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The Cancer Moonshot (SᴄɪPᴏʟ brief available) was announced in President Barack Obama’s final State of the Union address. By increasing the focus of government on finding ways to treat and cure cancer, which is the second leading cause of death in America behind heart disease, the program seeks “to achieve a decade’s worth of progress in 5 years” through targeted investments and the contributions of numerous government agencies and non-governmental entities.

Vice President Joe Biden leads the initiative. It includes health-oriented agencies in the Executive Branch – the National Cancer Institute (NCI), the National Institutes of Health, the Veterans Administration (VA), and the Department of Health and Human Services – as well as others such as the Department of Energy (DoE) and the National Endowment for the Arts.

Two related documents, both released in October 2016, describe current, ongoing, and future efforts of the Moonshot. The project’s Report of the Task Force details strategic goals, main initiatives, smaller programs, and policy goals, in addition to discussing current accomplishments. The Report to the President from the Vice President also discusses the government’s progress on the project’s main efforts, and additionally highlights private sector engagement. As detailed in these documents, actions to date undertaken by the Cancer Moonshot include a national summit that “brought together nearly 400 cancer researchers, oncologists, nurses, patients, their families, advocates and others”; more than 300 local summits; and private sector involvement such as Deloitte’s “Conquering Cancer” XPRIZE and Cancer Support Community’s “Frankly Speaking About Cancer Clinical Trials” program.

Much of the focus in these two documents is on utilizing recent advances in genomic research and big data analysis to improve cancer treatment outcomes. This brief looks at those two areas of the broader initiative. Within these two areas, the Cancer Moonshot aims to:

  • Develop the field of precision oncology;
  • Perform big data analysis on large databases of military personnel medical records the Department of Defense (DoD) has been collecting since the 1980s;
  • Create a Genomic Data Commons platform through which researchers can share data; and
  • Advance proteogenomics, the study of the expression of genes through proteins.

Genomic Research

DOE and NCI partnership to accelerate precision oncology

This project is being undertaken through the coordination of the DoE’s National Laboratories and NCI. It seeks to find ways to tailor individual treatments by examining the specific mutations of malignant cells.

Applied Proteogenomics Organizational Learning and Outcomes consortium (APOLLO)

The APOLLO consortium of the Cancer Moonshot is a collaboration between the DoD, the VA, and the NCI that will look for treatments for cancer based on proteogenomics. The initial effort will study a cohort of 8,000 lung cancer patients and make the data easily available to researchers.

Big Data Analysis

NCI’s Genomic Data Commons

The Genomic Data Commons (GDC) aggregates five petabytes of genomic data from individuals with various types of cancers. It also includes associated clinical data like cancer imaging and treatment history. Researchers and clinicians can access and share these data as they investigate precision medicine treatments.

DoD longitudinal precision oncology study

The DoD maintains large databases consisting of samples collected from military personnel. These include the cancer registry, which has been collecting data since 1984, and the serum registry, which was established in 1989. The DoD is using this longitudinal data to identify linkages between pre-diagnostic biological markers and various cancers. The DoD will partner with the Environmental Protection Agency (EPA) to link study results with the EPA’s Environmental Quality Index so as to evaluate environmental factors in cancer.

The Million Veteran Initiative

The Million Veteran Initiative, a collaboration between the DoE and the VA, will analyze half a million veteran records to look for relationships between clinical, environmental, and genomic data. With a focus on cancer, heart disease, and mental health, these relationships will improve understanding of those diseases’ detection, progression, prevention, and treatment.

Relevant Science 

Cancer is a family of over one hundred diseases. It is one form of abnormal growth of human cells. Benign and malignant tumors are both the result of abnormal growth, but only the latter is cancer and is capable of spreading throughout the body. Cancer risk is widespread; it affects 1 in 2 men and 1 in 3 women in their lifetimes. Susceptibility to the disease is a mixture of genetic, environmental, and behavioral factors.

Genomic Research

One of the major goals of the Cancer Moonshot is to better understand cancer susceptibility factors and their interactions in order to develop tailored prevention and treatment programs for patients. The precipitous drop in the cost of sequencing the human genome has enabled this research and treatment. In 2003, the Human Genome Project spent $450 million to sequence the first complete human genome. By 2006 the cost fell to $20 – 25 million; in 2015, it cost less than $1,500. The Cancer Moonshot will take advantage of this new reality, as detailed below.

DoE and NCI partnership to accelerate precision oncology

Precision oncology is the idea of determining an individual patient’s DNA to tailor cancer therapies. The basic procedure can be outlined in three steps: characterize the genomes of a patient’s tumor; evaluate this data in light of knowledge of existing treatment methods and their fit for such genomes; and provide this evaluation to doctors to incorporate in a treatment program. Such customized treatments are predicted to become the norm in many areas of medicine, but it has been said that “oncology arguably sits at its vanguard” because “cancer is a genomic disease: most cancers harbor a cocktail of mutated … oncogenes [a gene that could turn a cell tumorous] and tumor suppressors.”

But a number of criticisms exist. As one scientist argued in Nature, “precision oncology has not been shown to work, and perhaps it never will.” More specifically, the author noted that there are not currently any targeted therapies offered, the genes found that seem to be relevant to the cancer are not influenced by treatment, and his literature review only uncovered thirty two instances of a response to such treatment by tumors over all the years this idea has been pursued.

The Journal of Clinical Oncology and The Lancet have both published comprehensive summaries of the state of this technology.

