Deciphering The Cancer Research Puzzle

10/21/2016 04:25 pm ET Updated Oct 28, 2016

Occasionally you’ll hear someone say, “Big Pharma has a cancer cure in a safe, and they don’t want to let it out because it would hurt sales.”

Frustration with the elusiveness of a “cure” and the time and money required for cancer research is very real. Yet William Phelps, Ph.D., ACS Vice President for Extramural Research, counters by saying,

“Many times we’re working with gifted scientists who are survivors themselves or lost family to cancer. If they knew the cures, they’d put them out there. It’s absurd to think that such scientists would hide the secret.”

Three factors complicate the cancer research puzzle:

  1. Cancer is complex
  2. Cancer research is demanding and slow
  3. Deserving grants far exceed available funding

Let’s take them one at a time.

1. Cancer is complex

There is no “silver bullet” to cure cancer because there are so many variants of the disease. “Cancer” is a word describing over 200 different diseases, each characterized by out-of-control cell proliferation. The same cancer or the same treatment may affect different people in different ways, leaving some treatable and others not.

Cancer experts used to categorize cancers exclusively by the affected body part— lung, brain, and so on. Recent insights into the underlying biology of cell growth, cancer metastasis, blood biomarkers, and the immune system have revealed molecular and genomic factors that characterize some cancers across body parts. Such discoveries and new data analysis tools are accelerating progress in understanding cancer biology, learning how to prevent and detect it, and bringing new therapies to the bedside.

2. Cancer research is demanding and slow

The research challenge now is twofold:

  • How to accelerate the progress of discovery, and
  • How to bring that progress into the clinical setting faster to benefit patients.

The largest cancer research funder in this country is the Federal government, primarily through the years. Federal cancer research funding has remained flat and lost nearly 25% in purchasing power since 2005. Therefore, very promising work can’t be funded, and skilled researchers seeking financial security are leaving the field.

The largest non-governmental funder in the US is the American Cancer Society (ACS), which supports early career cancer researchers who don’t have the seniority or track records to win Federal grants. Each year, the Society dedicates approximately $100 million to highly innovative academic scientific researchers and $15-20 million studying cancer epidemiology, surveillance, behavioral research, and health policy.

The Society has invested more than $4.5 billion in research since 1946. Forty seven of its funded researchers have won Nobel Prizes for their work, and ACS-funded research has contributed to many life-saving cancer breakthroughs.

Bill Phelps of ACS explains that

“Advances in controlling infectious diseases let people live longer; cancer is generally a disease of aging, so your risk rises as you age. In the past few decades, we have made tremendous progress in our understanding of cancer, providing the opportunity to understand why a given therapy works on some cancers or in some patients but not in others, and how combinations of therapies might help. There is still much that we don’t know and much that we could implement today. It’s a perfect time to intensify research funding.”

On June 28, 2016, the Society committed to doubling the funds it raises specifically for ACS research to $240 million by the year 2021. This commitment parallels the Federal government’s Cancer Moonshot, which was announced in January 2016 to enhance collaboration and double the pace of scientific progress over the next five years.

3. Deserving grants far exceed available funding

NCI alone received over 9,500 cancer research grant applications and funded 12.2 percent of new grant proposals in 2015. Annually ACS receives between 1,500 and 1,600 grant applications and funds roughly 10-12 percent. Both organizations use a rigorous peer review process to determine which proposals represent the most innovative, impactful, or important potential scientific breakthroughs.

Because of intense competition, most NCI awards go to seasoned (more senior) researchers. In contrast, the Society funds primarily two kinds of early-career scientists: Post-Doctoral Fellows (intensive mentored research apprenticeships much like a physician’s residency), and Research Scholars (former post-doctoral fellows who have since obtained faculty positions). Their hiring institutions provide some financial support for these investigators, and ACS funding helps intensify and extend their efforts.

ACS grant proposals are reviewed by one of nearly 20 different panels of external senior reviewers from leading institutions, many of whom are full professors with their own research accomplishments. These reviewers evaluate each proposal from a scientific viewpoint, with particular focus on whether its results might change the course of the disease for a meaningful number of patients. They also give detailed substantive feedback to each applicant, regardless of whether he or she was funded. An ACS applicant whose proposal is denied may resubmit a revised proposal twice for reconsideration.

All proposals and applicant feedback are handled in strict confidentiality to avoid conflict of interest among reviewers and applicants with pre-existing working relationships or common institutional affiliations.

Once a review panel for a particular type of scientific work determines which proposals are worthy of ACS funding, a council of even more senior external scientists (usually academic department chairs, cancer center directors, and very seasoned investigators) and determine which specific grants will be funded, without limits by category of work or type of cancer. The only constraint is available funding.

Cancer research is complex, slow, and costly, but more funding is needed to save more lives. Doubling ACS research funding will make a difference for some investigators, but increased Federal funding is needed to create even more dramatic impact.

The ACS Cancer Action Network, the Society’s nonprofit, nonpartisan advocacy partner, is currently pressing Congress to increase cancer research funding by $1 billion over two years through full Cancer Moonshot support and the FY ’17 budget. To help solve the cancer puzzle, contribute to ACS patient services and research at www.cancer.org; to ask legislators to increase Federal funding, go to www.acscan.org.

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