To scientists’ relief, the “reignited” Cancer Moonshot to be formally announced today by President Joe Biden will not offer an unrealistic deadline for wiping out cancer. It instead sets a long-term goal of gradually reducing cancer deaths. The plan would focus research in several areas, including preventive vaccines and blood tests that screen for multiple cancers.
But research advocates noted that even though funding for Biden’s original Cancer Moonshot at the National Cancer Institute (NCI) is running out, a fact sheet released this morning before the announcement did not call for new spending. “There needs to be robust funding to enable the research that is going to propel us to achieve these new goals,” says Jon Retzlaff, chief policy officer for the American Association for Cancer Research, which has been part of discussions about today’s proposal.
In 2016, then–Vice President Biden launched the original Cancer Moonshot after his son Beau died from brain cancer, winning congressional backing to spend $1.8 billion over 7 years. The project has focused largely on immunotherapies, pediatric cancer treatments, and data sharing and aimed to make a decade of progress in 5 years. The new moonshot, in contrast, aims to cut cancer deaths by at least 50% over the next 25 years, and to improve the experience of those being treated for and surviving cancer, according to the fact sheet. This will “end cancer as we know it today,” the White House says.
Still, compared with some past goals, such as an earlier NCI director’s vow to eliminate cancer deaths by 2015 and Biden’s own 2019 campaign pledge to “cure cancer,” the new goal “is more realistic and more responsible,” says cancer immunologist Elizabeth Jaffee of Johns Hopkins University, an adviser for the first moonshot. Cancer deaths are already dropping more than 1% per year, largely because of fewer smoking-related lung cancers.
The new effort would speed progress in part by encouraging people to get cancer screenings, including visits missed during COVID-19 pandemic, and increasing access to therapies. The screening piece “can be executed pretty quickly” by reaching out to underserved communities and increasing access at NCI-funded cancer centers, says Ellen Sigal, founder and chair of Friends of Cancer Research.
The fact sheet also discusses applying lessons from COVID-19 clinical trials to speed testing of treatments for childhood and rare cancers. And it says NCI will work with other agencies to “develop a focused program to expeditiously study and evaluate multicancer detection tests, like we did for COVID-19 diagnostics.”
Those tests, which analyze mutations in DNA shed by tumor cells into the blood, or chemical markings on such DNA, are under development by companies such as Grail and Thrive. NCI has already announced plans for a randomized trial to test various multicancer early detection tests in a diverse population. The big question is whether such tests, which miss about half of early cancers and generate many false positives, will reduce cancer deaths without causing too many other harms such as unneeded procedures.
Another focus of the new moonshot is preventive cancer vaccines, like the human papillomavirus vaccine now offered to preteens that prevents cervical cancer. “Scientists are asking if mRNA [messenger RNA] technology, used in the safe and effective COVID-19 vaccines to teach your body to fight off the virus, could be used to stop cancer cells when they first appear,” the fact sheet says.
mRNA vaccines customized to create an immune response to a person’s existing cancer are already being tested, and Jaffee says the approach could also be used for preventive vaccines that target certain proteins produced by tumors. The pandemic has shown mRNA vaccines are “safe and pretty immunogenic,” she says.
The last installment of the current moonshot funding will be distributed in 2023, and funding for the new one could be proposed in Biden’s 2023 budget request for the National Institutes of Health, expected out in a few weeks, and as part of his proposed Advanced Research Projects Agency for Health (ARPA-H). The House of Representatives and Senate spending committees have approved $2.4 billion to $3 billion to launch ARPA-H, but Congress needs to pass separate legislation to create it. One draft bill will be discussed at a House hearing next week.
Although the details of the new moonshot are vague, “I think the granularity of what this means will evolve in the next few weeks,” Sigal says.