Applied Proteogenomics Organizational Learning and Outcomes consortium (APOLLO)

Proteogenomics looks at the expression of genes through proteins and is an intersection of proteomics and genomics. It is a new frontier of research, having only begun around 2008. Proteomics is the study of the proteins produced by an organism, just as genomics is the study of the genes of an organism. Proteogenomics is an improvement to the process of genome annotation, the identification of genes and determination of their function, because automated genome annotation can lead to erroneous results.  Proteogenomics can improve that process, which in turn can provide novel ways to address cancer.

A technical discussion of the subject is available from New York University while an applied version is available in Nature Methods.

Big Data Analysis

Another front in the Cancer Moonshot is big data analysis of existing databases. Big data began as a field in the early 2000s due to technological developments. It has been applied to fields like business sales, fraud protection, and medicine. Big data, among other oncological applications, has been predicted to help identify the most effective cancer drugs to treat patients or even to recommend non-cancer drugs which may be effective treatments.

NCI Genomic Data Commons

A recurrent theme in the Cancer Moonshot is the application of existing stores of data for new purposes using big data analytics techniques. As an example, the GDC began by combining two petabytes of data from two existing NCI programs, The Cancer Genome Atlas and its pediatric equivalent Therapeutically Applicable Research to Generate Effective Treatments. A petabyte is equivalent to 13.3 years of HD video or 500 billion printed pages of text.

Within the expanded GDC, algorithms will standardize the data to allow easier use by researchers. The hope is that the data can be used to identify relevant genetic markers that will inform diagnostics and treatments.

DoD longitudinal precision oncology study

There are approximately 1,000 new cases of cancer in active duty military personnel per year and approximately 250,000 samples available in the DoD serum and cancer registries. These long-term samples provide a robust dataset for longitudinal oncology study.

As used in the longitudinal study, protein signatures are computational predictive models used to classify proteins into families. Such classification provides a basis for predicting which functional and structural properties may be found in a protein that has heretofore not been experimentally characterized.

In the epidemiological context, a longitudinal study is a cohort study documenting different reactions over time in a group which shares a common characteristic. For example, such a study could investigate differences in a collection of men, all of whom have smoked a pack of cigarettes each day of their lives and were born in 1975, but only some of whom develop lung cancer or emphysema, to determine which factors contribute to disease susceptibility.

The Million Veteran Initiative

This program is an aspect of the Precision Medicine Initiative (SᴄɪPᴏʟ brief available). The Initiative aims to move beyond the traditional “one-size-fits-all-approach” in medicine toward customized treatments tailored using an individual’s genes, environmental factors, and lifestyle.

Genes regulate the cycle of cell growth and death. Cancer occurs when a mutation, or several, converge to create uncontrolled cell growth. Importantly, similar mutations can cause cancers in different parts of the body, so a treatment focusing on the same set of mutations can sometimes be applied to multiple kinds of cancer. This search in tailored medicine for correlations between genetic mutations and disease outcomes has been criticized as suffering from the research problem of confusing correlation with causation.

Endorsements & Opposition 

Endorsements:

Secretary Hillary Clinton’s campaign for President endorsed the effort in a blog post: “I could not be prouder to stand with Vice President Biden in this fight, and as President, I will take up the charge. My Administration will carry out the mission the Vice President has set, and continue to call on his advice, leadership, compassion, and sheer strength of will.”

The disease awareness organization Mesothelioma & Asbestos Awareness Center discussed the effort in a blog post: “While the goal is to prevent, treat, and cure all cancers, a focus on immunotherapy is especially good news for mesothelioma patients. Many of the newest and most promising treatments for mesothelioma are based on immune targeting.… [T]he funding and support behind the Moonshot could help to push new drugs down the pipeline faster and get them into mesothelioma clinical trials where they can start to make a difference.”

The conservative think tank Manhattan Institute has said conservatives should engage with the project: “[C]onservatives who worry about the government’s role in combating cancer are missing a key part of the picture: When it comes to making big gains against cancer, it’s not about central planners generating solutions from whole cloth; it’s about making sure nothing gets in the way of the cutting-edge treatments that are already within our reach. Conservatives can play an important part in the cancer moonshot by helping to keep it focused on its key task.”

Opposition:

At present, there has not been publicly reported opposition to the Cancer Moonshot.

Status 

The Cancer Moonshot has begun its work and issued reports, including a Blue Ribbon Panel report of 10 potentially transformative areas of research, and the reports discussed here from the Task Force and the Vice President.

Funding the Cancer Moonshot has remained contentious. The original proposal called for a billion dollars of funding. The White House has requested $680 million in funding for the project for the 2017 budget, but Representative Tom Cole, Chair of the Labor, Health and Human Services, Education, and Related Agencies Subcommittee of the House Committee on Appropriations, has expressed doubt: “It would have been a lot more helpful if the proposals had come earlier.… It’s hard to fund something completely until you know what it is you’re being asked to fund.”

In the 21st Century Cures Act, as passed by the House of Representatives on November 30, 2016, $1.8 billion was set aside for funding the Moonshot. At present, this bill still needs to be passed in the Senate and subsequently signed by the President before it becomes law, so additional Moonshot funding is not yet guaranteed.

Primary Author 
Brent Caldwell
Editor(s) 
Andrew Pericak, MEM
Recommended Citation 

Duke SciPol, “Cancer Moonshot: Report of the Task Force & Report to the President from the Vice President” available at http://scipol.duke.edu/content/cancer-moonshot-report-task-force-report-president-vice-president (December 1, 2016).