Moonshots and ‘Onco-nauts’

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We need to trade competition for collaboration, and we need to be sure we maintain a sustainable federal research-funding source that matches inflation. Doing so will ensure that our onco-nauts can continue to make progress in conquering cancer.
— Daniel F. Hayes, MD, FASCO

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Where were you on July 20, 1969? I certainly remember where I was—sitting in a mess hall at summer camp watching a grainy black-and-white TV as Neil Armstrong took “one small step for man, one giant leap for mankind.” I recall the sense of jubilation and accomplishment that all American citizens felt as we stared up at the moon and reflected on that monumental achievement—a brief 7 years after President John F. Kennedy challenged our nation to land a man on the moon before the end of the decade.

But what did this “moonshot” do for us personally and nationally? We haven’t built colonies on the moon. We haven’t found a treasure trove of resources we can exploit to make our lives better or more enriched. We haven’t used a base on the moon to bolster our defense system. So why did our country spend billions of dollars to achieve this goal?

One reason was to demonstrate we could succeed in the space race with the Soviet Union. The success of the Soviet Soyuz manned space missions in the early 1960s showed how far behind we were in our space program, and the Kennedy administration knew a moonshot would inspire and unify a whole generation of Americans in a singular purpose.

Second—and more important—the challenge of putting the first man on the moon in just 7 years galvanized talented scientists and engineers to do what seemed impossible: build a manned rocket spacecraft that could transport astronauts to the moon and return them home safely. We have benefited over the ensuing decades from putting that first man on the moon and from the well-resourced and sustained space program that grew out of this first moonshot, which led to technical advances like satellite-based global positioning systems and medical innovations, most famously, Dr. Michael DeBakey’s artificial heart pump.

Launching a Cancer Moonshot

Now, President Barack Obama, like President Kennedy before him, has challenged our nation to engage in a “cancer moonshot.” All of us were thrilled and honored to have Vice President Joe Biden, the head of this new national mission, speak at ASCO’s Annual Meeting in June to share his vision to accelerate the pace of cancer research, one we enthusiastically embrace.

Achieving the goals of the National Cancer Moonshot will be even more daunting than the ones faced by the original moonshot nearly 5 decades ago, because developing a drug to tackle cancer is unfathomably more complex than putting a man on the moon.

The Apollo program had one mission: to get an astronaut to the moon and back to earth safely. Oncology researchers have several missions to accomplish before they can declare success. We have to cure cancer, control cancer, improve patients’ quality of life, and tailor treatment to the unique presentations of hundreds of diseases. I am frequently asked, as I’m sure you are, “When are we going to cure cancer?” The answer is, “We already do, just not enough of them.” Successes in curing certain types of leukemia and lymphoma as well as testicular cancer and various other solid tumors are well known. But curing only some cancers is inadequate—We should cure them all and ensure that cancer survivors lead healthy and productive lives.

To accomplish this difficult task, we should use the Cancer Moonshot to achieve two objectives: make the technologic advances to build an “oncology rocket ship” to help us better understand the biology of cancer and how to diagnose and treat it; and inspire the nation to support a robust cancer research program to achieve these goals on the scale of the 1960s space program to take a man to the moon and back.

Building a Better Oncology Rocket Ship

The Human Genome Project launched in 1990 to provide researchers with the tools to understand the genetic factors in human disease is a great example of building a better oncology rocket ship. It is an amazing technologic accomplishment that was followed rapidly by other advances, such as gene-expression assays, which have radically changed our approach in the treatment of patients with breast cancer as well as other cancers. The Cancer Genome Atlas, which has permitted us to define the mutational spectrum of most cancers, is another example of how having a dedicated effort to better understand the biology of cancer has led to our own moon landing: personalized cancer care for our patients.

But these efforts alone aren’t enough to more effectively treat and, hopefully, cure more cancers. We need a better health information technology infrastructure to transform cancer care and improve patient outcomes, and that is where we should put our Cancer Moonshot focus. For example, CancerLinQ, ASCO’s big data, rapid-learning system, permits participating oncologists to download patients’ data from their electronic health records for quality-control analyses in real time—and once it is fully implemented over the next few years, CancerLinQ will generate unprecedented insight into cancer treatment outcomes.

But CancerLinQ is only one project. That first lunar landing in 1969 did not alone deliver the technical and medical advances we now depend on every day. Those successes were spun from a robust research enterprise. Likewise, a successful Cancer Moonshot program will need a sustained and well-funded national cancer research system to support it. Financial support for the NIH (National Institutes of Health), and by extension the National Cancer Institute, has eroded over the past decade, causing a decline in the number of federal grants awarded, which is raising the specter of possibly losing an entire generation of smart and well-trained researchers, especially in the clinical and translational fields.

Now, we need to catch up and keep up. Congress increased financial support of the NIH this year, and we are thankful for it. However, it is not enough to make the amount of progress we need in cancer research. Keeping established investigators in the field and enticing the best and brightest young minds to enter it must be a priority.

In his remarks during the ASCO Annual Meeting, Vice President Biden made a passionate plea for teamwork—the kind of sustained teamwork we saw in NASA after President Kennedy galvanized our nation. I couldn’t agree more. In 1962, when engineers began building the Saturn spacecraft, several former Air Force pilots retrained as astronauts (their lives immortalized in Tom Wolfe’s book The Right Stuff in 1979). Those early spacecraft were worthless without astronauts to fly them into orbit, and the astronauts wouldn’t have gotten far without the spacecraft; they needed each other for success.

Building An Army of Oncologist-Explorers

Like the early accomplishments of the space program in the late 1960s and 1970s, we have made great strides in our understanding of the biology of cancer since President Richard Nixon signed into law the National Cancer Act of 1971, which launched the field of oncology. Now, we need a new, stronger, and better-trained cadre of oncologist-explorers, or “onco-nauts,” to pursue innovations in cancer research, prevention, and health-care delivery.

In short, we need to trade competition for collaboration, and we need to be sure we maintain a sustainable federal research-funding source that matches inflation. Doing so will ensure that our onco-nauts can continue to make progress in conquering cancer. The Cancer Moonshot promises to help us build a better rocket ship to conquer cancer. However, just as we built a sustainable space program, we need to catch up and keep up regarding funding for basic, translational, and clinical research within the National Cancer Institute.

It has never been more important. ■