The Obama administration wants to speed up cancer research with its “Cancer Moonshot” program—packing 10 years’ worth of work on prevention and treatment programs into five is one of its rallying cries. Agreeing on what to do, and how to do it, is the first step. The FDA agreed this summer to reorganize the way it evaluates drugs, diagnostics, and other cancer-related products.
This week, a panel of 28 scientists presented the National Cancer Institute’s National Cancer Advisory Board a set of recommendations and national priorities for basic research, clinical trial practice, and drug development. In an interview with Xconomy, panel co-chair Tyler Jacks acknowledged the recommendations were broad, with many details yet to be worked out. (So broad, in fact, that they elicited no small amount of Internet eye-rolling, including this tweet Thursday from David Shaywitz, CMO of genomic data firm DNANexus.)
Moonshot recommendations remind me of Bart Giamatti's famous edict on day he assumed Presidency of Yale… pic.twitter.com/ZU3ZxJsVCQ
— David Shaywitz (@DShaywitz) September 9, 2016
A set of recommendations for policies and reimbursement is forthcoming from a different moonshot group.
The scientific goals, writ large, included nationwide data sharing among researchers and health practitioners; better prevention through medicine (such as the HPV vaccine) and public education (anti-smoking campaigns); and a registry that could match cancer patients to trials based on genetics and other factors. (The full report is here; a summary is here.)
Xconomy reached Jacks, who is director of the Koch Institute for Integrative Cancer Research at MIT, after the panel made its presentation in Washington, DC, this week. The following is an edited, condensed version of our conversation.
X: The report starts by recommending a national cancer patient network. Is this akin to a nationwide study, like the government’s precision medicine initiative?
TJ: No, it’s not a national study or clinical trial. It’s characterization of individuals’ cancers, a way to apply analysis to patients all over the country. Included is the idea that when a patients signs up they’ll get better information about their own cancer—bringing the science to the patient—and better access to clinical trials. If you analyze the genome of a patient’s tumor, a mutation in gene X might make [the tumor] sensitive to drug Y. Once they’re in the system, you can get them onto a trial. It’s related to the MATCH trial being run by the National Cancer Institute.
X: It seems every day there are more examples of one mutation identified as the driver of a cancer. But is there a danger of relying too heavily just on genomics to determine the course of a patient’s treatment?
TJ: We know that existence of particular mutations can predict sensitivity to some drugs, but in some cases they don’t. And in many patients there are mutations without appropriate drugs. We’re going to need other biomarkers to indicate different treatment strategies, such as RNA expression or protein expression. Right now, getting the genomic profile is easiest. But at the end of the day [the network] will integrate other data types.
X: This sounds a lot like the GENIE project to pool patient data among seven top cancer centers.
TJ: Yes. This is another [initiative] to create systems to more effectively catalog the collection of mutations that exist. GENIE is one of several ongoing. The hope is that we can bring it to a broader array of patients.
X: Even among the GENIE members, there are varying levels of resources to build the data infrastructure, convert existing data, and pay for things like genomic tests. How will you implement this across the country?
TJ: Important new infrastructures will have to be built, for sure. There are policy issues. And who will pay for the genotyping of every patient?
X: You don’t think that sequencing prices will come down enough? … Next Page »