For the Cancer Moonshot, collaboration is still the number one fuel

No one company or person is curing cancer.

Instead, the battle is being waged worldwide by thousands of academic labs, medical centers, government organizations, and life science companies working on everything from Big Data to diagnostics, clinical trials, and beyond.

As each entity chips away, the question arises: What would happen if we attacked cancer from an agnostic, 10,000-foot point of view? 

That’s what the Biden Cancer Initiative is attempting to do, as it carries the torch for the Cancer Moonshot. Via phone, President Greg Simon discussed his organization’s collaborative outlook as it works to break down cultural and logistical barriers. The ultimate aim is to power through a decade’s worth of cancer breakthroughs in just five years.

Simon is also taking part in a fireside chat at the upcoming MedCity CONVERGE conference in Philadelphia on July 31-August 1.

First a little background…
We’ve all heard of the “Cancer Moonshot,” but after several iterations, name changes, and a new White House administration, you may have lost track of the details.

The Cancer Moonshot publicly launched back in January 2016, introduced by former President Barak Obama during his State of the Union address. Biden had proposed the idea three months earlier and was appointed to lead the charge.

From the outset, three different arms were created. The first was the Cancer Moonshot Task Force, which was designed to unite all the relevant federal agencies with Simon at the helm. There was also a Blue Ribbon Panel of experts selected by the National Cancer Institute (NCI) to determine funding priorities within the field. A third and final group was built to facilitate private sector, academic, and nonprofit collaborations, either with the government or with each other. 

Each of the three arms had one year to mobilize and gain traction before the Obama administration left office. So they got to business.

By January 2017, the Cancer Moonshot had launched nearly 80 new actions and collaborations. It had also united some 7,000 people at nearly 300 events held in every U.S. state and signed 10 Memoranda of Understanding with overseas groups.

“We were able to get a lot of things started, despite the relatively short amount of time that we had,” Simon reflected.

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While there was logistical uncertainty going forward, the funding situation got an end-of-year boost.

In December 2016, Congress passed the 21st Century Cures Act with overwhelming bipartisan support. It authorized an additional $6.3 billion in funding over seven years for health-related research, including $1.8 billion earmarked specifically for cancer.

That money will be spread over seven years. Simon noted that the first year has already been appropriated and he feels confident the funding will continue.

Thus, as Obama and Biden transitioned out, the project morphed into the free-standing Biden Cancer Initiative run by Joe Biden and his wife Jill. It remains a non-profit, Simon explained, it just lacks a central White House address.

Data collaboration
“After we left the White House, everyone wants to know what happened to all of that,” Simon said of the early work.

The Biden Cancer Initiative is building on that base, he said, by breaking down the cultural barriers that hinder progress in the field. Some of those cultural barriers manifest as infrastructure problems, such as an inability to share data. However, Simon believes there’s a lack of intent underpinning it all.

“There are mechanisms to do it, but the cultural inertia keeps people from doing that,” he stressed. “They have business models built on proprietary information, rather than sharing information.”

The Biden Cancer Initiative believes a new approach is most urgently needed for data standards and data sharing, alongside clinical trials, access to care, and international collaborations.

“Our focus initially will be on the data issues, since that’s one of the issues we’ve been most adamant about — the need to share data of all kinds across the country and later the world.”

While it’s a mighty problem to tackle, there’s a systematic way to go about it. The Biden Cancer Initiative doesn’t solve the problems per se, it enables others to form a solution.

“Part of what we will do is to identify a variety of technical solutions to these kinds of problems in data sharing,” Simon said.

There’s clinical data, electronic medical records, patient outcomes, genomics, lifestyle factors; all of these things affect human health and can be used to build our collective knowledge about how to treat disease, he said. There are clusters of sharing, yet there is no meta-network.

“So one of the things we would do is identify the solutions that are working in these smaller networks and then figure out how to link these networks together to create a national network with data being able to to flow freely and ubiquitously and quickly across the network based on the need for that information for research, for treatment ideas, for education, for patient health, whatever it is.”

Research and clinical trials
Personalized medicine is an interesting paradox. On the one hand, it involves treating patients with the utmost customization. But to do so effectively, doctors need data and knowledge drawn from millions of other people. That’s why data sharing and collaboration is so important.

Simon used the example of CAR-T therapies, which are nearing an FDA approval. They have saved lives treating children with leukemia, but the same drug has proven fatal in multiple myeloma. All the other companies advancing therapies in this space need to learn from that death.

To that end, negative trial results should be published for everyone’s benefit, Simon said. While he’s far from the first person to make this call-to-action, his fight for collaboration and efficiency goes further.

There are over 1,000 clinical trials currently underway for PD-1/PD-L1 inhibitors such as Merck’s Keytruda and Bristol-Myers Squibb’s Opdivo. They all share a common mechanism of action, applied to different cancers, disease stages, and in combination with other therapies. Simon believes this causes a duplication of efforts, to the detriment of patients.

“If you have patients in 1,000 trials and each one of those trials has a control arm where they’re getting the standard therapy versus the immunotherapy, you are wasting thousands of patients’ time and money,” he said.

Data on the standard therapies already exist, in terms of patient outcomes, genomics, and medical records. The problem, Simon stressed, is that the companies don’t work together and everyone wants to design their trial with a slight twist, for an optimal position in the marketplace. The end result is a misuse of patients.

It’s part of a broader debate Simon raised around the design of clinical trials and the need to put patients first and include them from the beginning. He also believes more emphasis has to be placed on “real world people,” that have the kinds of added health complications and challenges found in the wider patient population.

Keeping on course
Under Simon’s watch, the Biden Cancer Initiative is keeping tabs on almost all aspects of cancer research, treatment, and care. That includes prevention (one of the Cancer Moonshot’s first collaborations was around smoking cessation), and at the other end, access to care.

The organization can’t feasibly take it all on at once, so for the most part, Simon’s job is to partner with and enable businesses and nonprofits that have already specialized in these areas.

“We’re not trying to do everything at once,” he stated. 

At the moment, there’s also a pretty big elephant in the room that could fundamentally change the landscape.

“Insurance is the biggest single factor in whether people survive cancer or not,” Simon said. “So if 20 million people lose their insurance, thousands of those people will die from treatable cancers that could have been saved. So that’s a very real consequence of what’s being discussed in health reform”

Photo: TaiChesco, Getty Images