The war on cancer—a status report
Editor’s Note: This story, first published in 2004, has been updated.
In 2004, FORTUNE magazine created a stir in the research community with a cover story entitled “Why we’re losing the war on cancer (and how to win it).”
The story’s author, Clifton Leaf, one of magazine’s executive editors and a cancer survivor, described "a dysfunctional 'cancer culture' ... that pushes ... physicians and scientists toward the goal of tiniest improvements in treatment rather than genuine breakthroughs."
Scientists interviewed for this issue of Lens disputed the “dysfunctional” label, but they said they could make faster progress if there were greater incentives for collaboration among researchers, clinicians and drug companies.
“Patients are going to benefit the most from combinational approaches,” yet current patent and regulatory constraints make it difficult to test new drugs in combination, notes Lisa Coussens, Ph.D., a cancer researcher at the University of California, San Francisco. “You have to test them as single agents and if they don’t demonstrate efficacy, they’re not going to go any further.”
Junior faculty also are discouraged from collaborating with each other because they have to demonstrate independence in order to be promoted and win research grants, Coussens says. Yet that’s exactly what’s needed to make progress, maintains Ernest Hawk, M.D., MPH, vice president for cancer prevention and population sciences at the University of Texas M.D. Anderson Cancer Center in Houston.
“I’m not talking revolution here, but it’s something the whole culture needs to take a look at,” says Hawk, who formerly lead gastrointestinal research in the National Cancer Institute’s Division of Cancer Prevention. “Getting researchers working together rather than quite so independently will reduce redundancy and perhaps maximize the effort we’re putting forward.”
Toward that end, the NCI is serving as a “catalyst”—bringing scientists from diverse fields together to develop new research strategies, and pursuing partnerships with pharmaceutical companies to hasten drug discovery and development.
The discovery that Celebrex can inhibit pre-cancerous polyps in high-risk patients emerged from just that kind of partnership. “That was just a six month trial, very fast, very small, very efficient,” says Hawk, who participated in the research, “and yet it had a profound impact … both for immediate clinical care of a high-risk group and then more broadly for the potential of many others.”
Tests of other potential drugs have been disappointing, in part because of the way they are tested both in animals and humans. “When we give a mouse cancer, we start treating immediately,” says Lynn Matrisian, Ph.D., chair of Cancer Biology at Vanderbilt, whereas experimental drugs traditionally are tested first in patients with advanced disease.
What’s needed is the development of smaller clinical trials looking at earlier stages of disease, says Harold L. Moses, M.D., former director of the Vanderbilt-Ingram Cancer Center. The studies should measure biological markers or “correlates” of drug activity, and be flexible enough to change course quickly if it becomes apparent that the drug is most effective in a subgroup of research subjects.
“The idea is to do it better, more quickly and with less expense,” he says.