UPDATED January 15, 2016 // Cancer societies have applauded last night's oratory from President Barack Obama, with his plea to "make America the country that cures cancer once and for all."
In his last State of the Union Address to the nation, Obama announced a national initiative to find a cure for cancer, an ambitious "moon shot" that Vice President Joe Biden will direct in the remaining months of the administration, as reported by Medscape Medical News.
All the major American cancer societies commended the speech and emphasized the progress currently being made in cancer research.
"We have indeed reached an inflection point, where the number of discoveries that are being made at such an accelerated pace are saving lives and bringing enormous hope for cancer patients, even those with advanced disease," said President of the American Association for Cancer Research (AACR) José Baselga, MD, PhD, physician-in-chief and chief medical officer at Memorial Sloan Kettering Cancer Center, in New York City.
"Now is the time for a major new initiative in cancer science that supports and builds upon our basic science foundation while translating these exciting scientific discoveries into improved treatments for cancer patients, such as in the areas of genomics, precision medicine, and immuno-oncology," he said.
However, while the commitment to increase funding of cancer research is laudable, there is "a lot that we can already be doing with what we know," said Robin T. Zon, MD, practicing oncologist at Michiana Hematology-Oncology PC in South Bend, Indiana. Rather than aiming to 'cure' cancer, she suggested that more realistic aims are reducing the incidence of cancer — by public health measures to reduce smoking and obesity — and controlling cancer by improving use of the treatments that are already available — by acting on clinical information collected in big data initiatives such as CancerLinQ, in which her practice is participating.
Two-thirds of cancers are due to lifestyle — smoking, obesity, alcohol, etc. — so putting money into public health initiatives would give a "bigger bang for your buck," she told Medscape Medical News.
But hope is important, others suggested. "In a hopeful era, we need hopeful leaders, so we applaud the president and vice president's commitment to change the face of cancer as we know it," commented Douglas R. Lowy, MD, acting director of the National Cancer Institute. "Thanks to many years of work by dedicated cancer researchers, we have, within our reach, real opportunities to prevent, successfully treat, or even eliminate many forms of cancer in adults and children," he said in a statement.
American Cancer Society (ACS) Chief Medical Officer Otis Brawley, MD, described the moon shot as "a galvanizing call for a renewed effort to find new tools to fight cancer.
"It is imperative that we continue to fund the brightest minds to explore the nature and biology of our nation's number two killer. Done right, we can build on our past investment and spur even more progress against the disease," he said.
However, some of our Medscape readers were a little more skeptical. There was a bit of déjà vu, with echoes of the gung-ho spirit last heard in 1971, when Richard Nixon declared the War on Cancer.
"I have to admit to some moderate irritation when hearing the president set such unrealistic goal," wrote a registered nurse in comments to our report on the speech, which was published last night.
"Makes me wonder who he has as his medical advisors," she wrote. "Did they mention that cancer is not one disease?"
Another commented: "Is there a single physician over the age of 50 who actually believes 'curing cancer' is a scientifically reasonable phrase for anyone to use?"
Another commentator took issue with the language used, in particular the term "moon shot," which harks back to the ambitious plan announced 55 years ago by President Kennedy to land a man on the moon.
"This is nothing at all like a moon shot, for goodness' sake," the commentator wrote. "I am appalled by the simpleminded and atavistic perspective that cancer cures come from engineering projects and that there is some comparison to be made to space travel. Cancer is a science problem and the challenge is provided by the indescribable complexity of biology."
Speaking to Medscape Medical News in an interview, Brian Bolwell, MD, chair of the Taussig Cancer Center, Cleveland Clinic, in Ohio, said that "directionally and in spirit," the message about increased funding for cancer research is very welcome, but he suggested that use of the word "cure" was jarring -- oncologists are "very cautious and we never use the word 'cure.' "
The only chance of a cure is surgery, and that is with regard to resection of an early-stage cancer, which does not happen often, he pointed out. But there has been great progress made with some of the newer drugs that can hold the cancer at bay and allow patients to live with the disease, he said. The "poster child" for this approach is chronic myeloid leukemia, which is held in check with tyrosine kinase inhibitors such as imatinib (Gleevec, Novartis Pharmaceuticals Corporation). This may not be a cure, but it is game changing, Dr Bolwell said.
He also emphasized the potential for prevention. Some research suggests that it may take 15 years from the first genetic abnormalities to the clinical manifestations of cancer, and if this process is better understood, there may be opportunities to intervene and stop the cancer as it is in the process of developing, he said.
The promise of increased federal funding for cancer research has come at just the right moment, "because our knowledge of genomics and immunology is leading to real clinical progress right now, with targeted therapies helping patients in ways we have never seen before," Dr Bolwell commented in an email.
