|April 19, 2016|
'Manhattan Project' for cancer aims to turn it into a chronic illness, not a death sentence
|In describing just how much of a powerhouse the group of six scientists leading Sean Parker's new $250 million cancer effort represents, Otis Brawley has to resort to a sports analogy. The chief medical officer of the American Cancer Society told Wired magazine: "He went to some major football teams, took the best players off the team, and said, 'I'm going to give you money to do what you do best.'"|
It's hard to overstate the hopes that are being pinned on this group. Under the new model --- to which Stanford University, Memorial Sloan Kettering Cancer Center and other major institutions agreed --- nearly 300 researchers specializing in the white-hot field of cancer immunology across the country will be following the lead of this central steering committee in determining the direction of their research.
The five men and one woman were each personally recruited by Parker, the billionaire philanthropist who is known for his founding roles at Napster and Facebook and who has a long history of disrupting established industries. At a launch event Wednesday, California Gov. Jerry Brown (D) said only half-jokingly, "Who would have ever thought cancer would be cured by Napster?"
Immunotherapy is based on the promise of being able to use a body's own immune system to attack cancer in the way it responds to other foreign invaders, such as bacteria and viruses. The challenge has been that cancer is a trickier foe than others and has ways of putting the brakes on our immune system. Researchers are working on two different ways to get around this issue. One involves supercharging your immune cells to create "armies" that can attack cancer. The other involves what are known as "immune checkpoint blockade inhibitors," which Parker describes as "retraining" the "troops" to be able to get around cancer's defenses.
The six scientists leading Parker's effort are:
•Jedd Wolchok, a medical oncologist at Memorial Sloan Kettering Cancer Center, who was the lead investigator in several important clinical trials, including one that led to the Food and Drug Administration's approval of a drug used for patients with advanced melanoma.
•Crystal Mackall, the only woman of the bunch and a pediatric oncologist who previously served as the head of the immunology section at the National Cancer Institute.
•Antoni Ribas, who headed the study that led to the approval of the drug that began a startling turnaround in former president Jimmy Carter's brain cancer.
•Lewis Lanier, a professor at the University of California at San Francisco who is an expert in "natural killer cells," which he describes as the "Marine Corps" of the immune system because they are often the first into battle.
•Carl June, who made headlines in 2012 for saving a 6-year-old named Emily Whitehead, who was near death because of leukemia, by using an experimental immunotherapy that sent her cancer into complete remission.
•James Allison, whom the Houston Chronicle called the scientist who "just might cure cancer."
During a wide-ranging panel discussion last week, they laid out where we are in terms of this research and where we're going. Their thoughts are wonderfully optimistic. Here are six big takeaways:
1. Despite the tremendous promise of therapies, accessing them has been difficult for many Americans. Only 200,000 of the 13.5 million with a history of cancer have tried the therapies. There are only a handful of approved treatments on the market --- most notably Merck's Keytruda and Opdivo --- and most of the rest of the estimated 1,500 therapies are still in the experimental stages. That's likely to change rapidly with the creation of the Parker Institute for Cancer Immunotherapy, a $125 million contribution to Johns Hopkins for immunotherapy by former New York mayor Michael Bloomberg and other philanthropists, and President Obama's "moonshots" effort to accelerate research.
2. The treatments have worked wonders in some patients, especially those with melanoma, but have not worked or have even been toxic for others. Those patients who we thought were lucky because they respond well to immunotherapy aren't actually lucky. There's something about their genetic or biological makeup that determines how they react, and the institute is launching a series of studies to systematically look at all of the different factors that may play a role.
3. The types of cancers that can be treated with immunotherapy are expanding, and there have also been strong results in patients with lung, brain and other cancers. But scientists say there are many barriers before they think they can get the treatments to work in other types of solid tumors. Part of that is because cancer cells in solid tumors appear to have learned how to "hide" better.
4. The scientists expect a multi-pronged approach to cancer treatment in the near term that will include immunotherapy but may also include chemotherapy, radiation and surgery. They are hopeful that these more "primitive" therapies will be replaced by more-effective immunotherapy solutions in the future.
5. As we develop new tools to help us predict cancer earlier, we'll be able to treat cancers before they even develop, by assessing genetics or other risk factors.
6. With the amazing results of some therapies, the language of cancer is starting to change. Instead of talking about cures and remission, doctors are now talking about cancer as being more of a controlled equilibrium with a tumor, in which it does not grow or cause issues.