Cancer is a complicated disease characterized by out-of-control cell growth that results from damage to DNA or genes. For years, cancer was categorized, researched, and treated according to the body part where it appeared, and individual research labs worked independently to understand the biology of specific types of cancer. Then, in 2000, Douglas Hanahan and Robert A. Weinberg articulated the concept of cancer hallmarks as a foundation for understanding cancer's biology across traditional cancer types.
Three initiatives built on that foundation now promise to accelerate development of more powerful life-saving therapies.
1. "Pan-Cancer" Discoveries Across Cancer Sites
Every human cell carries an enormous amount of chemical information (deoxyribonucleic acid, or DNA) in chromosomes from both mother and father. The combination of information (called the individual's genome) instructs each cell in your body how to function.
From birth, cells replicate themselves every day. In that process, sometimes the DNA mutates, or changes, as a result of environmental or lifestyle factors or simply as random biological mistakes. These accumulate with age.
Study of these processes now allows categorizing many cancers based on which chromosome has been disrupted and in what way. Commonalities now include factors that enable tumor cell growth, spread (metastasis), suppression, and survival or death. These create a pan-cancer "tumor microenvironment" that--if altered--might yield new and more powerful treatments.
Three government-funded programs have extended this work to support further genomics and immuno-oncology studies.
The Cancer Genome Atlas was launched in 2006 within the National Cancer Institute (NCI). The project identified organ-specific genetic changes and molecular pathways patterns in more than 20 different cancer types. The resulting data base is available to researchers and clinicians worldwide to help identify who will benefit most from particular therapies based on their genetic profile.
Extending this idea, the Pan-Cancer Project was launched in 2012 to identify common mutations and pathways across different types of cancers and to differentiate mutations and process pathways that are actually "driving" cancer growth. Ultimately such data should reveal therapies proven in treating one site of cancer that may be effective for other sites as well.
Some therapies are currently being tested for such pan-cancer applicability in "basket trials" that give therapies proven for one kind of cancer to patients with other cancers but showing the same genetic changes. The largest of these is NCI-MATCH, which will involve more than 20 drugs from 20 different pharmaceutical companies at up to 2,400 clinical sites.
2. Collaboration in Discoveries
Two collaborative trends--discovery sharing and collaborations among labs--are generating promising research momentum. One example is the research team led by Jay Bradner (of Harvard University and Dana-Farber Cancer Institute). Bradner's interdisciplinary team seeks to decipher gene regulation pathways, accelerate cancer research, and accelerate clinical applications through open sharing of discoveries.
Bradner himself said (in an interview with Myeloma Crowd Radio):
We like to think that . . . if we share openly and effectively with colleagues who deeply understand the disease, . . . connections will be made of therapeutic relevance and drugs will then emanate from these efforts.
In the first six years of the lab's existence, research developments transitioned into therapies three times. For example, the team discovered a molecule they call a "master regulator of cell growth" in myeloma; it has now been discovered to work for lymphoma and acute leukemia as well.
Currently the lab is focusing on potential synergistic drugs that work in combination with others. Bradner explained, in the same interview, that
By and large, companies want to make drugs that . . . they can sell without having to worry about some other drug. That means we're missing a whole class of drugs . . . that would work when combined and . . . be great partners for other drugs.
Time will tell what new incentives may be required to provoke more pharmaceutical company collaboration for combination therapies. Nevertheless, collaborative and out-of-the-box thinking is alive and well in Bradner's and some other nonprofit labs.
3. Funding Collaborative Research Initiatives
StandUp2Cancer (SU2C) was formally launched in 2008 by members of the media and entertainment industries who had experienced cancer themselves, in their families, or among their friends. Their mission seeks pooling of discoveries
to accelerate the pace of groundbreaking translational research that can get new therapies to patients quickly and save lives now.
SU2C often partners with other research foundations to fund collaboration, innovative and high-risk, and rapid-result initiatives. In the seven years since its founding, SU2C has raised over $370 million for cutting edge collaborative research, supporting 942 scientists, involving 123 institutions in collaborative research, and funding 151 clinical trials. Their website publishes updates on many of their cross-disciplinary "Dream Teams," together with the milestones achieved every six to twelve months.
In April 2015, a $20 to $25 million three-year Dream Team funded by SU2C, the American Cancer Society (ACS), and Bristol-Myers Squibb was created to fund researchers at Massachusetts General Hospital Cancer Center and Memorial Sloan-Kettering Cancer Center in search of "durable, long-term remissions" for lung and other cancers (including melanoma) with a particular gene mutation. Lung cancer is the leading cause of cancer deaths in the U.S.
SU2C and its funding partners are demonstrating that collaborative research can accelerate potential breakthrough discoveries.
Cancer research is expensive because there are so many variables that can determine why it starts, how it grows, and how it can be stopped. While pan-cancer and collaborative mindsets are accelerating progress, results depend on sustained private and public funding. In words taken from the SU2C mission statement:
Now more than ever, as government funding for cancer research is disappearing from the national agenda, every single one of us affected by cancer must stand up and be heard. . . . This is where the end of cancer begins.
If every HufPo reader contributed to a favorite cancer research charity and demanded that Congress increase federal cancer research funding, a cancer-free future would be more achievable.