Sorry, Joe, there’s no cancer moonshot

President Joe Biden speaks on the cancer moonshot initiative at the John F. Kennedy Library and Museum, Monday, Sept. 12, 2022, in Boston. (AP Photo/Evan Vucci)

The body is a brilliant machine designed to be strong and resilient. It heals wounds and fends off sickness. It provides T cells, which patrol the body to recognize and destroy abnormalities and invaders. Most of the time, the system self-regulates without us even being aware of its work. But sometimes, the system glitches: Cancer happens.

President Biden, who lost a son to cancer, is pouring money into a “c.” cancer moonshot.” While new treatments are extending lives, there is no bullseye for all types of cancer.

Cancerous cells contain an inhibitory signal that scrambles the immune system response. That’s what allows cancer to survive and the reason cancer cells spread—the T cells that are supposed to destroy them don’t know how to kill them. Once the immune system has been overridden, it’s traditionally been the job of conventional—and invasive—protocols to do that work of fighting cancer instead.

Because cancer invades on a cellular level, it can be an extraordinary challenge to remove it definitively—and blasting away cancer frequently comes at the expense of the healthy parts of the body too. Surgery cuts around wide margins of the cancer’s surrounding terrain. Chemo kills dividing normal cells as well as cancerous ones.

Even now, the default protocols for patient treatment are still often limited to the familiar trio: surgery, radiation, and chemo. And although overall cancer incidence and death rates have declined since what became known as the 1970s War on Cancer, progress has been slow, and success has been erratic.

One of the other great challenges for researchers has been that cancer has an exasperatingly bountiful array of manifestations. There are more than 100 different kinds of cancer that affect humans. There are cancers of the blood and bones, and organs. Cancer is many things, though “sneaky” and “unpredictable” tend to be among the universal traits.

A potential moonshot doesn’t automatically mean a hopeful “cure” for other types. Your neuroblastoma isn’t someone else’s breast cancer. The phrase “breast cancer” can mean different things to a person with the BRCA2 gene mutation and one without it. And because of individual circumstances and cell mutations, my melanoma isn’t your melanoma.

That’s why there will likely never be a cure for cancer. And I say that as someone who has been cured for all intents and purposes. Cancer is not a single disease; it almost certainly can’t ever be addressed with a single magical potion. It has to be approached with a variety of protocols. So when well-meaning people—or, more infuriatingly, specific cancer organizations that ought to know better—talk about finding “the cure” for “this disease,” it’s a good bet that they are talking a lot of nonsense.

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The path of medical research progress is not leading to one solution for everything. But as science moves forward with increasing sophistication and depth, more and more patients will be fortunate enough to obtain a specific treatment—or combination of treatments—that seems to eradicate their cancers.

Even then, there will probably always be people for whom those same treatments don’t work. We aren’t built on assembly lines. Our bodies are unique. Our cancers are too.

We have to decide the value of cancer treatments to extend life a couple of months or longer. Is a treatment that extends life three months worth $150,000, and what are the potential side effects?

There’s also another huge issue. Data from more than half of cancer trials underpinning drug approvals remains inaccessible, according to a shocking new study that audited over 300 clinical trials backing anti-cancer medicines approved by the US drug regulator over the last ten years.

Of the 304 industry-sponsored clinical trials that provided data for 115 anti-cancer drugs approved by the US Food and Drug Administration (FDA) between 2011 and 2021, only 45 percent had publicly shared patient-level data – or said they would do so when the researchers enquired about accessing data.

A study found that less than one-tenth of trials cited on three of the top-selling anti-cancer drug product labels made individual patient data available.

Right now, new cancer treatments are being promoted by the media. They often don’t do their homework on drug approvals or clinical trials and ask hard questions. Instead, people read a headline saying a new pill stopped breast cancer cells from reproducing without understanding that its use in mice is far from being available to patients.

President Biden, like many others, wants a cancer moonshot but it’s more likely going to take a lot of rockets to reach the moon cancer, a treatable disease for everyone.