Days after launching his $1-billion (U.S.) cancer “moonshot” last month, U.S. Vice-President Joe Biden was already grounding his space metaphor.
Biden first used the lofty analogy in October, several months after his son’s death from brain cancer. It was deployed again in January, when President Barack Obama tasked Biden with leading the White House’s “cancer moonshot task force.”
At the Abramson Cancer Center in Philadelphia Pa., where Biden kicked off his bid to “end cancer as we know it” on Jan. 15, he was already backing away from the metaphor.
“The first thing he said was, ‘You know, the choice of the word “moonshot” may have been an unfortunate one,’” said Dr. Chi Van Dang, the centre’s director. “It implies something too simple; that we can just assemble the engineers and the astronauts, make the rocket, and we’ll get to the moon and back,” Dang recalls Biden saying.
“He said, ‘It’s going to be a lot more complicated than that.’”
Critics have seized upon the flaws in Biden’s moonshot, particularly its $1-billion price tag — not even enough money to bring a single drug to market.
But for cancer experts like Dang, Biden’s backtrack on the metaphor is a good sign. It indicates their new White House ally understands defeating cancer will prove far more difficult than landing a man on the moon.
“When you talk about cancer, you’re talking about more than 200 diseases,” said Jon Retzlaff, managing director for science policy with the American Association for Cancer Research. “If people regard the moonshot as going to the moon, this would be like going to 200 different planets.”
Cancer is one of the world’s top killers, with approximately 14 million new cases diagnosed every year. In Canada, it killed an estimated 78,000 people in 2015, according to the Canadian Cancer Society.
Regardless of whether Biden’s initiative achieves moonshot status, cancer experts agree on one thing: his efforts come at a crucial moment.
Government funding for research has been drying up over the last decade. The U.S. National Institutes for Health only accepts eight or nine out of every 100 applications for research grants, Dang said. “There have been people who’ve left the field.”
Yet scientists understand more about cancer than ever before, and there is a feeling the stars are finally aligning. “Cancer is ripe for a big push,” Retzlaff said.
Cutting-edge approaches are bringing exhilarating opportunities. The research community is particularly excited about immunotherapy, which harnesses the power of the body’s immune system to kill cancer cells.
Until a few years ago, cancer treatment was considered a “three-legged stool sitting on a base of surgery, radiation therapy and chemotherapy,” oncology pioneer Dr. Vincent DeVita wrote in a 2012 article for the New England Journal of Medicine.
Immunotherapy has given cancer treatment a fourth leg to stand on. “I think it has changed the whole ball game in treatment,” said DeVita, a professor at the Yale School of Medicine. “It gives us an enormous and powerful tool.”
“Five or six years ago, there were no effective therapies for malignant melanoma,” he said. “Now, there have been patients who appear to have been cured … a few years ago, that was completely unheard of. No one survived.”
This is why cancer scientists are buoyed that Biden has prioritized immunotherapy, as well as other exciting areas for research, like personalized medicine.
Biden has also emphasized knocking down “silos” between researchers, institutions and companies, as well as improving data sharing — hugely important challenges, experts say.
“We have patients all over the country, hundreds of thousands of patients,” DeVita said. “All of that information is usable in terms of developing new strategies for treating patients, but it needs to be collected in a way that makes it decipherable.”
Despite the problematic moonshot analogy, Biden seems to understand the cancer fight. He has shied away from using terms like “conquest,” a word favoured by Richard Nixon when he declared his war on cancer. And Biden has avoided pledging to end cancer by a certain date.
Rather, Biden’s goals have been to “double the rate of progress,” “make a decade worth of advances in five years” and end cancer — not once and for all, but “as we know it today.”
With the looming election, Biden’s days in the West Wing are numbered, and there is no guarantee Congress will approve the request for funding.
But cancer research advocates believe Biden is in this fight for the long haul — the $1 billion isn’t a moonshot, but a “down payment.”
Ellen Sigal, founder of the advocacy organization Friends of Cancer Research, knows first hand that people who have lost loved ones to cancer tend to discover a passion for fighting the disease that does not fade.
Sigal’s commitment to research began after she lost her younger sister to breast cancer — in 1986. “This will be a lifelong journey for him,” she said. “Just like it was for me.”
200 years fighting cancer
1809 — Early surgery
Kentucky physician Ephraim McDowell, the “father of ovariotomy,” performs the country’s first abdominal surgery, removing a nine-kilogram ovarian tumour without any anesthesia. The patient, Jane Crawford, survives the operation — and lives for another three decades — providing evidence that tumour masses can be cured by surgery.
1863 — The science of cells
German physician and politician Rudolf Virchow develops the cell theory, and deduces that cancer cells (and indeed all cells) come from previous cells. At the age of 34, he publishes what has now become a famous aphorism: omnis cellula e cellula (“every cell stems from another cell”).
1895 — Advances in radiation
The age of radiation treatment begins, with Wilhelm Konrad Röntgen’s discovery of x-rays, and the discovery of radium by Pierre and Marie Curie. The age of modern radiation therapy only begins 55 years later with the discovery of cobalt teletherapy, however — leading to the world’s first cancer treatments with the “cobalt bomb,” performed in Canada.
1937 — The government takes a lead
Then U.S. President Franklin D. Roosevelt signs an act creating the National Cancer Institute, the federal government’s first agency centred on a single disease. The NCI goes on to play a major role in the development of anti-cancer drugs.
1949 — Early chemo
The U.S. Food and Drug Administration approves the first chemotherapy drug for cancer: nitrogen mustard for treating Hodgkin’s Lymphoma. For more than a decade, however, the use of chemotherapy is controversial, with fears that the drugs may cause more harm than good. This shifts dramatically when evidence emerges that cancers, like childhood leukemia and advanced Hodgkin’s disease, can be cured with combination chemotherapy.
1971 — Nixon’s ‘war on cancer’
Then U.S. President Richard Nixon announces in his state of the union address that he will request $100 million to “launch an extensive campaign to find a cure for cancer,” thus marking the beginning of his “war on cancer.” He follows up by signing the National Cancer Act, which leads to a major expansion of research.
1981 — The first cancer vaccine
The FDA approves the first vaccine to prevent cancer. The vaccine protects against hepatitis B, which makes people 100 times more likely to develop liver cancer. The vaccine is now given as a part of the regular vaccination schedule for children.
1990-1991 — Progress
With the help of chemotherapy, hormonal treatments and tools for early diagnosis, the rate of death from breast cancer begins to fall. After sustained efforts to reduce smoking rates, the incidence of lung cancer in men, and overall deaths from the disease, also begin to decline.
1996 — New angles
Cancer immunotherapy pioneer, Jim Allison, publishes a landmark paper showing that an antibody injection could stop tumour growth in mice. The study opens the floodgates to cancer immunotherapy treatments, in which the body’s own immune system can be harnessed to fight the disease.
2005 — More and more survivors
For the first time in the U.S., there is a decrease in the total number of cancer deaths for both men and women, driven largely by declines in the most common forms of cancer.