Just a little over a year ago,
Vice President Joe Biden visited the Abramson Cancer Center at the University of Pennsylvania to kick off the national “Cancer Moonshot,” an ambitious effort to accelerate progress in the fight against cancer.
“My commitment is not for the next 12 months,” Biden said at the time, referencing the fact that he was in his last year of his term as Vice President. True to his word, as a private citizen Biden remains actively engaged in the fight against cancer. In addition, he is now the Benjamin Franklin Presidential Practice Professor at Penn, where he will lead the Penn Biden Center for Diplomacy and Global Engagement, a University center focused on diplomacy, foreign policy, and national security. On Penn’s campus again on Feb. 28, he was one of several distinguished panelists who spoke at the David and Lyn Silfen University Forum. Penn President Amy Gutmann moderated the discussion entitled “A Formidable Foe: Cancer in the 21st Century.”
During the conversation, Biden repeatedly emphasized that it is important for experts to make the impact of their work understandable to ordinary people and policymakers. “There’s ultimately a need, whether it’s foreign policy or cancer policy, to be able to translate to the American people exactly what you’re doing without talking down to them,” he said. He asserted that, when you explain how something will impact people’s lives, they will support it.
“And that’s why these docs are so darn good,” he added, addressing his fellow panelists, who included Carl June, MD, the Richard W. Vague Professor in Immunotherapy in Pathology and Laboratory Medicine and director of the Center for Cellular Immunotherapies at Penn; Kim Vernick, a Penn Medicine patient and pancreatic cancer survivor; Otis W. Brawley, MD, chief medical officer of the American Cancer Society; and Nancy Davidson, MD, director of clinical research at the Fred Hutchinson Cancer Research Center and president of the American Association for Cancer Research.
“You go out there and you explain in plain, simple English, what’s at stake,” Biden said of this group. “And people will back it up and you’ll embolden the people who know better to stand up, because we can change the face of cancer in the next five years.”
Here are just a few of those highlights of “plain, simple English” ways that the panelists at the Silfen Forum explained the Cancer Moonshot and the status of progress against cancer.
A War Without an Army
After Biden’s son Beau was diagnosed with the brain cancer which ultimately ended his life, the Vice President tried to learn all he could about the state of cancer research—and he said he found that the picture today is vastly more hopeful than it was a few decades ago. “In 1971, when President Nixon declared the ‘War on Cancer,’ he was fully well-intended—he meant it seriously—but he had no army,” Biden said.
In the early 1970s, cancer was perceived to be a single entity. With that mindset, Biden explained, there was a race to be the first individual or solitary genius to find that one “silver bullet” cure. The motivation and the infrastructure for researchers to share and aggregate data didn’t exist.
Now, cancer is known to come in hundreds of different types with different molecular causes, and different researchers have overlapping bits of knowledge about this multifarious foe. But progress in building the infrastructure to share data has been limited, and most of it only in the last few years—not decades.
“What I learned is that, if we didn’t make another single breakthrough, if we just were able to aggregate the data we had, share it in real time, we’d be able to extend life for an awful lot of people,” Biden said. “That’s why, when the Moonshot came up, we began to focus on how to aggregate this data.”
The Moonshot brought a sense of urgency and contributed to the changing culture of cancer research from individual soldiers trying to fight the enemy on their own, to a coordinated army. a shared effort.
As Simple as Selecting Music in a Jukebox
A number of the barriers to progress identified through the Moonshot effort were more logistical and administrative than scientific. To find solutions to those challenges, Biden said, “you don’t have to know much about cancer, but you have to know about how to aggregate.”
One of those new solutions of aggregation is the National Cancer Institute Formulary. The formulary will streamline the process for researchers who want to test potential cancer drugs in combination instead of each drug singly—the same category of therapeutic approach that ultimately led to controlling HIV infection. But negotiating a licensing arrangement with different drug companies to test different drugs can take a long time.
“If you go into a bar or a restaurant and you want to play a jukebox, you drop a buck in,” Biden said, by way of explaining how the new formulary works. “You don’t have to have a licensing agreement with Beyoncé to listen to her song. That’s already worked out.” He added that, when companies joined the new formulary, the intellectual property and licensing arrangements were negotiated in advance so that when a drug, or combination of drugs, is shown to be safe and effective against cancer, companies know already how they will profit from the discovery. The number of drug companies that have signed on has grown from an initial six to 17, Biden said.
If Not a Cure, a Smoldering Fire
For many involved in fighting cancer, “cure” can become a four-letter word. Referencing the short film Fire With Fire, which opens with June discussing why he hesitates to say he is trying to cure cancer, Gutmann asked, “Should we be using the word ‘cure’ as our goal?”
“We’re at a time now where an optimist can see a time to the end of cancer, and I think that should be a goal,” June said. “But I think that early detection and prevention need to be at the foundation of this,” he added, advocating for the importance of finding early-stage cancers and ultimately developing vaccines to impede cancer growth.
Brawley noted that a lot of cancers already are curable, but for others, the future will bring models of treatment similar to diabetes and HIV. “People live a very long time taking a drug or two every day, and the cancer is like a smoldering fire and the person lives in peaceful coexistence, may even live to a normal lifespan,” he said. “Their cancer may not be cured, but their cancer will be held in abeyance.”
Extinguishing the fire remained a more desirable option than keeping it at a smolder for the panelist who was herself a pancreatic cancer survivor. “How about if you go for the cure, and if some of them end up in remission, that’s okay, you’ll settle for that?” Vernick suggested.
From ENIAC to the iPhone and Manufacturing CAR-T Cells Like Actual Cars
The question of scale and access to newer cancer treatments was a recurring theme in the conversation. June offered two analogies to explain how he hoped that the advances his team has made with ultra personalized chimeric antigen receptor therapies (CAR T cell therapies) may move forward to become more broadly accessible in the future. In CAR T cell therapies, a patient’s T cells are collected and then reprogrammed in a laboratory to hunt and kill cancer cells in the patient’s body.
“In part, the solution is going to be similar to automobiles,” June said. “We talk about CAR T cells. The cars that we make in Michigan, in Detroit, and elsewhere now, they were initially made one by one by mechanics.” Today, though, human hands almost never touch an automobile in production, he said; the work is done by robots. “We need these cell therapies to be made robotically and to be scaled.”
He used a second analogy familiar to many in the Penn audience: ENIAC, the first general-purpose electric computer, built at the University in 1946. It occupied an entire room. And, as June picked up his smartphone, he said, he now carries an exponentially more powerful computer in his pocket. Translating the type of improvements that took half a century or more for computers into cell therapies and other personalized therapies for cancer is what is needed now, he said. “What I don’t know is that timescale. That’s where I think the moonshot can make a massive difference.”
To go beyond these highlights and view the entire Silfen Forum conversation about cancer, watch the webcast online here.