Cancer ground-shot: going global before going to the moon (original) (raw)

Abstract

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The Cancer Moonshot initiative, aimed at advancing high-tech cancer research, has attracted global interest, yet it risks overlooking critical domains necessary for comprehensive cancer control. This commentary proposes a complementary approach termed the cancer groundshot initiative, which focuses on affordable, locally applicable innovations to enhance global cancer outcomes effectively. By advocating for a balanced agenda that integrates high-tech solutions with basic cancer care, this initiative aims to urgently address the needs of patients worldwide.

Key takeaways

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  1. The Cancer Moonshot initiative's focus on high-tech solutions may overlook crucial global cancer control needs.
  2. A proposed cancer groundshot initiative aims to improve global cancer outcomes through known effective treatments.
  3. Only 26% of patients with approved cancer therapies respond effectively, highlighting limitations in high-tech strategies.
  4. Cervical cancer prevention through HPV vaccination and screening is a critical focus for global cancer control efforts.
  5. Collaboration between high-income and low-income countries is essential for effective cancer research and treatment access.

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References (13)

  1. *Bishal Gyawali, Richard Sullivan, Christopher M Booth Anticancer Fund, Strombeek-Bever, 1853, Belgium (BG);
  2. Department of Medical Oncology, Civil Service Hospital, Kathmandu, Nepal (BG); Institute of Cancer Policy, King's College London, King's Health Partners Comprehensive Cancer Centre, London, UK (RS); Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada (CMB) bg.bishalgyawali@gmail.com We declare no competing interests. We would like to thank G Bouche at Anticancer Fund for his thoughtful comments on an earlier draft of this manuscript.
  3. Gay N, Prasad V. Few people actually benefit from 'breakthrough' cancer immunotherapy. Boston, MA: STAT News, Mar 8, 2017. https://www. statnews.com/2017/03/08/immunotherapy-cancer-breakthrough/ (accessed Nov 20, 2017).
  4. Gyawali B. Point: the imprecise pursuit of precision medicine: are biomarkers to blame? J Natl Compr Canc Netw 2017; 15: 859-62.
  5. Le Tourneau C, Delord J-P, Gonçalves A, et al. Molecularly targeted therapy based on tumour molecular profiling versus conventional therapy for advanced cancer (SHIVA): a multicentre, open-label, proof-of-concept, randomised, controlled phase 2 trial. Lancet Oncol 2015; 16: 1324-34.
  6. Nead KT, Gaskin G, Chester C, Swisher-McClure S, Leeper NJ, Shah NH. Association between androgen deprivation therapy and risk of dementia. JAMA Oncol 2017; 3: 49-55.
  7. 5 Khosrow-Khavar F, Rej S, Yin H, Aprikian A, Azoulay L. Androgen deprivation therapy and the risk of dementia in patients with prostate cancer. J Clin Oncol 2017; 35: 201-07.
  8. Booth CM, Karim S, Peng Y, Siemens DR, Brennan K, Mackillop WJ. Radical treatment of the primary tumor in metastatic bladder cancer: potentially dangerous findings from observational data. J Clin Oncol 2017; published online Dec 13. DOI:10.1200/JCO.2017.76.1759.
  9. Tewari KS, Sill MW, Long HJ 3rd, et al. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 2014; 370: 734-43.
  10. Bertolini F, Sukhatme VP, Bouche G. Drug repurposing in oncology-patient and health systems opportunities. Nat Rev Clin Oncol 2015; 12: 732-42.
  11. Pantziarka P, Sukhatme V, Meheus L, Sukhatme VP, Bouche G. Repurposing non-cancer drugs in oncology-how many drugs are out there? bioRxiv 2017; publsihed online Oct 6. DOI:10.1101/197434.
  12. Woolf SH, Johnson RE. The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. Ann Fam Med 2005; 3: 545-52.
  13. Sullivan R, Pramesh CS, Booth CM. Cancer patients need better care, not just more technology. Nature 2017; 549: 325-28.

FAQs

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What limitations exist in high-tech cancer research strategies today?add

The paper reveals that high-tech approaches like immunotherapy yield overall responses in only 26% of treated patients, dropping to 8% when considering all cancer patients in the USA.

How do global cancer outcomes necessitate a cancer groundshot initiative?add

Focusing on practical, affordable cancer interventions could save many lives, especially in low-income regions where over 85% of the cervical cancer burden lies.

What evidence questions the effectiveness of precision oncology?add

The only randomized clinical trial of precision oncology yielded negative results, highlighting significant concerns regarding the validity of biomarkers in guiding treatment decisions.

What financial investments are associated with the Cancer Moonshot initiative?add

The Cancer Moonshot is funded by the 21st Century Cures Act with an investment of $1.8 billion over seven years, with potential for more through public-private partnerships.

What collaborative strategies could enhance global cancer control efforts?add

Co-development strategies and drug repurposing could leverage knowledge and infrastructure across countries, ensuring affordable therapies for cancer care in diverse economic settings.