Aiming high

Douglas Lowy and Francis Collins (the director of the NIH) have just published this article in the New England Journal of Medicine where the follow up on the decision by US president Barack Obama to find a cure to cancer and change the impact of the disease on our society.

This initiative is meant to focus efforts on:

  1. Prevention and cancer vaccine development: which makes sense since in many cases (and despite the fact that luck does play a role), preventing cancer before it happens will help more people and will be more affordable than treating an established cancer.
  2. Early cancer detection: Again, finding about your tumor before it becomes aggressive or metastatic can substantially improve the chances of curing it. Having said that we (and others) work on the seemingly opposite idea: is that in certain cancers (prostate or breast for instance) some times it is better to watch and wait than to act in a hurry. What the best course of action might be very dependent on the type of cancer (and tissue!) the patient has.
  3. Cancer Immunotherapy: which seems to be the area where a lot of the cancer research field is going so we should expect some developments there relatively soon.
  4. Genomic analysis of a tumor and surrounding cells. The key here is that we are talking as well about the surrounding healthy cells. If you want to understand cancer and its evolution you need context.
  5. Enhancing data sharing. An area where we are hurting ourselves unnecessarily: More sharing, more caring, more smiles, better treatments.
  6. Oncology Centers of Excellence. Who does not like excellence anyway? There is a risk of course that you may put too many eggs in one massive but fragile basket.
  7. Pediatric cancer. Of course (and luckily) cancer is less prevalent in kids but when it happens it usually has a very different nature than cancer in adults. More needs to be done to understand why and what to do with them.
  8. VP’s exceptional fund CR fund. Designed to go through the red tape: sounds good and I bet there is a lot we can do to simplify things but there are obvious limits: patient safety and privacy.

To that Lowly and Collins reply with a list of targets that will receive considerably funding and focus in 2017:

  1. Cancer vaccines: sure, we had a lot of success with the HPV one and it is thought that about 20% of cancers are the result of a virus.
  2. Early cancer detection.
  3. Single cell genomic analysis: tumors are heterogeneous masses of cells so a better handle of that would be nice but do not forget that a tumor is more than a mass of tumor cells.
  4. Cancer immunotherapy.
  5. Pediatric cancer.
  6. Data sharing.
  7. Exceptional opportunities in CR fund. The NIH is a relatively conservative funding body so this sounds like the usual high risk high reward spiel that I will believe when I see it.

In any case these targets are well aligned with the vision laid out by POTUS. It is a bit of a shame that trying to understand the role of healthy cells near or infiltrated in the tumor is not described as boldly as in the president’s vision. Maybe 2018?

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