A panel of cancer experts has released its list of recommendations for the government’s big Cancer Moonshot program, a bid to bring the success of the Silicon Valley model to bear on cancer, the emperor of all maladies. It’s an intriguing list, spanning the very general to the very specific. It includes guidelines for how to improve everything from basic molecular biology to compassionate patient outreach. No matter how sound this panel’s list of ideas, though, the project itself could end up being scuttled by politics, and the never-ending pull of austerity.
This moonshot project, officially referred to as The Vice President’s Cancer Moonshot, was originally going to be priced at a cool billion dollars, but in the time since cancer authorities have asked for about $650 million. Like all science funding, its fate is uncertain as it seeks approval from the US Congress, and representatives from both parties are asking for more detail on how the money will be spent. Some say a billion is a lot to spend, while others question how much good even that much money could end up doing.
Well now they’ll have a better idea, at least in theory. The 10 recommendations include things like supporting immunotherapies and figuring out the molecular basis of anti-cancer drug resistance. On the other hand, it also includes a fair number of IT-related goals, including creating better algorithms for finding future cancers via patient information, and better methods for patients to be involved in their own treatment and future research. That’s one huge proposition: Add the ability for patients to share their genomic results with researchers, easily and proactively, without having to have been contacted by researchers for a specific study.
One big issue in treating cancer is that even the same type of cancer in the same area of the body might behave differently — which, in a certain sense, means that they are not the same type of cancer. What researchers are increasingly finding is that every patient’s cancer is, to a great extent, uniquely their own. Some basic umbrella treatments do work for the average patient. But virtually every patient could see improved results with a treatment regime that’s tailored to their personal cancer genome. This dream of fully personalized medicine will require the sort of monumental efforts in data collection and analysis that this Blue Ribbon group, and the White House, are proposing.
This is all indicative of cancer’s nature — not a single disease, but rather a class of diseases with a wide range of symptoms and causes. Trying to treat “cancer” is in many ways not a goal but a collection of goals, requiring a large suite of solutions to one of the most fundamental features of biology: the tendency of cells to abandon the social contract of all multi-cellular life and replicate themselves according to their own selfish priorities, with no regard for the welfare of the organism overall. We have to read the genetic payload of every tumor because the tumor is made of the patient’s own cells, and is every bit as unique as that patient themselves.
There are a multitude of ways the same cell type might try to achieve its cancerous goal. There are an even larger number of cell types, and each has its own array of possible paths to cancer. Curing cancer means finding a way to fix or head off all of these problems, perhaps in one swoop, but more likely as a growing mosaic of highly specific cures and preventative therapies. That’s what we see here: nearly equal priority given to pure research, therapeutic practice, and patient outreach.
That’s why questions about the effectiveness of this push seem to fall a bit flat. If this was simply more of the same, giving bigger cash infusions to the initiatives we’ve been pushing for the past fifty years, then there would be real cause for concern. But the idea seems to be both to conduct revolutionary research and to make the boring investments that allow revolutionary research to be conducted in the future. This is the sort of thing that the private research sector and even academic world have a hard time pulling off — the human genomic databases that currently exist are enormous by any standard, but also tiny compared with what’s needed.
The government has to decide on this project before finalizing the 2017 federal budget, or wait a full year more and effectively make this the next administration’s responsibility. That could easily mean death by shelving for Joe’s Big Moonshot Adventure. Judging by the breadth of these recommendations, that would be a sad day for cancer research.