Shooting for the Stars: What the Cancer Moonshot Means for You
Hope. That word comes up a lot when talking about the Cancer Moonshot, a major push from the U.S. government to advance cancer research and treatments. For researchers and doctors, the Cancer Moonshot is meant to provide new resources and attention and new ways of sharing information. But what it comes down to for many people with cancer, like Karen Peterson of Harlem, New York, is hope — hope that the future of cancer care will be brighter than the present.
Karen, 51, was watching the State of the Union address in January when President Barack Obama first announced the Cancer Moonshot. As a woman who was diagnosed last year with triple-negative breast cancer, she hopes the new interest in cancer will mean more research money and new treatments. Targeted therapies have changed the experience for women with hormone receptor-positive and HER2-positive breast cancers in recent decades, but women with a triple-negative diagnosis remain limited to chemotherapy for full-body treatment.
The Cancer Moonshot means new possibilities. Karen is excited about some of the recent findings in cancer research but wants to see the Moonshot bring more resources to those efforts. “The only way this is going to get cured is to find a treatment and the only way you can do that is by doing research,” she says.
Building the Launch Pad
Heading the Cancer Moonshot is Vice President Joe Biden, who lost his son Beau to brain cancer in 2015. His goal for the Cancer Moonshot is to move ideas from research into practice more quickly. Through more access to data for researchers, and to clinical trials for people with cancer, Mr. Biden says he wants to achieve in the next 5 years what would have taken 10 at the rate things were going last year.
There have been exciting developments in cancer research recently. Breakthroughs in genomics, the study of how genes in cancer cells are different than genes in healthy cells, and immunotherapy, which uses the body’s own defenses to fight cancer, have been especially inspiring.
“With the dramatic growth in our understanding of cancer development and additional therapies and diagnostic tests available, there is no better time for this bold commitment,” American Society of Clinical Oncology (ASCO) CEO Clifford A. Hudis, MD, says about the Cancer Moonshot.
But new information on cancer cells and treatments is often slow to come to the public. That prevents progress, Mr. Biden says. One common problem is that getting a research grant can be time-consuming and they’re awarded mostly to established researchers. This can keep young doctors and researchers from getting the funds to test new ideas.
Even after a study is funded, completed and released, publishers tightly control access to the information. Major health journals cost hundreds of dollars for each subscription. Most large universities can afford subscriptions to these journals, but many people working in different fields cannot. Mr. Biden has pointed to NASA as an example of what shared information can do. NASA shared the computer code it developed in the 1990s to fix images from the Hubble Telescope and medical imaging companies were able to use that code to help improve breast cancer screenings. Reaching Mr. Biden’s goal requires a broad look at how research is done, from the basic biology of cancer, to clinical trials testing new treatments in people. Advising the vice president on these matters are two teams at the heart of the program: the Cancer Moonshot Task Force, made up of leaders from 13 federal agencies, and the Blue Ribbon Panel of medical and research leaders from the president’s National Cancer Advisory Board. Mr. Biden also spoke to research organizations and he invites people, including those with cancer, to contribute ideas and stories through the Cancer Moonshot website, whitehouse.gov/cancermoonshot.
“I think it is starting off … in a very thoughtful way,” says Julie R. Gralow, MD, the director of breast medical oncology at Seattle Cancer Care Alliance and executive officer at the SWOG research network.
SWOG is a network of researchers that design and run clinical trials to improve cancer treatment and care. Dr. Gralow says people from the Cancer Moonshot visited the organization in the spring and spent days working with them to gain a better understanding of how the group works.
The representatives did not come in with a preformed idea of what the Cancer Moonshot would be, she says. Instead, they listened to researchers, an approach she was happy to see.
“A couple of representatives from the Moonshot … attended our meeting, met with all the key players, had lots of brainstorming sessions. [They] really tried to figure out what we did, what we needed, what were our successes, what were our failures, what were our gaps,” Dr. Gralow says.
