As part of the 2016 State of the Union address, President Obama reaffirmed Vice President Biden’s challenge to “end cancer as we know it.” Referred to as the “Cancer Moonshot,” the initiative called for a partnership across multiple government agencies to integrate science, technology, advocacy, social science and big data to develop new paradigms for preventing, diagnosing and treating cancer. In December 2016, President Obama signed the $6.3 billion 21st Century Cures Act, which includes $1.8 billion for the Cancer Moonshot.
This herculean goal may seem insurmountable, but let’s consider that when our country delivered on President Kennedy’s original Moonshot 50 years ago, we did so by building on an established foundation of science and technology. One of the keys to NASA’s success was fully leveraging existing knowledge, hardware and software to reach the moon.
The same approach may hold true for cancer. We have innovative, life-saving tools and technologies available — right now — that can be used to help us reach the Cancer Moonshot.
[See: 7 Innovations in Cancer Therapy.]
Three Stars Aligned
Today we have three powerful technology platforms to serve as rocket fuel for the Cancer Moonshot: radiotherapy, immunotherapy and big data.
Radiotherapy, a mainstay for treating and managing many types of cancer, has already helped millions of patients by disrupting the DNA of cancer cells and halting growth. We can further harness this treatment approach to achieve a number of the Moonshot’s objectives and help people everywhere who are battling cancer.
Today’s radiotherapy represents a significant evolution from earlier forms, particularly in the area of metastatic brain tumors (a difficult-to-treat form of cancer that spreads to the brain from primary cancers in other organs, e.g., lung or breast). For nearly a century, brain metastases were treated with whole brain radiotherapy, or WBRT, a process through which the entire brain is exposed to radiation. While this method is effective in treating tumors, healthy tissue is also impacted and patients risk cognitive damage.
In the late 1960s, the introduction of stereotactic radiosurgery, or SRS, radically altered the treatment of brain tumors through the use of focused radiation that hit the tumor directly, creating a highly effective treatment with minimal side effects. SRS is performed without a hospital stay, and while outpatient brain surgery might sound like a technology of the future, it is here today.
SRS has transformed how we treat patients who have multiple tumor metastases in the brain, replacing WBRT in this indication with a technology that effectively targets cancer cells while causing minimal damage to healthy brain tissue.
SRS has dramatically improved clinical outcomes and patient experiences. As such, it exemplifies how a unique and versatile technology that has been a foundation of cancer care for decades can be advanced, refined and re-envisioned in multiple capacities to achieve new therapeutic objectives.
Gamma Knife, one of the most commonly used platforms for SRS, has already been used to treat more than 1 million patients worldwide, and its ongoing innovation exemplifies how today’s technologies can serve as a launch pad for improved cancer therapies.
Applying lessons learned in the advancement and evolution of SRS technology and its clinical application to other therapies available today may help revolutionize treatment in other cancer indications in the near term, while we await the breakthrough technologies that the Cancer Moonshot is designed to enable.
[See: 8 Cool Uses for 3-D Printers in Health Care.]
A Biological Rocket Booster
I think most doctors would agree that our best chance for treatment success comes from a multimodal approach. A growing body of data suggests that combining radiotherapy with immunotherapies — treatments designed to stimulate the body’s own immune system to fight cancer — may result in improved patient outcomes. The Cancer Moonshot specifically identifies further development and evaluation of immunotherapies as a key priority. Multiple trials evaluating immunotherapy in combination with radiotherapy are currently enrolling patients.
A retrospective study of 77 patients treated with SRS for brain metastases between 2002 and 2010 showed that the addition of ipilimumab, a drug approved to treat melanoma that stimulates the immune system to attack cancer, increased median survival to 21.3 months, compared with 4.9 months in patients who received only SRS. Additionally, the two-year survival rate was more than two times greater for patients receiving SRS and ipilimumab compared with the non-ipilimumab group.
While it’s still too soon to claim we’ve found a magic bullet, additional clinical trials of SRS in combination with immunotherapies are ongoing, and more studies evaluating synergistic effects of these modalities are forthcoming. We must continue to evaluate a combination of therapies to understand how they might work together better.
More Than a Rocket to Reach the Moon
As we learned in the 1960s, it takes more than a powerful vehicle to reach the moon. Scientists and engineers involved in the first Moonshot had to harness the power of physics, aeronautics and computers to make their vision a reality.
Similarly, today’s Moonshot calls for more than discovering and developing new drugs and devices. Much of the initiative is about finding improved ways to share and harness data, incorporating big data technologies that use sophisticated algorithms to find associations between disease types, biological markers and patient outcomes.
As part of the Moonshot, a Blue Ribbon Panel of global cancer thought leaders called for a federated data collection network that will amass information about the most effective treatments for specific cancer types and patient populations.
Although the potential benefits of accessing data from thousands of patients may be apparent, our ability to harness such data is currently limited, in part because it’s challenging to standardize data across platforms and also because relatively few cancer patients volunteer to participate in clinical trials.
Several data collection networks have already been created in the field of radiotherapy. In 2014, the American Association of Neurological Surgeons and the American Society for Radiation Oncology initiated a national registry for patients treated with SRS. Through this registry, researchers are gathering data from 30 clinical sites including treatment and outcomes data for thousands of patients. The data will be used to define national patterns of care and refine treatment for individual patients, helping to ensure that future patients receive optimal treatment.
Understanding which treatments are most effective in specific cancer subtypes, patient populations and in combination with other treatment modalities requires highly powered statistical analyses. While the largest cancer studies and clinical trials typically include thousands of patients, big data approaches can aggregate demographic, treatment and outcome data from millions of patients. Robust globally accessible data repositories that allow us to learn from the experience of each and every cancer patient are essential to advancing the longer-term objectives of the cancer Moonshot.
[See: 8 Questions to Ask Your Doctor About Colon Cancer.]
Launching for the Moon from a Platform of Success
SRS has transformed the treatment of brain tumors and is a good example of the type of integrated, collaborative, technology-driven platform that should be replicated across other cancer types. I am optimistic that further evolution of SRS and similar technology platforms — used alone and in conjunction with other treatment regimens and combined with big data — will benefit the brain tumor patients of tomorrow.
While brain cancer is only one part of the disease burden, the approach clinicians have taken to improve treatment can be applied to virtually any other cancer type. Making a decade of progress in five years is ambitious, but by learning from the past, building on success and bolstering collaboration, we can make the cancer Moonshot as successful as NASA’s moonshot was more than 50 years ago.
Ronald E. Warnick, M.D., is professor of neurosurgery, John M. Tew, Jr., M.D. Chair in Neurosurgical Oncology; and director, UC Brain Tumor Center.
More from U.S. News
7 Innovations in Cancer Therapy
7 Things You Didn’t Know About Lung Cancer
8 Questions to Ask Your Doctor About Colon Cancer
Could Radiotherapy Be a Launch Pad for the Cancer Moonshot? originally appeared on usnews.com
