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Charting the path of the Cancer Moonshot

Danny Buckland
A year after its ignition, former US Vice President Joe Biden’s mission to conquer cancer by 2020 is still on course, writes Danny Buckland, but there are many challenges ahead.

Telescoping ten years work into a five-year term is ambitious even for a politician and, while few doubted former US Vice-President Joe Biden’s intent, it is hard to imagine a tougher task.

 

Cancer has corkscrewed its way through humanity, gouging and twisting to avoid ever-ingenious methods of control. Significant advances in breast cancer survival rates are tempered by the barely moving indicator on pancreatic cancer.

 

The umbrella name cancer hides a multitude of different and complex diseases that exact a fearful toll. In 2008, it counted for 7.6 million deaths around the world; by 2030 that figure is predicted to scale up and beyond 13.1 million.

The impact is measured in personal tragedy and also economic corrosion. Cancer drained the global economy of €662 billion – aside from the medical costs – in 2008.

Charting the path of the Cancer Moonshot

But the rising burden of morbidity and financial devastation is running parallel to unprecedented scientific advances with genome sequencing unlocking a treasure trove of epigenetic information and immunotherapy promising targeted treatments that harness the body’s defences to halt cancer without the need of the heavy hammer blows of chemotherapy and radiotherapy.

 

It is at this confounding nexus that the Cancer Moonshot can deliver its payload – a new era of clinical collaboration, data sharing and problem solving that unshackles the potential to achieve Biden’s dream.

A multi-faceted campaign

As the initiative reaches its first anniversary and the Union for International Cancer Control (UICC) marks World Cancer Day, on February 4, it is clear that the Moonshot is a multi-faceted movement that feeds off cultural change as well as scientific and medical advances.

 

The UICC warns that 19.3 million cases of cancer are expected to be diagnosed a year by 2025. Public health campaigns play a vital role in stemming the tide but the influence and potency of leading industry firms is key to winning the battle.

 

A three-year commitment by 22 biopharma firms, the World Bank and the UICC, announced at the Davos World Economic Forum 2017, will see $50 million invested to develop and measure sustainable programmes to combat Non-Communicable Diseases (NCDs) in low and lower-income communities.

At Philips, the imperative is to provide the innovation, technology, knowledge and drive that can re-draw the oncology landscape to enable greater clinical collaboration and data sharing. It has a bold programme that creates the support structures and capabilities to provide faster and more accurate diagnoses which will lead to better patient outcomes combined with cost effective healthcare.

 

An early example of an enhanced collaborative approach came with Cancer Research UK’s Manchester Institute, at the University of Manchester, joining forces with the University of Southern California to accelerate research into circulating tumour cells to further understanding of faulty genes. Identical laboratories are being set up on either side of the Atlantic with real-time sharing of research data and experimental procedures.

 

The pioneering union could quicken the pace to developing tests to detect early signs of cancer in otherwise healthy people and so improve survival and cure rates.

 

Sir Harpal Kumar, Cancer Research UK’s chief executive, comments: “We’re proud to be part of Vice President Biden’s initiative and share his ambition to see progress accelerate so that more cancers are cured. By pulling down the international barriers to foster collaborations between the best teams around the world we can enable them to share technology, insights and data that will transform how cancer can be detected, monitored and treated.”

Breaking down barriers

Health systems are buckling under the strain of an ageing, growing population – between 2015 and 2025, the proportion of the world's population over 60 years will nearly double from 12% to 22% according to WHO figures - and any solution to cancer’s rampant growth needs to be framed with a cost analysis.

 

Philips has a three-pronged approach that is creating a blueprint for modern oncology care starting with the Confident Diagnosis, allowing a pin-sharp multi-disciplinary characterisation of the cancer, followed by Personalized Therapies, using imaging based or integrated therapies to improve long term outcomes and minimize side effects, and then Efficient Delivery, which enhances workflow to drive down the cost of care while improving the patient experience and supporting it with vital Home Care.

