Cancer is a huge problem. Cancer surpassed heart disease as the leading cause of death in California and 21 other states. Two-hundred distinct diseases. Nothing scarier.
Oncologists like to worry. Cancer research scientists like to worry. They worry a lot. They worry about cancer. Finding it. Treating it. Beating it. Ending it. Everyone does. No one wants it. We all worry about how to cure it. We all worry about cancer research. We all worry about the existing silos.
Silos suck. We're breaking them down.
Scientists worry as cancer moonshots multiply: Fears rise that US government and private funders are working at cross purposes
Nature Article by Erika Check Hayden
April 27, 2016
The recent launch of multiple major US cancer initiatives has infused cash into immunotherapy, one of the most promising new methods of cancer treatment. But researchers warn that the money may be wasted without concrete plans to coordinate the programs.
“There’s a lack of overt leadership, and in the absence of a logical strategy we have a tendency to throw plates of spaghetti against the wall and hope it sticks,” says Ira Mellman, vice-president of cancer immunology at the biotechnology company Genentech in South San Francisco, California.
The broadest program is the US government’s National Cancer Moonshot, which hopes to receive US$1 billion by next year for 8 areas of cancer research. Immunotherapy, which recalibrates the body’s own immune defense against cancer, is among them.
It “is poised to be a critical part of our nation’s anticancer strategy”, the project’s leader, US vice-president Joe Biden, said at the 2016 annual meeting of the American Association for Cancer Research (AACR) in New Orleans, Louisiana.
An advisory panel will release more-detailed plans for the government program in June.
Meanwhile, three privately funded immunotherapy research projects are gearing up:
1. The $250-million Parker Institute for Cancer Immunotherapy, announced in April 2016 and funded by Sean Parker, co-founder of the music-file-sharing company Napster
2. A $125-million Immunotherapy Center at Johns Hopkins University in Baltimore, Maryland, unveiled in March 2016
3. The Cancer MoonShot 2020 Program, announced in January 2016 by biotechnology billionaire Patrick Soon-Shiong
This sudden proliferation of cancer initiatives is reminiscent of the spate of brain-research projects launched in the past few years — some of which have foundered through poor leadership.
Europe’s Human Brain Project, for instance, almost ran aground after a series of top-down decisions alienated the neuroscience community. By contrast, the US BRAIN Initiative set priorities after consulting with neuroscientists, and awarded grants through a conventional peer-reviewed process, ensuring community acceptance.
Now cancer researchers are left wondering how their moonshots will proceed.
At the AACR meeting, Biden said that he had met representatives of many cancer-funding projects. “Why is all of that being done separately?” he asked scientists in the audience, noting that progress is accelerated by collaboration.
The privately funded initiatives are more concerned with meeting their own goals — and satisfying their funders — than with coordinating efforts in the field.
“I don’t see my role as trying to answer this larger question about how does this all fit together,” says Jeffrey Bluestone, chief executive of the Parker Institute. “I’m focused on how to make sure what we do is impactful for patients.”
But Douglas Lowy, acting director of the US National Cancer Institute (NCI), which is coordinating the government moonshot, notes an overlap with the leadership of the various projects.
Soon-Shiong, Bluestone and leaders of immunotherapy initiatives at Johns Hopkins and the University of Texas MD Anderson Cancer Center in Houston are on the government initiative’s advisory panel.
And on 18 April 2016, the Biden moonshot launched a website to solicit research ideas. The aim, Lowy says, is to ensure that research areas recommended by the advisory panel do not duplicate topics being covered by the private initiatives.
There is wide agreement on major questions regarding immunotherapy, however. For instance, researchers don’t understand why the approach works in only 15–20% of patients.
Combining immunotherapies, and studying what distinguishes patients who respond, could make treatments more effective. Pharmaceutical companies are already developing new drugs and testing therapies in combination.
Philip Gotwals, executive director of oncology research at the Novartis Institutes for BioMedical Research in Cambridge, Massachusetts, estimates that industry has spent upwards of $1 billion on the field.
But scientists see a lack of basic cancer immunology research, even in the new programs.
“Many of these initiatives are moving forward ideas that are already out there,” says David Raulet, faculty director of the Immunotherapeutics and Vaccine Research Initiative at the University of California, Berkeley, which began in March 2016.
Many researchers are looking to the Biden project to make a big investment in basic cancer immunology and to address broader barriers to research, such as data hoarding.
