Movements Devoted to Improving Cancer Care

Movements Devoted to Improving Cancer Care

Cancer research—indeed, most medical research—is typically about the narrowly focused investigator with one small grant at a time. But advances in genetic profiling of cancers and the mutations that cause them are telling scientists and physicians they must stop working in silos and stop treating lung or breast or colon or prostate cancer as distinct diseases. Common genetic mutations, like one called p53 that controls cell death, are showing up across a whole swath of cancers. A mutation called BRCA1 is common in women’s cancers, such as breast and ovarian, yet the research and clinical work in those two diseases has largely been separate.

My personal explorations and conclusions derived from published NCI data and discussions with NCI staff members confirm the American Association of Clinical Oncology’s 2011 assertion that cancer research and care must be vastly improved. A number of organizations are taking advantage of this opportunity to move toward a sea change in the cancer field. Among the most prominent are the following.

Nation Academy of Sciences

As mentioned in Chapter Two, the need for change in the cancer field was  affirmed at a National Academy of Sciences Workshop in 2013 devoted to improving the affordability and quality of cancer care.4 A recurring theme of the workshop was the need for all stakeholders—including patients, clinicians, private and government payers and the pharmaceutical and device industries—to work together to address improving cancer care. Because cancer is such a prevalent set of conditions and so costly, it exposes all of the strengths and weaknesses of our health care system in general. The workshop suggested that oncology is where the action for change is going to be in health care.

Stand Up to Cancer (SU2C)

In his 2013 Time magazine article on cancer, Bill Saporito quoted the Massachusetts Institute of Technology’s Philip Sharp: “This disease is much more complex than we have been treating it. And the complexity is stunning.”5 Sharp—a Nobel Prize-winning molecular biologist who studies the genetic causes of cancer —is recruiting special-forces units to fight cancer. For the past four years, he has been wrangling “dream teams” funded by SU2C, an organization started by entertainment-industry celebrities unhappy with the progress being made against cancer.

What does it take to transform the way an entire medical ecosystem functions, Saporito asks? In this case, an unprecedented combination of celebrities, intensity and large amounts of money. In 2008 a group including Spider-Man producer Laura Ziskin, who lost her battle with breast cancer in 2011; Katie Couric, who lost her husband to colon cancer in 1998 and former Paramount CEO Sherry Lansing founded SU2C with the goal of attacking cancer the way you make a movie: bring the best and most talented possible people together, fund them generously, oversee their progress rigorously and shoot for big payoffs—on a tight schedule.

SU2C raises money through foundations in addition to corporate, organizational and private donors and then grants it to teams in the form of unusually large sums (up to $18 million, vs. about $500,000 for a typical grant from the National Institutes of Health) to produce results in a short time, initially three years. All the chosen projects are monitored by the American Association for Cancer Research. A SU2C scientific committee headed by Philip Sharp and other heavy hitters reviews each team semiannually, a checkup that can make top scientists feel like graduate students.

“When you have to answer to Nobel laureates and others, it’s a very tough review team,” Dr. Daniel Von Hoff, physician in chief at the Translational Genomics Research Institute—a dream team  launched by SU2C that’s studying pancreatic cancer, said to Saporito.

The team model also is disrupting the normal course of business across the medical-research community. For investigators, it means changes in the way careers are developed, the way data are shared and especially the way credit for achievement is shared. For institutions, team research means changes in contracts, compensation, titles and the ownership of intellectual property. For pharmaceutical companies, it means restructuring the way experimental drugs are allocated and
clinical trials are conducted.

NCI, which has parceled out its $5.5 billion cancer-research budget to a single principal investigator for each grant it makes, is recognizing the paradigm shift in its PPG and SPORES programs. National Institute of Health Director Dr. Francis Collins, who led the team at the Human Genome Project, said that under his watch, the 27 institutes he oversees will be less independent fiefdoms pursuing their own goals and more trustworthy collaborators that can team up to answer common and complex biomedical questions. “I am strongly anti-silo, strongly pro-breakingdown- barriers, bringing disciplines together, building collaborations and building dream teams,” he said.

Interdisciplinary Centers

An example of the growing interdisciplinary trend is the newly established cancer center at Weill Cornell Medical College and New York-Presbyterian Hospital on the Upper East Side of Manhattan that will bring together researchers in various fields —basic scientists, pathologists, surgeons, radiologists and more.6 A joint effort with Memorial Sloan-Kettering Cancer Center, the Rockefeller University, and the Takeda Pharmaceutical Company, the institute will facilitate translation of earlystage drug discoveries into treatments. Dr. Lewis C. Cantley, director of the Center said, “In the past, even with chemotherapy and radiation, we didn’t know why some people responded and some didn’t; now with these targeted therapies, we do know.

It’s not, ‘Let’s randomly try another set of poisons and see what happens.’ Because that’s what we’ve been doing for thirty years.”