How to win the war against cancer

The power of massive, integrated programs must be brought to bear

Nov 5, 2008
Frank L. Douglas and Robert E. Litan
Editor's note: After a decades-long war against cancer, experts are calling for new ways to approach the disease. The following is an opinion article running in our December issue, which we are running early to stimulate discussion online.After tens of billions of US federal dollars (plus billions more from private sources) and nearly 40 years of aggressive research, the war on cancer is depressingly far from over. Cancer will soon become the leading cause of death in America, passing heart disease. At some point in their lives, 43% of the public will get some form of cancer. Progress has been made, however. Age-adjusted rates for those who develop cancer are down, and survival rates have increased. Knowledge of the molecular and genetic mechanisms has increased significantly. Strategies for targeting therapies selectively to tumors are becoming increasingly available. We also know more about how diet and other lifestyle choices, as well as family history, affect the chances that individuals will have cancer.But we have so much more to learn. For moral, emotional and economic reasons, fighting the war on cancer remains a top priority. But we've got to change our strategy.The federal cancer research strategy resembles the way in which major new weapons systems are built, with pieces farmed out to as many congressional districts as are needed to assemble the requisite support for them in Congress. Although cancer research funding is peer reviewed, it still is spread across numerous universities throughout the nation. Whether or not politics explicitly infects the grant-making process, the result is a highly fragmented research effort. We now know from many areas of science -- including cancer research -- that collaborative research by investigators with different but complementary areas of expertise are more likely to crack difficult problems than "lone rangers" who work in isolation. With more cooperation and less competition in cancer research, the war against cancer is much more likely to be won.This fundamental insight has been recognized by one leading cancer research advocacy group, Stand Up To Cancer (SU2C) which funds research that seeks to translate basic science results into therapies. SU2C hands out money for cancer research on the condition that grant recipients demonstrate collaboration. This cooperative approach is also the premise of MIT's new $100 million David H. Koch Institute for Integrative Cancer Research that is bringing together biologists, chemists, and nanotech engineers. It is now time for the federal government to apply a similar approach. We propose that the National Cancer Institute reorganize its research program to solicit competitive grant proposals from consortia of research centers. Funding would become much more highly concentrated than it is now. For example, about 75% of the $4.8 billion NCI budget for 2008 will be spent on 60 Comprehensive Cancer Centers, 50 Specialized Programs of Research Excellence (SPOREs) and numerous other research grants and programs. NCI could realign these into three or four comprehensive regional cancer efforts that take a comprehensive approach to converting knowledge about cancer into diagnostics and therapies, one that involves researchers from multiple disciplines inside and outside traditional medicine, and both academia and industry. We suggest the following criteria for making the awards: • The breadth of expertise represented by the consortia• Emphasis on translating basic scientific knowledge into potential diagnostics, therapies, or prevention strategies• Academic-industry collaborations• Preference for programs that integrate at least three of the following disciplines: Molecular biology, Chemistry, Engineering, Systems Biology, Clinical Pharmacology, Genomics and Information Technology• Matching funds from private or from other public sources (state and/or municipal/county governments)• Mechanisms for commercialization of productsOnly by concentrating cancer research efforts will it be possible to avoid delays in discovery and translation. Scaling also should facilitate standardization of methods, implementation of electronic and personal health care records and counseling of families, based on genetic information. Let's get on with this new strategy. Too many lives hang in the balance. Frank Douglas is a Partner at Puretech Ventures and a Senior Fellow at the Kauffman Foundation. Robert E. Litan is Vice President for Research and Policy at Kauffman and a Senior Fellow at the Brookings