I’m a realistic optimist—or an optimistic realist. There is tremendous opportunity to make progress—and ultimately to win. We just have to keep our goals both ambitious and realistic along the way.— Eric S. Lander, PhD
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This past summer, Eric S. Lander, PhD, President of the Broad Institute of the Massachusetts Institute of Technology and Harvard in Cambridge, Massachusetts, and Co-Chair of the President’s Council of Advisors on Science and Technology, raised a few eyebrows at the Aspen Ideas Festival when he said it may take another 30 or 40 years to cure the majority of cancers or even convert them into completely treatable, manageable diseases. In an interview with The ASCO Post, Dr. Lander explained why he believes it will take decades to cure most cancers and how the national Cancer Moonshot initiative may help reduce that timeline.
A Chess Game of Genetic Evolution
Why do you think it will take so many more years to turn more deadly cancers into treatable chronic diseases?
I’m very optimistic about the advancements we will make in the short term. We will continue to make steady incremental progress against individual cancers. However, the idea that we will have a “cure” for most or all cancer types in the next few years is not a promise we can deliver. If, over the next several decades, we can convert cancer into a largely chronic disease, that will be an historic accomplishment—one we will be incredibly proud to tell our children. But it is going to require understanding cancer on multiple fronts, including how cancer becomes resistant to therapy and how to combine treatments so it does not recur. And, that will take time.
I know several decades to achieve a complete solution may sound like a long time. But making a fundamental biologic discovery, creating a drug based on that discovery of a new drug candidate, and then testing that drug in humans can take more than a decade. And we are going to need many drugs to treat cancer. If we work really hard, I think we can largely convert cancer into a tractable, manageable condition in several decades. But we have to wake up every morning focused on making that happen.
Of course, we all have friends with cancer who need better answers now. They are counting on the fact that new solutions that may buy them more time will appear every few years. They are counting on there being important incremental progress that continues over the course of the next 5, 10, and 15 years. I’m counting on that, too.
But that is not the goal I’m talking about. I’m talking about the long-term goal of reaching the point when a patient can walk into a doctor’s office and the doctor will be able to say with confidence, “We’re going to be able to fully manage your cancer” and have that be true for the vast majority of patients with cancer.
Why am I optimistic in the long run? Because we will increase our ability to anticipate all the genetic moves cancer will make to become resistant to our treatments—whether they are conventional chemotherapy, targeted therapies, or new immunotherapies—and we will have ways to combine drugs to block those moves. It’s a chess game of genetic evolution with cancer: We keep learning, but each new cancer starts naive as to what we know.
To reach the goal of curing most cancers, we will have to work together to share research and clinical data and will need cancer patients to choose to share their medical records, so we can learn from their experiences.
Challenges With Big Data Systems
Do you expect rapid learning systems such as IBM’s Watson and ASCO’s CancerLinQ™ will help accelerate the process of using the information in patients’ medical records and tumor-sequencing data to analyze their gene mutations and help inform the most effective treatment for individual patients?
Although machine-learning systems are improving, the issue of getting patients’ medical records in a machine-readable form is still remarkably challenging. Right now, we have the ability to extract a small subset of a patient’s electronic record—the continuity of care document—but this doesn’t contain most of the pertinent information needed to learn more about a patient’s tumor. So even if a patient wants to share his or her data to advance cancer medicine, there’s often no practical way to do it. There’s no simple button to push to be able to extract the important information.
We have to fix that problem. All patients should have the right—and the ability—to share their medical records with researchers, if they wish, to accelerate progress against cancer.
Speeding Progress Against Cancer
If the Cancer Moonshot initiative is fully funded, do you expect it to speed advancements in cancer research and lead to more effective therapies and potential cures for cancer?
Of course I do. A Cancer Moonshot Blue Ribbon Panel of experts has been established as a working group of the National Cancer Advisory Board of the National Cancer Institute; it has recently published recommendations for initiatives to accelerate progress against cancer, and I’m impressed. However, until the recommendations are approved and implemented, it is difficult to say how quickly we will begin to see progress in cancer therapy. (See “Cancer Moonshot Blue Ribbon Panel Recommends 10 Ways to Speed Cancer Advances” in the September 25, 2016, issue of The ASCO Post.)
Some people may think that a “Cancer Moonshot” means our work will be done in a decade, but that’s not right. What the Cancer Moonshot is about is making the rocket go faster—maybe twice as fast—to accelerate advances in cancer prevention, diagnosis, and treatment.
There are many thoughtful ideas on how to do that, including becoming much more systematic about understanding the biologic pathways in cancer and the vulnerabilities in the disease. For example, we now have tools like genome-wide CRISPR (clustered regularly interspaced short palindromic repeat) screens to tell us every gene that is essential to a specific cancer—the cancer’s Achilles heel. Having that knowledge alone won’t cure cancer, but it empowers thousands of researchers to move faster.
There has been so much advancement in genomics, immunology, genetic engineering, and computer science. It is a good moment to rethink how we can use all these advances to speed progress against cancer. The Cancer Moonshot will surely help this along.
Improving Survivors’ Quality of Life
There are now more than 15 million cancer survivors in the United States,1 but many are living with long-term and late side effects from their cancer and its treatment, both physical and financial. What improvements in cancer treatment do you envision in the near future that will enable survivors to live higher-quality lives?
The good news is there are more long-term survivors of many cancers than ever before. Now we have to figure out how to improve their quality of life. For patients on therapy, we need to optimize dosing and scheduling to reduce drug toxicities. We also need to understand whether side effects are on target or off target, so we attempt to avoid them, and we need to develop medications that address those side effects. For example, physicians often consider cancer cachexia as if it were an inevitable consequence of the disease; it isn’t. Cachexia is a biologic process, and we should be thinking about therapies that block cachexia and other side effects that impact patients’ quality of life.
You mentioned the financial burden of cancer, and that is one of the great challenges to our health-care system. On the one hand, we want to have a system that financially rewards companies for developing cancer drugs; we want to create incentives for people to commit private capital to cure cancers. On the other hand, the way drug companies are incented is through very high drug prices, and that’s a problem. As best as I can see, the solution has to be in competition. There have to be multiple companies with alternative drugs to compete with each other to hold costs down.
Solving any of these problems isn’t easy. That’s why I don’t like to give Pollyanna answers to your questions. However, I’m a realistic optimist—or an optimistic realist. There is tremendous opportunity to make progress—and ultimately to win. We just have to keep our goals both ambitious and realistic along the way. ■
Disclosure: Dr. Lander reported relationships with Codiak Biosciences, Neon Therapeutics, Third Rock Ventures, Infinity Pharmaceuticals, and F-Prime Capital. The Broad Institute (which he directs) holds patents and has filed patent applications on technologies related to CRISPR-Cas 9; however he has no personal financial interest.
1. American Cancer Society: Cancer Treatment & Survivorship Facts & Figures, 2016-2017. Available at cancer.org/acs/groups/content/@research/documents/document/acspc-048074.pdf. Accessed September 13, 2016.