The hero scientist who defeats cancer will likely never exist.
No exalted individual, no victory celebration, no Marie Curie or Jonas Salk, who in 1955, after he created the first polio vaccine, was asked, So what’s next? Cancer? — as if a doctor finished with one disease could simply shift his attention to another, like a chef turning from the soup to the entrée.
Cancer doesn’t work that way. It’s not just one disease; it’s hundreds, potentially thousands. And not all cancers are caused by just one agent — a virus or bacterium that can be flushed and crushed. Cancer is an intricate and potentially lethal collaboration of genes gone awry, of growth inhibitors gone missing, of hormones and epigenomes changing and rogue cells breaking free. It works as one great armed force, attacking by the equivalent of air and land and sea and stealth, and we think we’re going to take it out with what? A lab-coated sniper?
“This disease is much more complex than we have been treating it,” says MIT’s Phillip Sharp. “And the complexity is stunning.”
So it will take not one hero but many. Sharp — a Nobel Prize-winning molecular biologist who studies the genetic causes of cancer — is recruiting special-forces units to fight back. For the past four years, he has been wrangling dream teams funded by Stand Up to Cancer (SU2C), an organization started by entertainment-industry figures unhappy with the progress being made against America’s most deadly disease. Cancer still kills in large numbers: an estimated 580,350 people will die of the disease in the U.S. this year, according to the National Cancer Institute. Another 1.7 million cases will be diagnosed, and those figures will grow as the population ages.
Cancer research — indeed, most medical research — is typically about the narrowly focused investigator beavering away, one small grant at a time. But advances in genetic profiling of malignancies and the mutations that cause them are telling scientists and physicians they must stop working in these kinds of silos, treating lung or breast or colon or prostate cancer as distinct diseases. “You no longer do science and medicine differently,” says Dr. Lynda Chin, director of the Institute for Applied Cancer Science at MD Anderson Cancer Center. “It brings science and medicine together.” Common genetic mutations, like one called p53 that controls cell death, are showing up across a whole swath of cancers. A mutation called BRCA1 is common in women’s cancers such as breast and ovarian, yet the research and clinical work in those two diseases has largely been separate.
So what does it take to transform the way an entire medical ecosystem functions? In this case, an unprecedented combination of celebrity, intensity and unignorable amounts of money. In 2008 a team including Spider-Man producer Laura Ziskin, who lost her battle with breast cancer in 2011; Katie Couric, who lost her husband to colon cancer in 1998; and former Paramount CEO Sherry Lansing founded SU2C with the goal of attacking cancer the way you make a movie: bring the best and most talented possible people together, fund them generously, oversee their progress rigorously and shoot for big payoffs — on a tight schedule.
SU2C raises money through foundations and corporate, organizational and private donors and then grants it to teams in the form of unusually large sums (up to $18 million, vs. about $500,000 for a typical grant from the National Institutes of Health, or NIH) to produce results in an aggressively short time, initially three years. All the chosen projects are monitored by the American Association for Cancer Research. An SU2C scientific committee, headed by Sharp and other heavy hitters, reviews each team semiannually, a checkup that can make top scientists feel like grad students.
“When you have to answer to Nobel laureates and others, it’s a very tough review team,” says Dr. Daniel Von Hoff, Chief Scientific Officer at the Virginia G. Piper Cancer Center at Scottsdale Healthcare and physician in chief at the Translational Genomics Research Institute, a dream team launched by SU2C that’s studying pancreatic cancer. “You want to be at your best.” Says Dr. Lewis Cantley, head of the cancer center at Weill Cornell Medical College and New York — Presbyterian Hospital in New York City: “Having people review you every six months is very different. The model is really unique.”
The team model is also disrupting the normal course of business across the medical-research community. For investigators, it means changes in the way careers are developed, the way data — and especially credit for achievement — are shared. For institutions, team research means changes in contracts, compensation, titles and the path of intellectual property. For pharmaceutical companies, it means restructuring the way experimental drugs are allocated and clinical trials are conducted.
And yet what started in Hollywood is now being embraced by the very heart of the research establishment. NIH, which has parceled out its $5.5 billion cancer-research budget to a single principal investigator for each grant it makes, is recognizing the paradigm shift necessitated by the torrent of data pouring forth from genomics. NIH boss Dr. Francis Collins, who led the team at the Human Genome Project, says that under his watch, the 27 institutes he oversees will be less independent fiefs pursuing their own goals and more trustworthy collaborators that can be teamed up to answer common and complex biomedical questions. “I am strongly anti-silo, strongly pro — breaking down barriers, bringing disciplines together, building collaborations and building dream teams,” he says.
And for patients, it’s happening where the chemo hits the cancer. Dr. Ronald DePinho, president of MD Anderson Cancer Center, is adopting a similarly collaborative approach around what the world-renowned institute calls its Moon Shots program, assembling six multidisciplinary groups to mount comprehensive attacks on eight cancers: lung, prostate, melanoma, breast, ovarian and three types of leukemia. For DePinho, this is a $3 billion throwdown. He’s backing his teams massively, with plans for $300 million annually over the next decade by reallocating existing research funds and soliciting new donations. As in the SU2C effort, teams will be judged by patient outcomes, not by the number of research papers published. “Aspiring is not enough. You must achieve,” he says. “It’s about integration across the entire cancer continuum, and it’s about execution. People will be judged by whether they have reduced mortality in cancer.”