 

Achieving that will involve breaking down silos across the health continuum, clearing communication channels and promoting the clinical and cultural atmospherics to foster collaboration and data sharing as a natural element of cancer control.

 

“It is a good time to assess the impact of the Cancer Moonshot and its aspiration to achieve ten years of progress in five years and a lot of that is to do with getting people to talk to each other and collaborate in new ways,” says Maya Barley, Head of Integrated Solutions and Roadmaps at Philips.

“It is about using a lot of what we already have but bringing it together and breaking down those barriers. I do believe that has been accomplished.”

Treating patients as individuals

That landmark, although it doesn’t obviously push the cancer statistic needle backwards, is crucial to preparing the ground so new treatments, such as immunotherapy, can flourish. Many experts believe that failing to unite the cancer community and its bristling divisions of knowledge would be a wasted opportunity of catastrophic proportions.

 

“There are massive developments in cancer and it is absolutely critical in medicine, and in oncology particularly, to share,” adds Ms Barley. “It is such a rapidly moving field that each cancer patient is an individual and it is one of the big realizations of the last five years that you cannot treat a patient as anything other than an individual.

 

“Collaborations within the team treating the patient are essential as they are in and between hospitals where you have different levels of expertise; barriers between them need to go,” she says. “We need electronic medical records and the ability to share pathology, which until recently was about sending pieces of glass through the mail that used to break during delivery.

 

“I credit Joe Biden with his passion and commitment, which is obviously rooted in the personal loss of his son to brain cancer, but his natural ability to bring people together collaboratively has driven a lot of focus both in the US and globally and the dialogue has invigorated people.”

Charting the path of the Cancer Moonshot

Improving data integration

Ms Barley, who is based at Philips UK science park, says the technical capabilities can now end the practice of Tumour Boards struggling to get vital information to treat patients swiftly and effectively.

 

“It is about what we can do to improve data integration, sharing and visualization. What interfaces do we need between various platforms used by a hospital that store information? What can we do to bring that information together into a single database or platform and how can we make it easy for people to input information so it is not a burden to share?

 

“It is about improving efficiency and making sharing part of the work flow not another step that needs to be taken. The greatest incentive is when a medical team sees that sharing has changed the decision making therapy course in a positive way.

 

“But getting to the best outcomes at the lowest cost we also have to improve diagnostic accuracy. Finding something early and diagnosing it correctly speaks to the need for better imaging and digital pathology that can help you pull extra information out of the slides you are creating and share that, along with a need to understand dynamics of the cancer pathways.”

Patients defining outcomes

Cancer patient and blogger Richard Davies deBronkart Jr believes the Cancer Moonshot has taken us ‘closer than ever’ to a cure. He is an advocate of the patient using their healthcare data to improve treatment options and outcomes.

 

“One of the first things an e-patient learns (empowered and engaged) is that there's no one thing called cancer – it is many diseases. Precision medicine and the Cancer Moonshot have made that clearer to the public than ever,” he says. “How close are we to curing all cancers? Closer than ever, and the odds for most types are better than ever. But we have a long, long way to go.

 

“Curing all cancers will require three things: a radical increase in precision medicine knowledge (causes and cures), a commitment to health and cures at the society level so treatments are fairly distributed, and a commitment to citizen well-being at the government level - we cannot afford to let governments oppose science if it gets in their way.”

 

Patient contributions, he says, can accelerate research, adding: “We’re starting to see patients move into the driver's seat. Patients are increasingly defining what outcome measures are important to them, and are increasingly being asked what outcomes matter. If we make the most of this, it could produce an unprecedented alignment of incentives and motivations, so that - perhaps ironically - for the first time health care will be about what patients care most about. Of course, doing this will require the sometimes immense culture shift of researchers and funders seeing value in what patients want, and some have no training in how to think that way, so there is much mutual learning to do!”