However, he also pointed out a couple of practical issues that are currently hindering cancer care, which he argues must be addressed.
"Genomic testing of tumors must be covered by insurance companies," Dr Bolwell commented in an email. "This will allow all cancer patients the opportunity to receive such new, precision-based therapies."
And he brought up the biggest issue currently in US cancer care -- the sky-high prices being charged for new cancer drugs, as reported many times in the past by Medscape Medical News.
"The cost of prescription cancer targeted drugs must become more rational," Dr Bolwell commented. "A course of new cancer therapy has increased 10-fold in the past decade -- to over $100,000. This rate of price acceleration is entirely unsustainable and will blunt the ability of scientific progress to reach patients with cancer," he adds.
The American Society of Clinical Oncology (ASCO), in applauding the new initiative, took the opportunity to highlight one its pet projects, the "big data" initiative CancerLinQ, which it has previously claimed "will revolutionize cancer care." The aim of this project is to collect clinical data from 'real life' rather than clinical trials and to process the data through computer analysis to find trends. ASCO Chief Medical Officer Richard L. Schilsky, MD, said that this system will allow "insights that have taken years to discern could happen much more quickly, helping us to better understand which treatments work best for each patient and the high impact areas where additional research is critically needed."
Some Details of the Project
A few details of the new cancer initiative were revealed by Biden on his website.
"The goal of this initiative is simple — to double the rate of progress. To make a decade worth of advances in five years," he writes.
He now has met with "nearly 200 of the world's top cancer physicians, researchers, and philanthropists," and he has personal experience of having someone close affected by the disease (his 49- year-old son died from brain cancer in May 2015).
In his post, Biden outlines the problem as one in which more communication between active parties is needed.
"Several cutting-edge areas of research and care — including cancer immunotherapy, genomics, and combination therapies — could be revolutionary.... But the science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients," he writes.
He intends to "break down these silos and bring all the cancer fighters together — to work together, share information, and end cancer as we know it." At the same time, he intends to increase both private and public funding of cancer research.
The federal government will support cancer research through funding, targeted incentives, and increased private-sector coordination, he pledges, and "we'll encourage leading cancer centers to reach unprecedented levels of cooperation."
The need for cooperation between different players was also highlighted by Dr Brawley at the ACS. "Cancer will not be cured this year. But we should do all we can to ensure 2016 is remembered as the year we came together in an effort to work smartly, and with all the resources we needed, to harness the power in our hands to reduce the devastating impact of cancer."
But Dr Brawley also emphasized what already could be achieved if all current knowledge was acted upon. "Just as important as continuing to explore new science is a concerted effort to gather what we already know about cancer and find ways to apply these tools more effectively to save lives," he said in a statement.
"If we applied what we already know about cancer prevention, early detection, and treatment, we could prevent a substantial proportion of the nearly 600,000 cancer deaths in the US each year. These remarkable tools mean nothing if they sit unused, unavailable to those in need because of gaps in care caused by poverty and other factors."
The American Institute for Cancer Research (AICR) also highlighted prevention.
"As a plan for the future, President Obama's pledge is inspiring," the AICR said in a statement.
But there are huge challenges ahead, it added. "Cancer is not one disease but many, with different risk factors and, of necessity, different treatments. Furthermore, any two people who contract the same cancer possess different genetic and metabolic profiles, which means any treatment -- let alone cure -- must be highly tailored and targeted."
Better treatments are only half the cancer story, it adds. "AICR research has shown that we can prevent nearly one third of the cancers that occur every year in the US if Americans made healthier choices, including moving more and eating smart." In addition, if smoking stopped, approximately half the cancers in the United States would be prevented.
It is not just cancer that would be reduced -- such lifestyle changes would also reduce the risk for heart disease, diabetes, and other chronic diseases, the AICR points out.
The point about prevention was also raised by several of our readers. "The War on Cancer has cost billions yet how many lives have been saved?" wrote one physician. "Let's get real and prevent cancer rather than spend 70% of our resources fighting off the terminal stages of it"
Another wrote that the moon shot oratory "very much distracts from the idea that prevention is the ultimate 'cure' and we should be spending more money on education of that idea rather than the $billions and time distraction on 'discovering,' marketing, selling expensive medications that buy little time and less quality of life."
"The best spent money on cancer, heart disease, and most of the top 10 killer diseases in this country would be on PREVENTION. But in this country prevention is given lip service because there is no money in it. The big dollars are in drugs, surgeries, and hospital stays," wrote another.
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Cite this: Cancer Societies Applaud US Moon Shot 'to End Cancer' - Medscape - Jan 13, 2016.