In light of the recent announcement by Vice President Joe Biden to infuse the US cancer research program with $1 billion, a so-called “moonshot” program, we are speaking today with Giulio Draetta, a clinician and cancer researcher at MD Anderson Cancer Center at the University of Texas in Houston, who leads that center’s Moon Shots program.
—Interviewed by Anna Azvolinsky, PhD
OncoTherapy Network: Could you tell us about how MD Anderson’s Moon Shots program and how it came about?
Dr. Draetta: In 2012, we started to ask the question of whether the investments in research we were making at MD Anderson, considering our budget is about $800 million a year, we were questioning whether we were really doing enough to solve the cancer problem. And one thing that was evident, when you think about cancer, you really have to think about it comprehensively. You can’t just worry about taking care of patients on their last leg with advanced disease which is typically what MD Anderson does, as we are a tertiary cancer care center primarily focused on taking care of patients with advanced disease. So we asked whether a comprehensive approach that starts to consider prevention, early detection and then treatment would make sense. And in this regard, we in fact, had already invested for many years in epidemiology as well as early detection research, but we really wanted to do more and wanted to really work around the concept of being much more aggressive about focusing on addressing very significant problems in cancer.
OncoTherapy Network: You talked a bit about the scope, so maybe a bit more on the goals of the program and the program is now a few years old so any highlights on any results you are seeing?
Dr. Draetta: When we first started, we asked the question of whether there could be a project that would address problems from the start, where we could measure the impact of cancer mortality in the short- to mid-term. So the premise of the program was to study any area of the cancer continuum from prevention to early detection to treatment that would give us an opportunity to impact the course of disease.
So in this regard, for example, we initiated programs in melanoma that would enable legislation that would prevent access to tanning facilities for minors, major campaigns that led to enactment of legislation in Texas and other states. We initiated programs of smoking prevention in schools and cessation. We have enabled novel approaches to surgery in ovarian cancer that allow us to create an opportunity for patients to have a significant reduction of disease burden ahead of operation by giving chemotherapy first and then operating because what we have learned in this particular disease over the years is if we can use chemotherapy to reduce the number of lesions in the abdomen then that will result in much better surgery and the patient will have a better chance to not recur as the more lesions that you can eliminate when you operate, the better the patient will do in the long-term. So the chemotherapy ahead of surgical intervention was really helping patients with this disease.
Another relevant example was the creation of a system for managing information around the patient, including all of the genomic profiles that is necessary these days to understand cancer at the molecular level. So we had to do that as we know that cancers are immediate diseases and you have to approach treatment based on your understanding of the underlying genomics and specific characteristics of every cancer type. So on one hand, we wanted to enable genomic testing for every patient and every tumor and at the same time, we really wanted to make sure that all of this information was brought together into a general database that would allow us to learn from every patient and anticipate new approaches based on what we would learn from analyzing one patient after another. And we have created a major database which is linked to a program that we call the APOLLO [Adaptive Patient-Oriented Longitudinal Learning and Optimization] program where we link patient history as the disease develops with the genomic information and this is essential and has proven to be essential for much of the investigations we do.
Another aspect we enable in full is immunotherapy which as you know, is really changing the course of the disease for many metastatic cancers starting from melanoma and non-small cell lung cancer, kidney, and other cancers where we are seeing activity with these immune-checkpoint inhibitory therapies. And we have now enabled more than 125 immuno-oncology trials across the institution and have put 11,000 patients on trial, on average, per year and we are very active in this area, also because we have had a strong tradition of tumor immunology at the center.
So all in all, it’s a comprehensive effort to really bring to the forefront, therapies that make sense for the patient. The patient is at the center of our effort, it is not necessarily research per se. We are really looking for game-changing activities that are not solely focused on individual scientists or physician-scientist interests but on the opportunity for these people to work together to identify solutions.
OncoTherapy Network: What do you think about this announcement by the vice president of this new federal program. What does this mean for cancer research, do you think?
Dr. Draetta: Clearly, we have seen a reduction in funding for research in the past decade and this is a most welcome effort. And I think that, in my opinion, if they were to adopt similar concepts to the ones we have adopted, which are, a transparent, systematic effort to identify projects that are worth conducting, with very clear time lines so that these are not based on open-ended funding for any research around cancer mechanisms. Rather, they are more about, okay, let’s move the needle from where we are now to where we need to be, this could certainly be a fantastic opportunity. It would require a change in approach from the typical NIH [National Institutes of Health] funded mechanism and should really focus on enabling team science around teams that are agreed upon not just among the scientists themselves, but also with patients and patients’ advocates, foundations for example—the Leukemia Society, melanoma alliances, and so on, to really align to identify approaches worthwhile conducting if we have to keep in mind bringing forward a solution in the next 5 to 10 years. And again, about 50% of cancers are preventable. Approaches for early detection are absolutely necessary if we have to intervene and cure diseases like ovarian and pancreatic cancer and so forth, it is very important that immunotherapy is enabled to its fullest extent. So these priorities have to be clearly identified. Then the national efforts must make perfect sense. MD Anderson is a very large and number one hospital for cancer treatment, but there are so many other good places that could conduct this and today may not have the necessary funding to do that.
OncoTherapy Network: Are there any drawbacks that you see for this federally-funded Moon Shot program?
Dr. Draetta: So it is too early to tell because, again, the mechanisms have not been identified. I am looking forward to seeing again, the transparent criteria that are measurable. And I would advocate for decisions that are not just made by scientists, but really made by the community at large, looking at what progress is being made, once you get the funding. The way that we conduct review of our projects is we review all of our programs on a 6-month basis and really look at the advances that have been made towards the goals that are agreed upon in the cancer types in the 12 Moon Shot focus programs at MD Anderson, the different disease subtypes. And each of these we conduct a really stringent review and if the national program were to be conducted based on similar principles, may be on a yearly basis, but you have to look at progress and force people to work together. Even when there are collaborative grants, once you get the money, everybody goes off and does their thing. But it’s about getting together and working around solving the problem along very stringent criteria if you want, industry-like criteria, that define milestones and measurable goals for the program.
OncoTherapy Network: Thank you so much for joining us today, Dr. Draetta.
Dr. Draetta: Thank you.