Gotwals, for instance, notes that the results of industry-sponsored clinical trials now under way could help other companies to decide which approaches to test, but that results are typically not made public until 9–12 months after a trial ends.
Companies are reluctant to share data before then, both to comply with regulatory requirements and to protect their intellectual property. “It’s not trivial to figure out how to make that work,” Gotwals says.
Biden seems to be hearing that message. At the AACR meeting, he said that data sharing often comes up when he speaks to scientists about the moonshot.
Lowy says that the NCI is already planning to open a Genomic Data Commons in June to host detailed information on cancer patients.
Sharing data collected in company-sponsored clinical trials is trickier because patients must give informed consent.
In the meantime, the government moonshot faces a major hurdle: its funding is at the mercy of legislators who may be loath to give US President Barack Obama a victory in his last year in office.
“It will be very difficult for us to initiate all of the programs that we’re looking forward to the blue-ribbon panel recommending if there isn’t funding,” Lowy says.
Nature 532, 424–425 (28 April 2016) doi:10.1038/532424a
Biden urges cancer researchers to work together toward ‘moonshot’ goals
STAT Article by Dylan Scott
April 20, 2016
Joe Biden sees cancer silos starting to come down. But many are still standing. In his travels across the world since the White House announced a cancer “moonshot” initiative, the vice president said world leaders are constantly asking him what they can do to help. Leading researchers are talking about how they can better share data and work together.
But as Biden spoke to the American Association for Cancer Research (AACR) in April 2016, he said that too many barriers remain to reach the ambitious goals for cancer research that he and President Obama have laid out this year.
“I ask you a rhetorical question,” Biden told the group at its meeting in New Orleans as he closed his speech. “Are we collaborating enough? What can you do? What can we do?”
Breaking down silos — as he has often put it on his road tour since the cancer initiative was announced in President Obama’s State of the Union address — has been a regular theme for the vice president. By that, he means encouraging researchers to collaborate and corralling disparate interests in government, academia, and the private sector.
Facing a crowd of those very researchers, Biden hit that theme hard at AACR.
He ticked through all the world leaders he’s met with since the cancer moonshot started. Even in meetings that have nothing to do with medicine, such as a discussion in the United Arab Emirates about the Islamic State, officials have asked him about cancer, he said. It came up again during a recent meeting with 50 heads of state at the White House and when Biden recently visited Israel. Other leaders have asked if they can enter an agreement with the United States to work together on cancer.
There are also projects underway — like AACR’s Project GENIE and the ORIEN network, among others — that aim to pool data and other resources among different research institutions with the hope of identifying patterns in cancer and treatments sooner.
But Biden noted an irony there.
“Quite frankly … when I met with all the heads of each of those groups, it raises the question for me: Why is all of this being done separately?” he said. “Why is so much money being spent when, if it’s aggregated, everyone acknowledges the answers would come more quickly?”
The Obama administration’s stated goal is making a decade’s worth of progress in cancer research in the next five years.
Biden admitted that the current model for research — how grants are awarded, how institutions evaluate their researchers — doesn’t necessarily reward that kind of collaboration.
“The way the system now is set up, researchers are not incentivized to share their data,” he said. “Too often grants are given for what you’ve already done rather than what you are doing. … The more outside the box, which may be the answer to some cancers, the less likely you are to get funded.”
The vice president didn’t unveil any new specifics, but he said that fixing that model would be a focus for his cancer task force. He said that researchers should be evaluated based on patient outcomes, not publications, and that data should be more readily available once published. There isn’t much grant money right now in verifying other published research, even if such verification is important, he said.
Biden also rebuffed those who have questioned the usefulness of sharing data — namely a New England Journal of Medicine editorial that worried data sharing could breed data “parasites.” (The journal later softened that statement.)
“But every expert I’ve spoken to says we need to share this data in order to move this progress more rapidly,” Biden said.
Those hurdles to collaboration are part of what Biden has come to call “cancer politics” — the competing and conflicting interests that he says are inhibiting research.
It is an issue that those in the field are well aware of.
“Probably like many fields, the metrics for advancement will always start with, ‘What have you accomplished?’” Dr. Levi Garraway, a member of the moonshot advisory panel and a researcher at Dana-Farber Cancer Institute, told STAT recently. “Lots of people are willing to collaborate in principle, but they don’t want to collaborate to the point where they don’t get credit.”
Likely with that in mind, Biden warned: “This is not the system that will get us to our goals faster.”