At the Biden Cancer Summit in Washington, D.C., an eclectic group of speakers and participants reaffirmed their commitment to speeding progress against cancer.
In addition to the Washington anchor event, 450 community cancer summits were held simultaneously around the country-bringing together thousands of participants. U.S. and global communities were able to share their cancer experiences in real-time through Shared Studios portals. For example, through the technology, people in Gaza City discussed care, comfort, and resilience, while in Mexico City, patients, medical students, and residents discussed the breadth of the cancer journey. The summit ended with a town hall meeting with Joe Biden.
The cancer summit was hosted by the Biden Cancer Initiative (BCI), a nonprofit organization founded by the BCI co-chairs, former Vice President Joe Biden and his wife, educator Jill Biden, after he left office. The BCI is a response to former President Obama's January 2016 Cancer Moonshot launch; as reported in Oncology Times, the goal of the Cancer Moonshot is to achieve in 5 years progress against cancer that otherwise would take 10 years. A Cancer Moonshot Blue Ribbon Panel convened by the NCI recommended 10 new research directions to reach that goal. In December 2016, the U.S. Congress approved $1.8 billion over a 7-year period to implement the panel's recommendations.
For Joe Biden, cancer is personal; his son Beau Biden, former attorney general of Delaware, died of glioblastoma in May 2015.
"The Cancer Moonshot went from a goal to a national and international movement," Joe Biden said at the Washington summit. "Now everywhere I go...the first thing almost everyone wants to talk about is cancer." He said the goal of the summit was to showcase progress from BCI partners, find out the most urgent issues that affect communities, and bring to bear resources and solutions that matter.
"Our call for collaboration has been met by an overwhelming response," said Biden. He noted the nation needs a sense of urgency about making progress against cancer. "Together we can make hope real. Change is coming; I see it every day," said the former vice president.
The cancer summit was intended to be "a different kind of cancer meeting," said cancer survivor Gregory Simon, President of the BCI. Throughout the day, researchers, community activists, football players and coaches, business entrepreneurs, survivors, and chief medical officers shared their stories of purpose, resilience, and commitment. Large screens showcased videos of real patients' cancer journeys.
"It's really about respect for the patient," said Simon of the need for patient-centered care that gives patients control over their own data. He emphasized the importance of clinical trials, stating, "The rate of adults in clinical trials has to go up... . We can do better than we're doing. We have to find models that are working to bring hope and real solutions to people."
Simon has stressed that the challenge now is to fulfill the promise of the Cancer Moonshot as it was envisioned, specifically the recommendations of the Blue Ribbon Panel, and not fall into inertia and embrace the status quo.
Implementing Change
Speakers and panelists emphasized the sea changes that are allowing the acceleration of progress against cancer. "When I began my career, basically we were looking for a needle in a haystack in terms of a drug," said panelist Richard Pazdur, MD, Director of the FDA Oncology Center of Excellence. Now, "we have a much more sophisticated approach" where drugs can be selected for specific patients.
Pazdur said the cancer journey of his wife Mary, an oncology nurse who died of ovarian cancer in November 2015, brought home for him the fact that side effects from treatments are underreported, and sensitized him to the importance of incorporating the patient's experience into drug development and cancer care.
"We have learned over past decades that cancer is not one disease but a spectrum of conditions ranging from very low risk to very aggressive," said panelist Laura Esserman, MD, MBA, Director of the Carol Franc Buck Breast Care Center at the University of California at San Francisco. "Our biggest failure is not to design our trials with that in mind. When you invest in earlier stages of disease, you can really cure people."
Esserman, a surgeon who is founder and co-principal investigator of the innovative, adaptive breast cancer trial I-SPY 2, told Oncology Times, "It's taken a long time, but we're getting there." She said that I-SPY 2 was a direct result of having spent a lot of her career trying to improve the outcomes of women with early-stage and potentially curable aggressive breast cancer.
Shortly before the Biden summit, Esserman announced that I-SPY 2, which was launched in 2010, has achieved marked progress in improving the outcomes of these early-stage breast cancer patients who are at high risk for early recurrence. The trial features an adaptive statistical trial design where every patient's data contributes to a learning system; the overall goal of the trial is to personalize treatment for each patient, using biomarkers, molecular analysis, and imaging to determine each subtype of breast cancer.
