Monday, April 4, 2016

Another War on Cancer

Preparing charts, developing strategies, allocating expenditures, all flow from any new initiative. Cancer is a highly complex disease. As we have been noting for a decade in just a few cancers, a "simple" and significant cancer such as that of the prostate has hundreds if not thousands of genetic complex profiles. Thus diagnosis and prognosis not to mention treatment must and will be tailored personally. It is not one size fits all.

In an article in NEJM the NIH authors announce the key elements of their program:

Cancer vaccines: Produce Epstein–Barr virus (EBV) vaccine for human safety testing; explore development of other vaccines for high-risk persons.

Early cancer detection : Develop tools and techniques to improve sensitivity, specificity, and utility of molecular-detection assays.

Single-cell genomic analysis: Conduct single-cell analyses to uncover the -omic spectrum of malignant and nonmalignant cells in the tumor microenvironment.

Cancer immunotherapy: Support basic research to further elucidate cancer immunology and extend the reach of immunotherapy to all kinds of cancer.

Pediatric cancer: Prepare and screen new libraries of compounds chosen for their potential to interfere with these transcription factors; intensify the collection and analysis of very rare childhood cancers.

Data sharing: Expand capacity of the National Cancer Institute Genomic Data Commons to handle and analyze genomic and clinical data from patients and health care providers.

Exceptional Opportunities in Cancer Research Fund : Pursue previously unanticipated and novel scientific opportunities to improve basic and applied cancer research.

It is worth examining the above. 

Vaccines have some value on well known virus that can be directly linked to cancers. There are few at this stage and of course we always want to identify others and prevent them. However this may be far from number 1. Early detection is a complex issue due to several factors, First we really do not know what to look for. Second it is expensive. Third most people just will not seek the opportunity until too late. The smoker, the alcoholic, the obese person all present risks far in excess of viruses. Single cell analysis is another door that is just opening. As we have indicated elsewhere in PCa the expression is massively different in almost ever presentation and in every part of the body. Furthermore we do not understand the dynamics of the stem cell. Immunotherapy with MABs is moving along. But the more we learn the more we can fine tune the approach. Pediatric cancers are devastating and always worth a try. Data sharing can and is being done already so what is new here? Doing something new; of course.
NIH also announces the Blue Ribbon Panel to work this Program. They state:

“This Blue Ribbon Panel will ensure that, as NIH allocates new resources through the Moonshot, decisions will be grounded in the best science,” said the Vice President. “I look forward to working with this panel and many others involved with the Moonshot to make unprecedented improvements in prevention, diagnosis, and treatment of cancer.”

The Moonshot metaphor has always been misplaced. Having spent a few years in the 60s on Apollo Program I know something about it. We had Kepler and Newton, we had Kalman and Battin, we had computers and Gyros. We even had improved German rockets. It was a matter of scale and not new knowledge. Cancer still has many unknowns. We want accuracy and NOT precision. It is akin to saying that we will land on the planet at exactly noon, and it will be Mars or Jupiter. Very precise but not very accurate.

They conclude:

Fueled by an additional $680 million in the proposed fiscal year 2017 budget for the National Institutes of Health (NIH), plus additional resources for the Food and Drug Administration, the initiative will aim to accelerate progress toward the next generation of interventions that we hope will substantially reduce cancer incidence and dramatically improve patient outcomes. The NIH’s most compelling opportunities for progress will be set forth by late summer 2016 in a research plan informed by the deliberations of a blue-ribbon panel of experts, which will provide scientific input to the National Cancer Advisory Board.

 Regrettably Boards are managed by Government Staff and we don't have the Feynmans to participate and add reality. Hopefully they accomplish something other than just assuage the grieving.