Biden’s next silo?

Vice President Biden spoke recently about how he will spend his time when he leaves government in a few weeks.  The “Cancer Moonshot” will be behind him, but his dedication to the cause of reducing the burden of cancer will not.  Through his Cancer Moonshot, he has spoken with passion and eloquence about the importance of breaking down cancer research silos that limit our ability to share information about the genetics of cancer.  He has challenged us to change our culture and develop new collaborative models for cancer research.

He also expressed concerns about the economics of cancer therapy.   More specifically, as we develop better cancer therapeutics, can we afford them?  This is one of the items he will address when his term as Vice President comes to an end.

The cost of cancer drugs is breaking the bank.  Combinations of cancer medicines are going to be the wave of the future – and if nothing changes, the cost of the most effective new cancer treatment combinations could top $250,000/year.  This is unsustainable.

In looking at this complex issue, let’s start with the basics where there is general agreement:

  • We need new, more effective, less toxic cancer medicines.
  • Cancer research has progressed to the point where such medicines are within reach.
  • We are willing to invest in research to bring these medicines forward. Although such research is expensive, as a society we are willing to pay the price.
  • Once a cancer medicine has been identified, the research completed, and the indications for the new cancer medicine’s use established, the cost of manufacturing most cancer medicines is relatively low.

In other words, the vast majority of the societal cost for cancer medicines is expended up front in research and development.  Once cancer medicines are identified, the cost of scaling up manufacturing so we can provide these medicines to all patients who might benefit from them is modest.  Given these simple and undeniable facts, the current industry approach of managing the cost of cancer medicines after they have been developed by limiting access and rationing their availability makes no sense at all.

Vice President Biden, in his cancer moonshot efforts, called the cancer research community to task (and appropriately so) for a culture that resulted in researchers working in silos and not doing enough to share their research results.   At Holden, we have taken Vice President Biden’s charge to heart and are working collaboratively with other cancer centers to explore new ways to share cancer research information with the goal of accelerating progress in cancer research (more on this in future blogs).

A similar message to change culture and break down silos is needed when it comes to addressing the cost of cancer medicines.  As a society, we have already paid the research and development costs for new cancer treatments.  It is irrational to control costs by only allowing those cancer patients with the deepest pockets or the best insurance access to the silo containing the newest and best cancer medicines.

While the problem is clear, the solution is not.  I will remain engaged and supportive as Joe Biden adjusts from being Vice President to being a private citizen and brings his passion and high profile to finding ways to break down yet another set of silos.

Rejuvenation of failed cancer research hypotheses

I just returned from one of my favorite meetings of the year, the annual American Society of Hematology (ASH) meeting that I have attended almost every year since becoming a cancer researcher  in the late 1980s.   At the ASH annual meeting, research and clinical advances in blood cancers and other blood disorders are presented and discussed by scientists and physicians.   Several presentations at this year’s meeting led me to think about my first ASH meetings.

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Disruptive Innovation in Cancer Medicine – See Cancer Differently

We are in a remarkable time in cancer medicine. The investment in cancer research over the past several decades has helped us in our understanding of the biology of malignant cells, and how such cells interact with their microenvironment, especially the immune system. We have learned that cancer is more complex at the molecular level more than we ever imagined.

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Cancer moonshot – all systems “go”

About a year ago, I blogged about “going to the moon” as a metaphor for cancer research. More recently, the phrase “cancer moonshot” has taken on new meaning. In his state-of-the-union address, President Obama charged Vice President Biden with refocusing the nation’s effort on cancer and cancer research. To quote the President – “Vice President Biden said that with a new moonshot, America can cure cancer… I’m putting Joe in charge of Mission Control.” The cancer research community was already energized by the amazing potential for cancer research to reduce the pain and suffering caused by cancer at this particularly point in time, and welcomed the renewed focus on cancer research. Nevertheless, there was also a degree of skepticism. Many wondered whether the “cancer moonshot” was another example of politicians over-simplifying the incredible challenge of cancer in the short term. They worried that the result would be raised expectations without significant change or meaningful acceleration of progress in the long term.

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Cancer immunotherapy, research funding, and new cancer drugs – a year in review

It has been a while since I submitted a blog entry, and one of my New Year’s resolutions is that I will get back to posting entries more regularly. I thought I would start with a summary of the past year in the field of cancer in general and the Holden Comprehensive Cancer Center in particular.
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Addressing complex, painful, inescapable truths

I spent an evening last week doing two things that, at first, I thought were unrelated.

First, I viewed a preview of “Cancer: The Emperor of All Maladies,” a PBS documentary based on the book by Siddhartha Mukherjee. His preview was sponsored by the Iowa Cancer Consortium, The American Cancer Society, The Iowa Department of Public Health and Iowa Public Television. It included excerpts from the 3 part PBS documentary by producer Ken Burns that starts tonight, March 30 and runs through Wednesday, April 1. The preview was followed by a panel discussion. My fellow panelists and I made brief statements, and then entertained a range of outstanding questions from the audience.

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Beautiful hypothesis – ugly fact

Dr. Laura Rogers, a post-doc in my research lab, likes to start her presentations during our weekly research laboratory meetings with a quote. One she used a few months back was from Thomas Huxley, a renowned British biologist from the 1800s, who said, “The great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.” It was a very appropriate quote for Laura to use given the results we were discussing that day.

As Huxley’s quote illustrates, Laura wasn’t the first scientist to see a beautiful hypothesis slain by an ugly fact, and she will not be the last.

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Hope Without Hype

Last week, I had the honor of moderating a panel discussion on Capitol Hill on behalf of the Association of American Cancer Institutes and the American Association for Cancer Research. This panel was sponsored by the congressional cancer caucus and focused on the importance of the nation’s premier cancer research centers. In such settings, it can be challenging to talk about the vital importance of the work done at our cancer centers in a way that highlights the hope without appearing to be resorting to hype.

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Onco-Ecosystems

Environmental biologists have studied it for years – cancer biologists are just starting to think about it – and it has the potential to result in a fundamental change in our understanding of cancer. I am talking about ecosystems.

We all learned in elementary school that diversity helps an ecosystem thrive. Bees need flowers so they can make honey from the nectar. Flowers need bees for pollination. Neither would be able to exist without each other.

How does this concept apply to cancer? Our traditional view of cancer is that cancer cells within a tumor are the same. One cell starts growing out of control, pushes out the normal cells, and the result is cancer. Indeed, we talk about cancer as being “monoclonal,” i.e. all cells being the same. A major goal of cancer research over the past decade has been to understand the changes in genes that drive the monoclonal growth of cancer cells. In some cases, such as chronic myelogenous leukemia and some cases of melanoma, we have identified the gene that causes the cancer to behave badly, and have been able to treat the cancer successfully by targeting the product of the rogue gene.

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