Investigational drugs based on those subtypes are given prior to surgery. The design of the trial allows evaluation of up to five investigational therapies in parallel. The trial has enrolled more than 1,300 patients at 16 U.S. sites and, by the end of 2018, some 17 drugs will have entered the trial and 12 will have completed evaluation. To date seven investigational drugs have graduated from I-SPY 2, with two receiving accelerated approval and one gaining breakthrough designation from the FDA.
Focused on Progress
The Biden summit featured focus groups addressing a range of topics: clinical trials, cancer prevention, health disparities, patient navigation, survivorship, value and access in cancer treatments, translating innovative ideas into improved health, and tackling the toughest cancers. The Biden Cancer Initiative had requested ideas for specific next steps from these focus groups to accelerate progress against cancer.
During the focus group on clinical trials, Mark Fleury, PhD, a principal for Policy Development and Emerging Science at the American Cancer Society Cancer Action Network, noted: "Clinical research is a different and distinct entity from normal clinical practice; only large centers can have clinical trial specialists."
He said that what large cancer centers do well is have a full portfolio of numerous trials, screen everyone, and offer trials to those who qualify. But, he noted, for smaller centers and oncology practices, the incentives do not favor putting patients on trials because the pressure is focused on seeing as many patients as possible.
"Small centers don't have a systematic way to screen people," Fleury stated. "They might have one or two trials available." Participants in this focus group noted that medical providers in these smaller settings lose money because of their incentives to see as many patients as they can, the lack of institutional infrastructure for trials, and the extra time it takes to enroll a patient on a clinical trial.
Going through the informed consent process with a patient as part of the trial's enrollment process is particularly time-consuming, stressed Patricia LoRusso, DO, PhD, Associate Director of Experimental Therapeutics and Director of the Early Cancer Therapeutics Program at Yale Cancer Center, New Haven, Conn.
Participants in the clinical trials focus group made these specific suggestions to enhance advances against cancer:
* Work to provide much more awareness and education of the public on how clinical trials work; some patients do not understand what randomization means, for example, and they may have unrealistic expectations about the goals of clinical trials.
* Ensure that cancer patients are asked whether they want to participate in a trial; some 50-70 percent of patients will agree to participate in a trial if they qualify, said participants, but the challenge is that far too few are asked.
* Reduce redundancy in clinical trials to better use available resources and potential participants.
* Reframe the national trials registry, clinicaltrials.gov, to make it more user friendly.
* Standardize clinical trials contracting to simplify and streamline the process.
* Employ innovative and adaptive trial designs when appropriate.
Accelerated progress against cancer, as envisioned by the Biden Cancer Initiative, is achievable, if 18-year-old Kavya Kopparapu is an example of the scientific talent in the next generation of researchers. While she was a high school student at Thomas Jefferson High School for Science and Technology in northern Virginia's Fairfax County, she developed a precision medicine platform to identify a biomarker for glioblastoma using artificial intelligence.
Now a freshman at Harvard University, Kopparapu noted, "I want to turn the research I'm doing into a company." Stating that she wants to integrate cutting-edge technology into medical care, she added, "I love being a learner. I call myself a forever learner."
A Commitment to Stopping Cancer
The Biden Cancer Initiative announced more than 50 new commitments to help double the rate of progress against cancer. Some of those included the following ideas.
* A new pediatric project from the non-profit Life Raft Group to strengthen research on effective treatments for a rare subset of gastrointestinal stromal tumor (GIST) patients unresponsive to standard treatments. Named the Pediatric and SDH-Deficient GIST Consortium, the new effort has set a goal of identifying at least one effective treatment within 3 years, as shown by the initiation of clinical trials for the SDH-deficient population.
* Airbnb's expansion of its Open Homes platform to enable patients traveling for medical treatment or respite in the U.S. or globally to stay for free in homes where hosts open their doors to them.
* A partnership between Family Reach and Abbvie that allows the expansion of financial services to 25 hospitals in 25 U.S. states, enhancing financial support for an estimated 4,400 additional families.
* WeWork's new hubs for collaboration, providing space, platform, and people for researchers, patients, caregivers, and survivors to share information and ideas and collaborate to fight cancer together.
* The National Minority Quality Forum's Cancer Index Atlas, a portal providing 2016 patient-level data for breast, colorectal, prostate, lung, endometrial, and blood cancers to focus on concerns about cancer health equity.
* The Health Record Request Wizard project by X4 Health, a new tool that allows patients to leverage their HIPAA "right of access" to their own electronic medical records.
* A new project of Lyft to provide free transportation to cancer patients so they can get to their medical appointments.