Wednesday, January 13, 2016

Obama's Moon Shot

From NBC News:

It just might be the right time for President Barack Obama's ambitious "moon shot" to cure cancer, according to experts.
Obama announced the initiative Tuesday night in his State of the Union address and put Vice President Joe Biden in charge.
"Last year, Vice President Biden said that with a new moonshot, America can cure cancer. Last month, he worked with this Congress to give scientists at the National Institutes of Health the strongest resources they've had in over a decade," Obama said. "Tonight, I'm announcing a new national effort to get it done."
It's good time to do it, says the American Cancer Society's Dr. Otis Brawley.
For starters, Biden has a proven track record of being able to get Congress to stand with him on this issue: He helped get Congress to add $264 million to the National Cancer Institute's budget in the 2016 spending bill, part of a $2 billion raise for the National Institutes of Health.
"He may actually be able to get Republican and Democratic support for this," Brawley said.
But even more important, the research is advancing more quickly than ever, says Dr. Jose Baselga, Physician-in-Chief and Chief Medical Officer at Memorial Sloan Kettering Cancer Center and president of the American Association for Cancer Research.
"The field has obtained such a critical mass of knowledge that now we are ready," Baselga told NBC News.
"This is the golden era of cancer research," agreed Dr. Ronald DePinho, president of the University of Texas MD Anderson Cancer Center.
Money wasn't enough to do it in 1971, when president Richard Nixon declared a war on cancer. Experts didn't even know then that cancer is entirely caused by genetic mutations, and that the place it starts tells a doctor very little about the tumor itself.
But money will help a great deal now, Baselga said.

"I do think in a great part it's a money issue," he said. "The amount of discoveries that are occurring are many. We see them at a speed that we have never seen before. I think money could go a long, long way."
It will take coordination, too, said Brawley. Biden notes this in his comments on the new initiative.
"Several cutting-edge areas of research and care — including cancer immunotherapy, genomics, and combination therapies — could be revolutionary," Biden, whose son, Beau, died of brain cancer last year, wrote.
"But the science, data, and research results are trapped in silos, preventing faster progress and greater reach to patients. It's not just about developing game-changing treatments — it's about delivering them to those who need them," Biden added.
"Right now, only 5 percent of cancer patients in the U.S. end up in a clinical trial. Most aren't given access to their own data. At the same time, community oncologists — who treat more than 75 percent of cancer patients — have more limited access to cutting-edge research and advances."
This is precisely what's needed, said Brawley.
"We have tremendous difficulty collecting patient data because of privacy laws or the perception that privacy laws are preventing them from doing so," Brawley said.
"That is something the vice president can fix in six months."
Baselga said cancer centers like his own have huge amounts of data that they can share with one another about what genetic changes are involved in cancer. Sharing this information with other centers and with the companies that actually end up making new treatments is critical, he said.
"Since every tumor is different, you need to have thousands and thousands of tumors to be able to get a good representation of what is going on." Right now, there is little incentive for anyone to do that.
And then there are the disparities. No breakthrough can save lives if people don't get access to it, Brawley noted.
"We need to figure out why we have had a 40 percent decline in breast cancer deaths over the last 25 years, but not in nine states," Brawley said. "We have got good data to show that 20 percent or more of women who get a breast cancer diagnosis right now do not get the fruits of the research that has already been done. They get less than optimal treatment."
One study found an equally horrifying pattern with ovarian cancer.
It found just 41 percent of eligible women are getting chemotherapy delivered directly to the affected area, even though the benefits are so strong that the National Cancer Institute made a rare recommendation for doctors to use it.
And it's better treatment, in the form of drugs such as tamoxifen that can not only treat but also prevent breast cancer, that is responsible for half the decrease in breast cancer deaths, Brawley said. Screening in the form of mammograms is probably a distant third factor, after the increased willingness of women to seek treatment in the first place.
Bringing down costs will be a huge part of this, also.
The average price of new cancer drugs was more than $100,000 a year in 2012. Cancer experts have started to rebel, but they also point out that the promise of profits can attract drug makers into a field where drug development relies on the private sector.
Cancer's still the No. 2 killer in the U.S. But the American Cancer Society just reported that 1.7 million people escaped death from cancer since 1991.
Here are just a few of the new approaches that have cancer experts thinking it's a good time to double down:

New immune therapies

Former president Jimmy Carter tried out the new cancer drug Keytruda, which helps the immune system take on brain tumors. He says the drug shrank the tumors; doctors note he got pretty good targeted radiation, also.

Targeted treatments

Targeted treatments such as Imbruvica, known generically as ibrutinib, help patients with a hard-to-treat form of leukemia live longer and healthier lives, and free them from unpleasant drug infusions at the same time.
Personalized immune therapies involve finding immune cells in patients' own bodies that recognize and attack the tumors, and growing more of them in the lab. They have remarkable results in a few lucky patients.

Lifestyle insights

Other advances include studies that show just how diet and obesity affect cancer risk. And, of course, the sharp decrease in the number of people who smoke has helped.

Information sharing

Not least, sharing information can save lives. One cancer registry linked a woman's rare childhood ovarian tumor with a genetic mutation that caused her baby boy's seemingly unrelated lung tumor years later, and pointed them to ways to treat it.
Another found that more than 8 percent of children with cancer have unsuspected genetic mutations that could run in their families.
No single approach is going to wipe out a disease that experts now know is in fact dozens, if not hundreds of different diseases.
"Nobody is going to cure cancer in a year," Brawley said. "I don't think anybody going to cure cancer in a decade. We can decrease a lot of pain and suffering due to cancer."

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