As an academic cancer researcher who’s “in the trenches,” I am accustomed to depressing news of stagnant federal funds for cancer research. Thus, I was positively surprised to hear of the White House’s bold $1 billion Cancer “Moonshot” Initiative, announced during the president’s State of the Union address. At the same time, I became weary of the possibility that the Cancer Moonshot, as has happened before with similar grand initiatives, may be targeted toward novel, unproven technologies that excite scientists, but fizzle once they reach patients.
This time it is different.
A paradigmatic shift in cancer research is under way, due to the advent of new treatments that may not principally target the tumor itself, but work by eliciting immune responses against the tumor (cancer immunotherapy). Rudimentary observations of the immune system’s capacity to fight cancer date back more than a century. Today’s advances are the result of much improved insight into how cancers instigate immune system suppression and the invention/improvement of strategies to overcome this either by stimulating inherent immunity against the tumor or transferring the capacity of mounting an attack to patients. Importantly, much has been learned to control the significant side effects that can result from enabling efficacious anti-cancer immune responses.
Immunotherapy is showing remarkable successes against certain cancers in the clinic, including cancers that routinely resist currently available standard therapy. As the field progresses, it is becoming increasingly apparent that even the most deadly and difficult-to-treat cancers may be amenable to immunotherapy approaches.
Despite the enormous promise of cancer immunotherapy emerging in the clinic, progress in this area will be slow, hard-won and difficult to achieve. The most remarkable clinical responses with immunotherapy, and the targets of new FDA-approved immunotherapy drugs, cluster in cancers that are regarded as relatively “immunogenic.”
These are tumors where the patients’ own immune system naturally is inclined to mount a response against the malignant cells. Attaining cancer immunotherapy is less onerous where the immune system appears to be primed to go on attack. Unfortunately, many of the most lethal forms of cancer, for example most types of pancreatic cancers, brain tumors (glioblastoma), liver cancers, stomach cancers or breast cancers, deviously suppress any attempt of unleashing the immune system against them. Vanquishing these tumors will be a tremendous challenge. It will require devising more ingenious immunotherapy strategies, combinations of drugs that complement each other and better management of side effects.
It is important to remember that it took more than 100 years of hard work and sacrifice to get where we are today. There is little doubt that bringing cancer immunotherapy to its full potential against all types of cancer will demand much more of researchers, clinicians, patient caretakers and cancer patients who enroll in clinical trials to come.
Reaching this potential will require a funding commitment from society to sustain the discovery and early clinical testing of new immunotherapy strategies. The critical breakthroughs we are witnessing in cancer immunotherapy today tell us that this is the right moment to invest in translational cancer research. Therefore, the White House’s Cancer Moonshot Initiative is a powerful signal that comes precisely at the right time and carries the promise of significant improvements in care and outlook for all cancer patients.
Matthias Gromeier, MD, is an associate professor in the Department of Neurosurgery and the Department of Molecular Genetics & Microbiology at Duke University Medical Center. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