Role of research and collaboration

This view is echoed by Professor Alan Ashworth, former Chief Executive of the Institute of Cancer Research, London, who was appointed to the prestigious post of Director of the UCSF Helen Diller Family Comprehensive Cancer Center, at the University of California, San Francisco, in 2014. He believes that the power of patient data and reservoir of knowledge released by genome sequencing are shifting perceptions and providing a new perspective to research and treatment.

 

“People are sharing data in a way we have never seen before and that has been inspired by the Cancer Moonshot,” he told a cancer debate on KQED Radio, in California, last month.

 

Jan Liphardt, a bioengineering scientist at Stanford University, is seeing natural growth on his inclusive patient website, cancerbase.org, where people share information and experiences which can be used to inform lines of study and therapy pathways.

 

“We need this knowledge and an unrestricted flow of information so we can make the best of new therapies,” added Ms Barley. “We don’t understand when these cutting edge therapies work and don’t. We hear about examples in the news such as a six-year-old girl about to die whose tumour melted away but there are many more where the patient dies and, while we are in this phase where we don’t fully understand what is going on, the only way to get to a level of understanding is basic research and discussing it.”

Commonality in patient data

Ms Barley’s approach is both personal and professional as her mother has a rare form of cancer experienced by only 6,000 people worldwide.

 

“She has been going to doctors who have never seen a case like it who are suggesting treatment but what if you could log onto a system which reveals what treatments have worked, and those that haven’t, so treatment has more chance of success?” she says.

 

“We could share information from genetic aberrations, family history, sets of co-morbidities and how combinations of therapies have worked. This is where the future lies while we are still understanding immunotherapies and these amazing new therapies.

 

“The key part is that if you diagnose a cancer early then you save a lot of money down the road because finding it early means you can remove small amounts of tissue surgically while misdiagnosing a lung cancer as a benign cyst can result in the patient coming back with stage 3 cancer a year or two down the line.

 

“New imaging techniques can help clinicians characterize the tumour fully and choose the most appropriate treatment for that patient to minimize the amount of time a patient is receiving an ineffective and costly therapy and maximize the time they are getting onto the right treatment. Good monitoring also ensures patients react well and don’t stay on treatments that aren’t working.

 

“If data is shared across hospitals, regions or across countries then you can start to look for commonality in patients which also streamlines treatments. It is also important not to underestimate the value of patient satisfaction – early diagnosis and clear treatment and their involvement can reduce anxiety.”

Sustaining the Moonshot momentum
Matthew Ong, of the Cancer Letter, the leading publication on cancer research funding, legislation, and policy, believes the Moonshot has already reached its goals on data sharing and bioinformatics in oncology, the streamlining of Food & Drug Administration (FDA) regulation and bringing scientists together to ‘figure out what are the most significant areas in oncology that require investment.’

 

He says: “The moonshot is an old analogy that has been well used over the last 50 years and, in oncology, it can be overused. It is appealing to say: ‘let’s launch a moonshot and cure cancer’ but what is different about this moonshot is that is from the beginning Biden’s team was aware that cancer is not a problem easily solved. You cannot just throw money and people at it and it will cure itself so you have to go down the ‘unsexy path’ of what can and can’t be achieved.”

 

The challenge for Biden is to sustain momentum now that he is out of office. The imprint of the White House will now be replaced for a non-profit organization he is forming but it remains to be seen how much of the $1.8bn authorized for research by the Obama administration makes it through - $30 million will be available during 2017 but the other $1.5bn is in doubt.

 

Matthew Ong adds that the exciting potential of immunotherapy keeps the scientific agenda pulsing and requirements in the 21st Century Cures Act, passed under Biden and Obama, will make it easier for companies to pursue innovation and create standards for data sharing.

 

The fight against cancer is far from over but the weaponry at our disposal and a new era of collaboration mean that the Moonshot’s ambitions are within grasp.

Danny Buckland

Danny Buckland


Danny Buckland is an award-winning health journalist who writes and broadcasts on healthcare technology, current affairs and features. He has worked for major national newspapers, including the Daily Mail, Daily Mirror and The Times, and magazines for more than 25 years.

 

Follow Danny Buckland on: LinkedIn.

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