Cancer ‘moon shot’ a real long shot

Like many oncologists and cancer researchers, I rolled my eyes when I first heard about Vice President Joe Biden’s cancer “moon shot,” but not because of the noble goal. I was among the many people who were sorry to hear about the death of the vice president’s son Beau from cancer last year. And I, too, have mourned the untimely deaths from the disease of people close to me. Those of us who care for cancer patients would give nearly anything to be able to cure all those with cancer, or at a minimum, to greatly extend their lives. Today, we can sometimes do this, but sadly those circumstances remain far too limited.

But a cancer moon shot evokes a sense of deja vu. The 1970s ushered in the War on Cancer, which was largely unsuccessful at generating better treatments. In 2003, Andrew Von Eschenbach, the head of the National Cancer Institute, assured then-Sen. Arlen Specter that for just $600 million a year, we could rid the world of cancer by 2010 — five years ahead the target at that time. Now here were Biden and the Obama administration making another tall promise. Did we really need this again?

Then, the specifics emerged. Biden announced that the Food and Drug Administration would speed the approval of promising drug combinations. But thinking you will substantively improve cancer treatment by altering how it is regulated is like thinking you can run a faster mile by buying a new stopwatch. The efficacy of cancer drugs is beyond the FDA’s control, and no one doubts it would approve transformative drugs or drug combinations if they appeared.

Another oft-mentioned proposal is harnessing the power of big data. One such idea is to closely examine what therapies have worked for individuals and which unique genetic traits allowed those therapies to work, and then extend these findings to other patients. Unfortunately, such an approach is fraught with limits.

Biden has recently offered up two more moon shot ideas: immunotherapy and increasing access to trials. Immunotherapy refers to promising new drugs that harness the body’s immune system to fight cancer, and indeed these have generated impressive outcomes for some patients. But with dozens of immunotherapy studies underway, that rocket has already lifted off, and it’s unclear what Biden’s moon shot can add.

Increasing access to cancer trials would be a great thing, but it is hard not to think of it as only a modest step, as well.

The fundamental problem with a moon shot aimed at cancer is that it does not fit the way that medical progress occurs. Scientific discovery is hard to predict, and breakthroughs occur in serendipitous and unexpected ways, arising from diverse disciplines. A serious moon shot would require funding science broadly, consistently and in steadily increasing amounts. This money would go to cancer biology research, but also to physiology, molecular biology, genetics, physics, chemistry, social science, clinical trials, supportive care and on and on. The way in which we will ultimately make progress in fighting cancer, and for that matter Alzheimer’s disease, and emphysema, and mental illness, will likely surprise even the most farsighted experts, and may have surprisingly diverse origins.

Such science is not just the best way to improve human health but also the only way. A commitment to funding science generally, and not just fad projects or treatments, in times of both budget surplus and shortfall, would be a true moon shot for the United States. Sadly, this is the one moon shot no one in politics seems to have the courage to fight for.

Vinay Prasad is a cancer researcher and assistant professor at Oregon Health and Science University. He wrote this for The Washington Post.