President Biden, whose son Beau died of a brain tumor, has pledged to “end cancer as we know it.” To better understand how this could happen, USA TODAY spoke with Ned Sharpless, director of the National Cancer Institute, who will help lead the effort.
Sharpless spoke of the current “golden age” of cancer research, with investments decades ago that have finally paid off for patients, as well as the role NCI can play in helping patients. make even more progress, despite the challenges that remain.
Question: What does the president mean by “end cancer as we know it”? Is it really possible?
Notice what the president didn’t say. The president did not say to eradicate all cancers. This is unlikely to happen due to the fundamental links in biology between cancer and aging. It would be difficult, with current technology and an understanding of biology, to end cancer deaths completely.
What I believe the president meant by that was to take cancer from what it is, what we know today, to more of a disease where age-adjusted mortality is much lower. and where cancer mortality largely occurs in the elderly and frail. The idea is therefore to reduce mortality and incidence in otherwise healthy individuals.
Q: What about extremely deadly cancers like pancreatic cancer or the glioblastoma that killed Beau Biden? Will it be possible to make progress in this direction anytime soon?
It will require new thinking and new ideas. The hard thing to predict is when it’s going to happen. In 2000, I wouldn’t have said we were on the verge of making huge strides in melanoma. It didn’t seem particularly timely at the time, but now the world has changed very quickly.
Q: A cancer researcher once told me that although he has spent his life fighting the disease, the best approach would be to prevent it in the first place. What progress do you expect in cancer prevention?
The bad news in prevention is that once you get past smoking, obesity, and the viruses we can vaccinate for, it starts to get more difficult quickly. The NCI has tried many trials to feed people a vitamin or a retinoid or a drug that we think may prevent cancer. It didn’t really work out. There is no food we recommend you eat or vitamin that we recommend you take to avoid cancer. We recommend that you stay slim, we recommend that you exercise, but far beyond that our recommendation is quite limited for cancer prevention.
Q: What about cancer screening? Is there a potential to detect cancer early enough to become more treatable?
There are two real opportunities in cancer screening.
The things we do that we know to work could be used much more widely. We are particularly struggling to get cancer screening to underrepresented minority populations, people who live far from cancer centers. We now know that low-dose computed tomography screening for lung cancer is effective and widely underutilized.
We also think there is a new area of screening that is very exciting: a series of different blood-based technologies that could detect 10 to 50 cancers in the same patient at the same time. People who are otherwise healthy – maybe over 50 – would come and have this test at a certain interval and based on those results, they would be told that you seem like you don’t have cancer this year or that you need a closer look. These technologies are now ready for large-scale clinical trials. The National Cancer Institute can be very helpful because these are large trials that require many patients.
Q: Isn’t there a risk of overdiagnosis with such an approach?
The crucial question is whether these tests find the most aggressive cancers likely to be harmful and not the indolent and clinically insignificant cancers – and that is an open scientific question.
Q: You were appointed by President Trump and are now under the leadership of President Biden. Has the change of administration affected your work at the National Cancer Institute?
It’s an exciting time to get involved with the NCI, regardless of the president. The entire pandemic has been very disruptive to both cancer care and cancer research. I can’t say it’s been fun, because it’s a national tragedy, but being able to work in the public interest during that time has been very satisfying professionally.
To have a President of the United States who has a personal connection to cancer, to have someone who has such a good understanding of cancer research and such a clear goal of ending the tragic elements of cancer as quickly as possible is truly exhilarating for our field. .
It’s a great time to be a cancer researcher in the United States.
Q: You said we are in a “golden age” of cancer research. What do you mean?
It was in 2001 that the golden age began for me. A group of investigators were able to show that cancers that we thought were a bit the same – we thought we had a type of breast cancer, a type of lung cancer – that they weren’t, that there had many different subtypes.
In the old days I would give the same medicine to all people with colon cancer and it would work in about 20% of patients and you’d be like wow that’s weird why doesn’t it work in 80% remaining?
Now we say: I want a drug that works in 5% of lung cancer patients with BRAF mutations or with EGFR mutations or whatever. When you divide the cancer into these separate fractions, it’s a much easier problem to solve.
Q: But it didn’t start to pay off right away, did it?
It was in 2010 that the therapeutic sauce train started in terms of the massive new drug numbers and advancements you see every year now in cancer research.
Put the immune system to work
Q: One of those advancements was likely immune therapy – using a person’s own immune system to fight tumors. How is this changing cancer care?
A hundred years from now, we will be teaching medical students that there are four ways to treat cancer: surgery, radiation therapy, chemotherapy, and immunotherapy. There might be a fifth or sixth thing, but there will be at least four, and immunotherapy will be critically important. It will really be the only way to treat certain types of cancer.
Q: Has immune cancer therapy still delivered on its promises or are more treatments yet to come?
As deep as it has been to this day, the field is really in its infancy. (The challenge now) is to try to really figure out how to make the immune system work for all patients, not just the 10-20% who benefit very deeply on average. Some tumors seem to have to respond, but they don’t. There is something that holds back the immune system. How to get rid of this barrier is kind of the fruit at hand.
Q: What’s the next great idea after immune therapy?
One of the problems we have in cancer research is that there are so many great ideas. People are leaving other fields of science to become cancer researchers. If we don’t keep putting more money aside for this researcher-initiated science, the success rate of these applicants will drop precipitously and we won’t come to this paradigm-shifting idea that we need to fund.
What can NCI do?
Q: Collecting patient data has become extremely important in cancer, to better understand the differences between cancers and how to treat them. What is NCI doing to improve data collection?
One of our main roles is to build the infrastructure: cloud computing, data usage dictionaries. We are also carrying out a demonstration project on collecting data on childhood. The idea is to learn from every kid with cancer in the United States, to really understand what’s going on so that we can learn how to treat these patients as quickly as possible. It’s harder than you might imagine – balancing research questions and protecting patient privacy is very difficult – but I think we can do it.
Q: What are the other key roles of NCI? In what areas can this have the greatest impact?
(Say) we have therapy that is working and we want to see if we can give less of it. It’s not really in the best interests of a pharmaceutical company, but these trials can be very, very important to patients. We just had a major ER + breast cancer de-escalation trial where we showed that we can give women less chemotherapy and have equivalent results. This is a huge benefit to these patients, even if that’s the sort of thing NCI needs to do.
Q: President Biden has made fairness a cornerstone of his administration. How does this play out in cancer care?
We have known for decades that cancer outcomes are largely linked to access, race and socio-economy, wealth and education. NCI spends approximately $ 500 million a year studying the barriers that create health disparities in the United States and what needs to be done to address them.
If you want to get back to the president’s goal of making rapid progress against cancer, you have to address the issue of fairness. The chairman was very clear. He didn’t say “we want to end cancer as we know it for some people”. He wants to end cancer as we know it for everyone, so we really need to make sure that these advancements – some of these new, almost miraculous therapies that we have – are available to all patients regardless of their wealth, their status. access, their race (or). access to education.
Q: What do you plan for the next year or two as NCI has more money to spend and more public attention?
As we come out of the pandemic, there’s this combined feeling in our field that all of these different approaches and new technologies, along with the new vigor and focus from Congress and the White House, are going to be a really good time to be. cancer research. It’s really up to us to use this national investment to make a difference for our patients.
This interview has been edited for length and clarity.
Contact Karen Weintraub at [email protected]
Patient health and safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial contributions.