Shooting for the Moon…and Beyond

Steven Eric Finkelstein, MD

This is an exciting time, as reports of major news impacting oncology research are emerging, it seems, on a daily basis. Just recently, the National Cancer Institute (NCI) announced it had assembled a blue ribbon panel made up of cancer leaders, scientific experts, and patient advocates. The panel will influence NCI’s goals and direction for Vice President Joe Biden’s $1 billion National Cancer Moonshot Initiative, which will provide funding to promote finding new methods of detecting and treating cancer. Our government has also indicated its commitment to modernizing our research infrastructure through such proposals as 21st Century Cures and the president’s Precision Medicine Initiative.

The National Cancer Moonshot aims to forward progress through the enhancement of data access and facilitation of collaboration between doctors, researchers, philanthropies, patients and their advocates, and pharmaceutical and biotechnology companies. The Moonshot’s goal is to achieve a decade worth of advancement in 5 years, improving our ability to prevent cancer and detect it earlier, while making more therapies available to more patients.

The blue-ribbon panel will function as a working group under the presidentially appointed National Cancer Advisory Board. Its goal is to provide scientific guidance from cancer community thought leaders.

Members of the panel come from a variety of scientific disciplines, such as immunology, biology, diagnostics, genomics, bioinformatics, and cancer prevention/treatment. The panel also comprises investigators who have expertise in cancer health disparities and clinical trials. Significantly, cancer advocacy groups along with biotechnology and pharmaceutical companies will also be represented on the panel and its working groups.

Unfortunately, there are no radiation oncologists on the blue-ribbon panel.

In addition, funding for research in radiation oncology has been dwindling, and remains well below the level of other therapeutic areas. According to an analysis by the American Society for Therapeutic Radiology and Oncology (ASTRO), spending on radiation oncology awards represented only about 2.2 percent of the NCI’s budget for fiscal year 2015.

Over the next several months, the panel will consider how to advance the themes that have been proposed for the initiative. These themes include the development of cancer vaccines, advances in immunotherapy and combination therapies, single-cell genomic profiling of cancer cells, enhanced data sharing, and new approaches to the treatment of pediatric cancers.

Of the themes listed above, the development of radiation- driven personalized systemic therapy—involving radiation therapy, surgery, chemotherapy, and one of my personal interests, immunotherapy—may provide the best treatment options for many cancer patients. For those familiar with some of my publications on the area, radiation-driven immunotherapy (RDI) coupled may improve outcomes for our patients. Indeed, the deeper dive into how radiation influences systemic changes in vivo, in humans, is critical to understanding which patients are most appropriate for immunotherapy.

Building a collaboration of the best scientists in the cancer field is laudable; including radiation therapy and supporting the development of existing and adoption of powerful new combination therapies, equally so.

To promote advances in cancer care using radiation therapy, there must be consistent funding to expand the field. Providing specific input and funding for radiation oncology will ensure a stable future for the best minds as they set out to shoot for the moon...and beyond.