Cancer Moonshot Aims to Expand Research, Early Detection, and Equity

The White House launched the Cancer Moonshot initiative in 2016 as a way to improve and expand scientific discovery in cancer research. The program aims to advance research and collaboration in the field of cancer diagnosis and treatment.

In 2022, President Joseph R. Biden relaunched the Cancer Moonshot program. The main goals, he noted, are to reduce the cancer death rate by at least 50% over the next 25 years, improve the experience of patients, and ultimately, eradicate the disease.¹

The Cancer Moonshot program is now part of the Biden administration’s health care agenda, which also includes prioritizing lowering health care costs and expanding patient coverage. Specific goals of the program are to diagnose cases earlier, address environmental exposures, and deal with inequities in access to treatment. Additionally, the program is working to better the fight against pediatric cancers and take the experiences of all patients with cancer and learn from them.

In an interview with Targeted Oncology^TM, Manmeet Ahluwalia, MD, MBA, FASCO, chief scientific officer, chief of medical oncology, deputy director, and Fernandez Family endowed chair in cancer research at the Baptist Health Miami Cancer Institute, discussed the Cancer Moonshot program, its progress, and its next steps.

Targeted Oncology: Can you provide some background on the Cancer Moonshot program?

The Cancer Moonshot program was initially funded through the 21st Century Cures Act passed in 2016 and has been 1 of the primary initiatives of President Biden, when he was the vice president, but more importantly, now during his presidency, and the latest iteration released in 2022, basically has a bold footprint. It is to decrease the cancer mortality rate in the United States by 50% over the next 25 years. How does the program envision doing that? It has got multiple pillars, which we can break down in terms of themes. One is focused on cancer prevention and cancer screening for earlier detection of cancers, reduce the disparities in research, but also more importantly, cancer care, and enhance our research being done not only at academic institutions, but also in the community, because that's where the bulk of the care is given in oncology, and also to improve the quality of life of a patient with cancer, but also, importantly, cancer survivors, because now we have patients who are living longer with cancer, and there are more patients who are getting killed, so how do we ensure that they have a great quality of life?

What progress has the program made so far?

The Cancer Moonshot program has been going on for the last 6 to 7 years and has made tremendous progress in the areas of immunotherapy. There is ongoing work that is making sure that we build on some of the strides. We have made initial successes in immunotherapy, and there is focus now on immunotherapy, but also translational aspects to it. Because we do know that 30 to 50% of patients with lung cancer, head and neck cancer, melanoma, and a number of other cancers get durable and great benefit from immunotherapy, but there's still a proportion of patients who do not. Now [the] emphasis is, how do we build on this?

Then there is also ongoing work to improve progress for difficult-to-treat cancers like pancreatic cancer. There is an effort in trying to understand the microenvironment of pancreatic cancer. Patients like to see the physicians who look like them. We do know that minorities are underrepresented in medical schools or in medical oncology. There is a big push to enhance or increase that component.

There is also a big focus on childhood cancers. A lot of them beat cancer, but then because they have a long lifespan. How can we ensure not only that we are ensuring cures for our patients, but also how we ensure care for our patients? Also, there are efforts to minimize the [adverse] effects of cancer treatments, so picking the right drug for the right patient with minimal [adverse] effects is some of the purviews of such a program.

How does this program affect community oncologists and what should community oncologists know about this program?

Seventy percent of the care for oncology patients is delivered in the community. In the last few years, a lot of efforts have been made to enhance the research in the community because not all patients can go to tertiary care centers or academic institutions to get care. One of the emphases which will happen for community oncologists is there'll be more opportunities for research in terms of delivering a high level of care for these patients. I think it is good for community oncology.

But more importantly, I think it is good for patients. We also do recognize that cancer screenings are going to be a big part of recognizing cancers early so that we can find them and cure them. I think a lot of care is given in the community. Hence, a lot of data that is generated in terms of real world evidence is going to come from community oncology. The FDA now is willing to look at real-world evidence in terms of even approval of drugs. I think community oncologists are going to play a critical role in not only the care of the patients that they have delivered for a long period of time, but also further enhancing the preventive measures, research, and also quality of life as they provide care to these patients going forward.

What is next for the program and what are you excited to see coming from this?

I am very excited to see this bold initiative under the auspices of Cancer Moonshot. I think it is the right thing to do. We are in the best era of advancement and innovation in the history of humankind, and so we need to build on cancer screenings. I would like to give you an example. In the multicancer detection research, which is a [National Cancer Institute (NCI)] project now looking [at] a blood test to screen cancers early but also to screen them with a high specificity and sensitivity. That means if someone has cancer, we identify it. But also, if we identify something, it's not a false positive, because otherwise that gives a lot of anxiety for our patients. There is a launch in 2024 of a vanguard effort from NCI which is going to look at 24,000 patients to look at early detection of cancer. If that program shows promise, there is an effort to increase it to over 200,000 patients.

I think this will forever move the needle in terms of finding cancers early and then hopefully curing them. I am excited about the initiatives in terms of equity, decreasing disparities. We do know that patients of minority origin do not participate in enough numbers on clinical trials that get drugs FDA approval. We do not know when a drug gets FDA approval what kind of a benefit will it have for a [Black] patient or a Hispanic patient. We are also excited about improving quality of life or quality of care that we are providing to our patients every day with cutting-edge research but also efforts to mitigate the [adverse] effects of therapies and then also ensuring that we have a good quality of life for our cancer survivors, because due to all the advancements we've made in last several decades, the great thing is that we have more patients surviving post-cancer, but we need to do a better job to enhance ensure that we have a good quality of life for those patients.

REFERENCE:

1. Fact sheet: President Biden reignites Cancer Moonshot to end cancer as we know it. The White House. February 2, 2022. Accessed March 25, 2024. https://tinyurl.com/7uhh8dm6