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A decade's worth of cancer progress in five years

U.Va. Medical Center contributes to Cancer Moonshot Initiative

President Barack Obama and Vice President Joe Biden participate in a meeting with the White House Cancer Moonshot Task Force in the Vice President’s Ceremonial Office in the Eisenhower Executive Office Building of the White House, Feb. 1, 2016. (Official White House Photo by Pete Souza)
President Barack Obama and Vice President Joe Biden participate in a meeting with the White House Cancer Moonshot Task Force in the Vice President’s Ceremonial Office in the Eisenhower Executive Office Building of the White House, Feb. 1, 2016. (Official White House Photo by Pete Souza)

In 2016, former President Barack Obama chose his Vice President, Joe Biden, to head the Cancer Moonshot initiative — intended to achieve ten years’ worth of cancer research and treatment progress in only five years. Interactions between healthcare providers, the government, research institutions and the private sector bolster efforts to improve and expand treatment options, prevention strategies and information available to medical professionals.

“The idea was to get together and figure out what were some of the roadblocks to cancer research, and what could be done about it,” Dr. Christopher Moskaluk, Chair of Pathology at U.Va. Health, said.

The University provides both a source of lung samples, via Dr. Moskaluk’s lab, and information to help propel the Cancer Moonshot. These efforts aid in reaching various milestones set forth by the Cancer Moonshot Task Force, which was created under the Initiative. Several of these milestones include pursuing new partnerships centered around drug creation, accelerating review of patents related to cancer treatment and increasing accessibility of clinical research trials, medication and health information.

The Task Force created under the Initiative is charged with implementing the actions necessary to meet five strategic goals — “catalyze new scientific breakthroughs,” “unleash the power of data,” “accelerate bringing new therapies to patients,” “strengthen prevention and diagnosis” and “improve patient access and care.”

The National Cancer Institute’s Blue Ribbon Panel — including 28 individuals ranging from scientific experts to those involved with cancer advocacy groups — was appointed to advise the Task Force. The Panel divided themselves into seven working groups, which included Panel members as well as other people from the outside.

The seven working groups focus on clinical trials, enhanced data sharing, cancer immunology, implementation science, pediatric cancer, precision prevention and early detection and tumor evolution and progression.

Neal Kassell, professor emeritus of the Department of Neurosurgery, studies focused ultrasound applications at the University and contributes his expertise in biomedical research, patient care and clinical trials to the Panel.

Kassell said the working groups interacted via a series of teleconference and face-to-face meetings before presenting project recommendations in a final report. The planning period between April and August was a very intense period, he said, with a lot of debate as to which projects should make it onto the final list.

Now that Kassell and his working group made their recommendations to the Panel, though, their involvement has significantly diminished.

“They keep us informed as to what's happening, and I suspect as some of these things are implemented, they may call upon us for advice,” Kassell said. “Our work is done — the final report was the work product that came from the Blue Ribbon Panel.”

One of the 10 recommendations made in the Cancer Moonshot Blue Ribbon Panel Report was to “mine past patient data to predict future patient outcomes.” Moskaluk’s program, the Lung Cancer Biospecimen Research Network works to achieve this goal.

According to Moskaluk, to effectively investigate cancer, researchers must study malignant tissues from patients, which can prove difficult to obtain.

“What happens to the tumor after the patient gets them resected for their care is that people like me — a pathologist — will take just a little bit and look at it under a microscope to confirm that it’s cancer and do a few other tests,” Moskaluk said. “But a majority of it is just disposed of, incinerated — like we do with all resected surgical tissues. So there’s really a lot less cancer tissue available for research than you might think, for how common a disease it is.”

Moskaluk and his collaborators at universities across the country collect samples of patients’ tumors after surgery and blood, urine, saliva and various bodily fluids at various stages in treatment. These samples are then distributed to national labs which do molecular profiling of the tissue.

The Cancer Treatment Centers of America website describes the role of biomarkers in diagnosis and treatment of cancers.

According to the website, “Every cancer cell has its own pattern of active genes and proteins. Molecular profiling tests for a variety of biomarkers in the DNA of a tissue sample to help us better diagnose, stage and treat cancer on an individualized basis.”

Moskaluk and his team identified 50 patients cured of their cancer and 50 patients whose cancer recurred after their surgery. They said that molecular profiling should help elucidate the differences between the cancers.

“We’re hoping by doing this enormous profiling of DNA, RNA and protein that we’ll get some clues as to the molecular signatures that predict if the disease will act in a more aggressive fashion,” Moskaluk said. “And if we can find what those molecular signatures are — those are called biomarkers — we might even be able to create a new clinical test that tells us when a patient presents with cancer if their disease is going to progress more aggressively and then maybe we can design some kind of therapy tailored to that person’s tumor.”

Moskaluk said the program could lead to better diagnostics allowing doctors to identify cancer earlier and less invasively, perhaps using only blood tests.

As researchers and physicians better understand the molecular basis of the cancers, they will potentially be able to design molecularly-targeted therapies that are highly specific to a particular patient and his or her cancer.

Moskaluk said that some of the biggest challenges of the project include the technical issues of doing extensive tests on tissues of such small size and navigating regulations and data-sharing between institutions. Generally, the norm in science is to keep data private until publication in order to decrease the risk of another research group taking credit for discoveries.

There must be a broad understanding between organizations that data is going to be shared, he said.

“In fact, we’re doing something atypical, we’re not waiting for publication to release data, this data will be getting out into public databases even before any publication,” Moskaluk said. “That’s the whole point of the Cancer Moonshot program, to get as much data out there as quickly as possible so people can start using this.”

According to Kassell, collaboration is historically not a major feature of biomedical research, but everyone involved in the Moonshot understands that to move the field forward quickly, collaboration proves necessary.

Biden’s motivation catalyzed the interaction between these groups — focused on cancer or science — that would not naturally work together. However, both Kassell and Moskaluk do not anticipate the change in federal administration to lead to a breakdown in the momentum already achieved by the Blue Ribbon Panel.

“Fighting disease and cancer research really is bipartisan,” Moskaluk said. “Right before the Obama administration left, there was a 21st-century Cures Bill that basically just sailed through both the House of Representatives and the Senate. Even though it began in a Democratic administration, it sailed through Republican chambers of Congress.”

The funding for the Moonshot began in January, yet Moskaluk anticipates the data for his group to be analyzed and then released within the year. Ultimately, Moskaluk and his peers hope to recruit 8,000 lung cancer patients within a three-to-five year range.

According to Moskaluk, being able to do research and develop cures is largely dependent on partnerships between doctors and patients and the willingness of patients to participate in research studies.

“One thing that we’ve got running at U.Va. right now is a project called ORIEN, it’s Oncology Research Information Exchange Network, where we’re trying to basically recruit every cancer patient if possible at U.Va. to join in this,” Moskaluk said. “Again, we’re just asking for donations of blood and — if they’re coming to have a surgery — any extra tissue that’s going to be removed from them, and then for us to be able to follow them through their clinical course so that we have reagents available for study of the disease.”

According to Moskaluk, response so far to ORIEN has been great — 97 percent of patients approached since last December have consented, with approximately 1,000 patients recruited in the last year alone.

“We’re all — everyone — is in this together; I mean we’re all going to become a patient someday and everyone’s going to develop a disease,” Moskaluk said. “It’s only a partnership between patients and doctors and scientists that are really going to move this disease cure faster.”

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