The Cancer Moonshot Summit on June 29 was the largest public event of the initiative. Mr. Biden gave an address at Howard University, in Washington D.C., that was broadcast to regional summits held around the country. After the address each regional host held breakout sessions with researchers, healthcare providers and people who have experienced cancer, like Kathleen Petrozelli, 56, from Whitehouse Station, New Jersey.
Kathleen was impressed by the summit and struck by the vice president’s message. But she hasn’t gotten caught up in the big promises.
“I was hopeful and I’m still hopeful, but I’m reserved as well. I am a little skeptical that things can happen [with] the speed they want,” Kathleen says.
Working with organizations like ASCO, SWOG and the American Association for Cancer Research, Mr. Biden has set out certain aims for the Cancer Moonshot. Speaking at the Vatican in April, he said the Moonshot would work toward better access to treatment, a concern ASCO has brought up in talking with the Moonshot team. The Moonshot is an opportunity to get underrepresented groups, including women of color and older women, access to better health care and into clinical trials,
Dr. Hudis says.
At the Cancer Moonshot Summit in June, the National Cancer Institute (NCI) announced a new, easier-to-use search tool for clinical trials through their website. The information there is also available for anyone to build into a new phone app or online tool, which the NCI hopes will extend its reach even further.
Mapping the Journey
Genomics, in particular, is a field that is growing in importance in breast cancer research and one that has the potential to advance much faster if information is shared. Genomic testing allows doctors and researchers to look at genes in cancer cells and map the mutations, or changes, that set them apart from healthy cells. It is being used to learn more about different types of cancers and to develop medicines that target cancer cells without hurting healthy tissue. The more data researchers and doctors have on different mutations and how they are associated with certain cancers, the better they can target therapies.
The Genomic Data Commons (GDC), which went online this spring, is meant to help with this. It’s a large, open database that enables doctors and researchers to compare tumors of different types and behaviors and explore why some stop responding to medicines, grow faster or spread to other organs. Researchers will be able to submit data from their studies and access the larger body of genomic information from other studies.
Breast cancer was one of the first cancers to benefit from targeted therapies, but finding new mutations to target has been difficult, Dr. Gralow says. The GDC will allow researchers to find the specific changes that don’t stand out in smaller samples.
This could help women like Karen with triple-negative breast cancer. Dr. Gralow says researchers are starting to find subtypes within triple-negative breast cancer that could lead to the targeted therapies Karen is hoping for.
By again bringing attention and resources to cancer research, the Moonshot has inspired hope throughout the community. But such a broad initiative will also be viewed with some skepticism. People remember the disappointment from the “War on Cancer” in the 1970s. And advances in treatment have not affected every type of cancer evenly.
Beth Caldwell, of Seattle, Washington, posted an open letter to Mr. Biden on July 11. She was concerned about the lack of women with breast cancer on the Moonshot Blue Ribbon Panel, in particular the lack of women with metastatic disease.
Beth, 39, was diagnosed with stage IV breast cancer in 2014 and has been an active voice for the metastatic community. She is a founder of MET UP, which works to bring greater attention and funding for metastatic breast cancer research. She also runs a blog called The Cult of Perfect Motherhood, where she posted her letter to Mr. Biden.
People with cancer are often mentioned as an important part of these efforts, but are not placed on panels where decisions are made, Beth says. So while she is excited about what the Cancer Moonshot may do for research, she believes women with breast cancer can and should be involved at every level of the discussion.
Making sure the Cancer Moonshot remains a priority and continues to receive funding after a new president is elected may require more people like Beth raising their voices.
“The power of the patient voice in driving change in cancer can’t be underestimated,” Beth says. “We can go to Congress and we can tell our stories and we can ask for help in ways that are different from a researcher who goes there. We have to have both those voices.”
Mr. Biden will end his term as vice president in January. People and organizations whose work relates to cancer may be better able to speak to each other and across fields thanks to the work done this year. But it will be up to the next administration to decide what role the U.S. government will play going forward. Visit whitehouse.gov/cancermoonshot for updates.