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Getting Cancer Research Back On Track Requires ‘Behemoth’ Effort

In 2016, then–vice president Joe Biden launched Cancer Moonshot just 1 year after his son Beau died from glioblastoma multiforme. He wanted to “cure” cancer, he said. While that may be easier said than done, Moonshot has been instrumental in fostering research collaborations by encouraging data sharing among scientists.

“It also brought together a new way for the National Cancer Institute and Department of Energy to drive progress on some of the big data initiatives. The initial Cancer Moonshot infused a sense of urgency and hope into this effort,” said Danielle Carnival, PhD, coordinator of Cancer Moonshot, a program within the White House Office of Science and Technology Policy.

The Biden administration relaunched Moonshot in 2022 with newly defined goals: Cut the rate of cancer-related deaths in half within 25 years; improve the experience of people with cancer, cancer survivors, and their families; and “end cancer as we know it,” President Biden said in a press conference.

Between 2017 and 2022, Cancer Moonshot created more than 70 consortiums or programs, and funded about 240 research projects. Its fundamental goals of improving data sharing and encouraging collaboration are very important, said Tanios S. Bekaii-Saab, MD, leader of the gastrointestinal cancer program at Mayo Clinic, Phoenix.

“Because, historically, what happens with cancer is that researchers compete for resources … and they become very protective of their data. Sharing gets more difficult, collaborations become more onerous, and it becomes counter-productive,” he said.

Bekaii-Saab noted a couple examples of networks designed specifically to share data, such as the Human Tumor Atlas, a National Cancer Institute Cancer Moonshot–funded initiative to create publicly available atlases of cellular, morphological, and molecular features of human cancers, and PDXnet, a patient-derived xenograft research network.

Despite these efforts, cancer research fell behind during the COVID-19 pandemic, he said. “This is true not just for Cancer Moonshot, but for everything including prevention and research. It really affected our capacity to continue to move forward at a fast pace.”

When the program was created in 2016, Congress passed the 21st Century Cures Act authorizing $1.8 billion for the program over 7 years. For FY 2022, Cancer Moonshot received $194 million from the $6.9 billion National Cancer Institute budget.

Joseph Alvarnas, MD, a hematologist-oncologist and vice president of government affairs at City of Hope, Duarte, Calif., sees the Moonshot budget as a potential shortcoming.

“The priorities are well founded and based on what we would think are the most important things to cover, but, if we’re going to achieve these extraordinarily ambitious goals of halving cancer mortality and serving communities more equitably, it’s going to need more funding positioned at making these things real,” he said.

Moonshot is being positioned as an opportunity to double down on efforts started in 2016, but treating cancer is complex and goes well beyond funding new research.

“We know that we have amazing research and progress around innovations that will drive us toward the goal of reducing the death rate from cancer. But we also know that we have tools that aren’t reaching all parts of the country, so we have a great opportunity to make sure that we’re doing all we can to prevent, detect and treat cancer,” Carnival said.

Can Cancer Be Cured?

Cancer is the second-leading cause of death in the United States after heart disease, but it may indeed be possible to cut the total number of cancer-related deaths in half over the next 25 years.

“As a hematologist who’s been involved in both research and clinical care, I think it’s important to realize this is actually doable. Between 1990 and 2020 cancer mortality rates decreased by 31%, and in the last American Cancer Society’s annual report, mortality rates dropped by the largest percentages for 2 consecutive years in a row. The question shifts now from ‘is this possible? to ‘how do we ensure that it’s possible?’ The spirit of Cancer Moonshot 2.0 is identifying the multiple paths to move this effort forward,” Alvarnas said.

But without a significant infusion of cash for research, it’s doubtful cancer-related deaths will drop by 50% over the next 25 years.

“There are a lot of big and lofty goals in Cancer Moonshot, and the words ‘ending cancer,’ well those are big words,” Bekaii-Saab said. “The reality is how do we measure in 25 years the impact of this today? I think it will require significantly more funding over the next few years to achieve the goals set by the Moonshot. Otherwise it will be a 7-year done deal that will accrue a lot of great numbers but won’t make a dent in those goals for the next 25 years. To stop it at some point and not invest more into it, we will probably lose most of the benefit.”

A Shift in Funding Priorities?

While there is no new funding dedicated to the relaunch, there may be a significant shift in funding priorities in FY 2024.

“We fully intend to support the great ideas that are coming out of the cancer cabinet by bringing together leadership of cabinet agencies across the government. We know that it’s going to take all of us coming together and while we haven’t put out a specific budget around Cancer Moonshot, there are already programs across all those agencies and leveraging toward these goals.

“I think when we do the process for the budget for FY24 – after we’ve had time to really explore the best ideas and build the foundation for some of these new aspects of the Cancer Moonshot – we hope to have something more concrete going toward these efforts,” Carnival said.

Cancer funding has been stagnant for years. When adjusted for growth, it has been stagnant since at least 2003 – at least in relative terms, Bekaii-Saab said. “This affects a lot of the things we do, including NCI-funded clinical trials. It pushes us to work with the private sector, which is not necessarily a detriment, but it doesn’t advance the academic mission at the same level. So overall, I wouldn’t call it tragic, but I do think we’re falling behind,” he said.

“The great challenge to us in the 2020s is not only about developing new and more effective technologies, but also in doing a better job of getting existing life-saving treatments into the hands of underserved populations,” Alvarnas said. “One of the really positive challenges set forth by the Biden administration is the idea that financing care equity is as important if not more so than advancing care technologies. If there’s been stagnation, it’s because from a government and resourcing point of view, that priority has been ineffectively supported financially.”

The Pandemic Stymies Cancer Research

The COVID-19 pandemic has had a tremendous impact on cancer research, including disrupting ongoing studies, but also, the loss of employees as a result of the Great Resignation that followed the pandemic. “A lot of employees just decided to change jobs in the middle of the pandemic, which led to a cancer research staffing crisis,” Bekaii-Saab said.

Since 2020, there has been a significant decrease in the launch of clinical trials for cancer and biologic therapies. “That can affect every aspect of our research operation including studies funded through NCI. It will require a behemoth effort to get back to pre-COVID times,” he said.

“We all recognized that turning so much of the attention of the entire biomedical research engine and health system to the COVID-19 pandemic would have an impact across cancer research, screenings and care,” Carnival said. “There is work to do to get us back to whole, but from the research perspective we’ve seen a reorientation of the trial networks we were using for COVID-19 research back to their initial purpose. Some of those are cancer and oncology networks, so we’re excited about that and fully believe that we can catch up.”

But then there’s also the impact the pandemic has had on cancer patients who delayed their care at the primary level. This, Bekaii-Saab fears, will lead to more patients presenting with more advanced disease in years to come. “One of the biggest problems was that a lot of patients delayed their care at the primary level. My biggest concern is that in the years to come we will see a lot more patients presenting with more advanced cancer.”

This story originally appeared on MDedge.com, part of the Medscape Professional Network.

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