followed up if it is to have a chance of speeding progress, there’s also widespread agreement that the idea behind the ‘moonshot’ – to make the fight against cancer much more coordinated than it has been up until now – is sound. "What I see right now is a system that needs more command and control, and with that, we’ll be able to save a lot of money and the money we’re spending now could go much further," stresses Brawley.

Cancer experts also agree that the areas highlighted by the White House as priorities for funding are spot on. "This effort needs to really focus on the entire cancer continuum," Retzlaff remarks.

"This effort needs to really focus on the entire cancer continuum."

And this goes beyond the science itself to the systems through which these breakthroughs are recorded and shared. Currently, the same piece of research may be done six or seven times by different researchers because scientists within the same field don’t have access to other institutions’ data. But if data sharing was improve – a key focus of the moonshot – this duplication could be hugely reduced, and money saved. Plus, research that has already been carried out could be analysed much more thoroughly.

"By exploring existing information, standardising data collection and exchange, and building large and heterogeneous data repositories, we hope to gain insights into the impact of specific standard interventions in under-studied populations and to be able to collect heretofore rare and widely distributed clinical experiences so that we can begin to see patterns of response and outcomes," says Clifford Hudis, former president of the American Society of Clinical Oncology (ASCO) and current chair-elect of the ASCO Government Relations Committee.

Sustained funding will lead to more cured cancers

As Retzlaff says in conclusion, we’re not starting from scratch here; increased funding and coordination will largely serve to progress ideas that the cancer research community is already working on.

"There are some very good things happening – for example the National Cancer Institute (NCI) has been funding innovative cancer trials for years and this will allow us to increase these numbers," he says. "It will also help increase the momentum for the wonderful data sharing programmes that are taking place. If we start seeing sustained, robust, predictable budget increases, it will further those opportunities, we’re going to start seeing success rates go up and we’re going to be able to fund more innovative, creative ideas, which will in turn lead to further progress.

"With continued investment and coordination we have a real possibility of accelerating progress," concludes Hudis.

"This will certainly include increasing the number of cancers we are able to cure as well as the number we can control for long periods of time."

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