Shooting for the Moon

Defeating cancer is many times more difficult than planting a flag on our lunar satellite.

By | April 1, 2016

ANDRZEJ KRAUZELast year, Vice President Biden said that with a new moonshot, America can cure cancer . . . .Let’s make America the country that cures cancer once and for all.

—President Barak Obama, State of the Union address, January 2016

The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal.

—President Richard Nixon, signing into law the National Cancer Act of 1971, December 1970


In the decades separating these statements, such exhortations and promises didn’t come only from politicians; many scientists have also claimed that eradicating cancer was within reach. Beginning in February 2003, Andrew von Eschenbach, who served as director of the National Cancer Institute from 2002 to 2006, repeatedly named 2015 as the year by which he believed the disease could be vanquished.

So, in 2016, what’s the right degree of optimism to adopt? Treating cancer is enormously complicated by the fact that it is not a disease with just one root cause. It’s not even a single disease. But as massive databases accrue ever-more genomic information on myriad tumor types, cancer’s molecular underpinnings are coming into focus and beginning to guide the design of tailored therapies. Still, many conundrums remain.

This issue of The Scientist looks at progress in solving a number of those. Otto Warburg knew almost 100 years ago that tumor cells metabolize glucose differently than healthy ones. In “A Different Way of Doing Things,”  Kivanç Birsoy and David Sabatini dive into the diverse ways that cancer cells reprogram their own metabolism to fuel their rapid proliferation. New findings about these altered metabolic pathways are pointing to novel therapeutic possibilities for stunting cancer’s growth.

An appreciation for the importance of a tumor’s surrounding environment has also been growing for some time now. Solid and fluid pressures exerted by and on tumors influence proliferating cancer cells starved for nutrients and oxygen, and affect inflammation, metastasis, and drug delivery. Lance Munn and Rakesh Jain describe the interplay between cancer cells and components of the extracellular matrix (ECM) in which a tumor resides (“The Forces of Cancer,”). Targeting ECM components such as collagen and hyaluronan to alter physical stress on tumors could aid the delivery of antitumor drugs.

Metastasized cancers cause more than 90 percent of cancer deaths, but how that process occurs is still largely mysterious. An expanded version of The Literature section examines a number of recent reports about how exosomes released by primary tumor cells play a special role in preparing the metastatic site before the arrival of the primary tumor cells themselves. “They’re terraforming the envi­ronment to make it hospitable,” is how one researcher describes it. Exosomes are also possible targets for reducing cancer’s spread.

A relatively new conundrum in cancer research, and a complex one at that, is the role of the microbiome in both spurring and protecting against tumorous growth. Kate Yandell reports on how alterations to the gut microbiome and attendant changes in immune-modulated inflammation have been implicated in the progression of cancer and in the action of many anticancer therapies (“Microbes Meet Cancer”).

Conquering cancer will require deeper dives into genomic data and better noninvasive methods for diagnosing both the presence of cancer and treatment efficacy. “Pulling It All Together” describes system-biology approaches that take this plunge, identifying functional elements, master regulators, and dysregulated but highly conserved genes that may serve as potential new drug targets. And the hype and hope about liquid biopsies is examined in “Banking On Blood Tests.”

There are lots of reasons for optimism, but no shortage of conundrums as researchers continue their quest to wipe out cancer. 

Mary Beth Aberlin Editor-in-Chief 

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Comments

Avatar of: N K Mishra

N K Mishra

Posts: 60

April 20, 2016

With so much of background knowledge, there are reasons to believe that the solution( cure) to this disease would be found out in totality.

Avatar of: wctopp

wctopp

Posts: 110

April 20, 2016

We're going to get ourselves into a "boy who cried wolf" situation here.  The people who pay our bills are going to get tired of hearing that if they give us just one more huge pot of money,  this time cancer really will be cured.  What we ought to do is agree to pick just one cancer, carefully chosen, and state that if they give us a big pot of money we'll agree to come back with a cure for that one cancer.  If we succeed, not only will it restore our credibility (currently zero, or it ought to be) but it'll teach us what organization and approachs work and which don't so that when we move on to the next cancer we'll have a far better idea of how to do it.  I nominate multiple myeloma.

Avatar of: JtSimon

JtSimon

Posts: 5

April 20, 2016

Cancer is not one disease. A single cancer may prove to be "not one disease" rather a spectrum of problems. We began studying cancer in the basic research community as a means to understanding how the normal cell and normal tissues function, not necessarily to cure cancer. We jumped on the "cure it" bandwagon in order to drum up research money and hopefully defeat cancer in the future. Fortunately some real progress has been made - Jimmy Carter's apparent remission; Glevic [sic]; etc.. We still don't know a lot about how the cell, the genome, the epigenome, the proteome, the metabolome, etc. actually work in concert to create tissues and whole organisms. Knowing how something works is necessary for fixing it, or knowing if it can be fixed. So we need the research money but we should be honest with the public and not paint ourselves and future cancer scientists into a corner. Getting to the moon wasn't easy - it took decades, if not a century of rocket science. This is a long haul.

Avatar of: dmarciani

dmarciani

Posts: 51

April 20, 2016

Talking about curing cancer is like talking that we are going to prevent death. Cancer is a collection of different diseases where the common factor is uncontrolled growth, i.e. death is caused by many reasons and some of them are preventable. Hence, promising total conquest of cancer in some arbitrary timeline is naïve at best. Yet, with new discoveries and methods we are making significant progresses against that collection of diseases called cancer; but, we should be honest and recognize that the challenges of preventing/curing cancer or diseases like Alzheimer’s are significantly much more complicated than an engineering problem, because the target is always changing and frequently is developing strategies to avoid those drugs used against it.

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