
A Cancer ‘Moonshot’ Needs Big Data - aficionado
http://www.wsj.com/articles/a-cancer-moonshot-needs-big-data-1452813330
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sjg007
More importantly, we need FDA regulatory reform. There is absolutely no reason
that approved anti-cancer drugs in one cancer type and stage should be limited
to just those cases. You should be able to spin up a direct Phase II study
without going through Phase I. And more importantly you should be able to get
these drugs when all other options are exhausted.

People need to read the book "The Death of Cancer" by the former NCI chief
Vincent DeVita. I agree that we need a cancer czar and that the NCI needs to
run the show including drug approvals. In addition, academia needs to get with
the program.

~~~
chrisamiller
I'm sorry that you think academia isn't "with the program". There's lots of
great basic and translational research going on in the academic sphere. Can
you at least elaborate, if you're going to paint us all with a broad brush?

~~~
sjg007
Academic cancer centers need to focus on improving clinical outcomes, not just
basic research. That cancer centers are associated with primary research
institutions universities is largely a compromise between with the NIH and the
NCI when the national cancer act was implemented. Tenure is based on basic
research publications and on not clinical trials. So therapies are not
optimized.

~~~
88e282102ae2e5b
How are we supposed to cure diseases we don't fully understand? How can
radical new solutions be tested if we don't even know if they're feasible?
Basic research answers these questions.

~~~
sjg007
If you would have waited until you fully understood a disease in order to
treat it then kids would still be dying of leukemia today instead of having a
90% remission rate today. People should read about Emil Freireich and the
development of chemotherapy.

~~~
nonbel
>"kids would still be dying of leukemia today instead of having a 90%
remission rate today"

Do you know a good source for the historical data? I am wondering how they
rule out that in the 1950s/60s they saw only much sicker patients, while today
a bigger population gets diagnosed and treated. Related, there may be lead
time bias:
[https://en.wikipedia.org/wiki/Lead_time_bias](https://en.wikipedia.org/wiki/Lead_time_bias)

Any source with discussion of these methodological issues would be helpful.

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fallous
"Cancer" isn't a single disease or problem domain, but what could be
categorized as a syndrome that shares some basic commonalities.

The governmental "War on Cancer" began under Nixon and was pitched as a
"moonshot" type of program, which promptly ran aground on the realities of
cancers.

If only there were some sort of documentation for this kind of effort...
perhaps they could call it "The Emperor of All Maladies" or something.

~~~
nonbel
>'"Cancer" isn't a single disease or problem domain, but what could be
categorized as a syndrome that shares some basic commonalities.'

Cancer is characterized by having cells with an abnormal number of chromosomes
and genetic instability. It is one disease. I don't know the origins of it,
but this "many disease" claim sounds like an excuse for lack of progress in
targeting aneuploid cells.

"In contrast to normal cells, aneuploidy--alterations in the number of
chromosomes--is consistently observed in virtually all cancers."
[https://www.ncbi.nlm.nih.gov/pubmed/15549096](https://www.ncbi.nlm.nih.gov/pubmed/15549096)

~~~
fallous
Of course cancer is a result of genetics gone amok, but that's about as useful
as saying that death is caused by hypoxia... of course it is, all death is the
result of lack of oxygen to the brain.

Cancer as a disease, in its expression, effects, and treatment, is not a
monolith and has been utterly resistant to attempts to treat it as such.

~~~
nonbel
If you could count the chromosomes in every cell of a patient's body and
specifically kill cells with/without certain numbers, you could cure the
cancer. For practical purposes it is one disease with a single identifying
characteristic and molecular target. Only technical limitations are preventing
a cure.

No disease manifests exactly the same way in every person, so I don't get the
point of calling cancer multiple diseases.

~~~
jack9
> you could cure the cancer

Or you could vaccinate against a virus and prevent the cancer. Not all cancers
need to be attacked the same way.

~~~
nonbel
>"Not all cancers need to be attacked the same way."

Ok, but what does that have to do with the (apparently new) idea of calling
cancer "multiple diseases"?

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chrisamiller
I don't agree with much that Tom Coburn says, but he's right that 'data silos'
are a big problem in cancer research. To elaborate on a few points:

\- While enrolling 500 people with breast cancer in a study might be easy
enough at one academic hospital, there are lots of rare cancer types. It's
fiendishly hard to gather enough cases to do real research on these, and
samples are like gold, so people are resistant to sharing.

\- There's lots of duplication of effort. While studies funded by the NIH are
required to deposit their data, what's being deposited is raw sequence data,
which requires lots of computation, disk, and skill to turn back into useful
information about the mutations in cancer.

\- The clinical data (phenotype) that is released with studies is often
incomplete or vague enough to be useless

\- Getting data into and out of these access-controlled repositories is, to
put it mildly, a pain in the ass.

We do need to protect people's privacy, but removing some of these hurdles
would go a long way towards accelerating the field.

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aaronmck
Well, better / more uniform access to patient records would be nice, but more
money into basic research is probably the best bet (as it has always been). It
makes me think of this Gregory Petsko commentary (open access):

[http://www.genomebiology.com/2001/3/1/comment/1001](http://www.genomebiology.com/2001/3/1/comment/1001)

With the great quote:

"...If a hundred years of cancer research has taught us anything, it is that
if you must get cancer, you want to be a mouse, because we can cure cancer in
mice."

~~~
danieltillett
>”...because we can cure cancer in mice.”

Actually as far as I know we can’t cure mice of cancer - by cancer I mean
natural cancers that mice get as they age just like human cancers. I have
looked through the literature in great detail and I can’t find a single recent
paper where anyone has even tried curing mice of cancer. If anyone know of one
I would love to read it.

The way we go about trying to cure cancer is insane. We basically take inbred
mice, inject them with a cancer cell line to give them cancer, and then treat
them with experimental drug X. This process is nothing like how real human
cancers arise. On top of this we only test new drugs in people that have
failed all other treatments and have very high tumour burdens. We then demand
that the new drug have a significant effect in these patients despite us
needing drugs that work in newly diagnosed patients. If we get a drug that
works it is more by chance than design.

~~~
nonbel
>"I have looked through the literature in great detail and I can’t find a
single recent paper where anyone has even tried curing mice of cancer."

It's interesting how your perspective will change after reading the
literature. It is the same thing with the various mutations claimed to cause
cancer. For example, in this thread someone claims mutations to BRAF cause
cancer. I am nearly certain that inspecting the literature will not result in
any studies where that gene in a normal cell was mutated, and then it took on
the properties of a cancer cell.

Maybe we will see some data on many cell generations later and in conjunction
with various other treatments, but not the direct experiment of "non-cancer
cell + BRAF mutation = cancer cell" while "non-cancer ell + control treatment
= non-cancer cell".

~~~
danieltillett
Cancer in humans is never driven by one mutation - if it were there is no way
we could reach adulthood. Cancer is the slow process of accumulating mutations
in cell lineages - the time between the first mutation in say BRAF and a
metastatic cancer is 20 to 40 years. Lots of other mutations have to happen
before you get clinical cancer.

~~~
nonbel
>"the time between the first mutation in say BRAF and a metastatic cancer is
20 to 40 years"

Actually do you have a ref for this? I can't easily think of how they would
date the mutation.

~~~
danieltillett
I haven’t got one off the top of my head, but it is pretty well known. An
really good example was the atomic bombs in Japan. They tracked all the
survivors and when they got cancer and the delay was in decades.

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downunder
I think we should be talking about 'uranushots' rather than moonshot because
1. the moon is close and now relatively ho-hum while uranus is in another
category altogether; 2. For these things to happen a little good luck is
required.

