In early May, less than two weeks before Ted Kennedy learned of his brain tumor, he chaired a Senate hearing about revamping the war on cancer, a war he championed at its outset in 1971. Though acknowledging advances, several witnesses expressed impatience with the failure to achieve the central goal of the war: to cure cancer through a concentrated scientific effort akin to the ones that split the atom and took us to the moon. Some 37 years later, 565,000 Americans yearly are dying because of unchecked cancer, and their ranks are swelling. It is now the No. 1 killer of adults under age 85.
Several witnesses called for a new direction, if not a major overhaul of a system that may be too calcified to take strategic leaps however much money it has. As Gregory Simon, a former presidential adviser and now head of the cancer advocacy group FasterCures, said, "We are not soldiers in a war against cancer; we are students majoring in cancer." Learning is vital, but it must translate into curing. Why should it take 17 years to turn discoveries into effective treatments? he asked.
He's right—and there's particular urgency now that the science is ripe to take on huge challenges as never before. To win the war, early detection of the deep and hidden cancers will be key. We have screens for only four or five cancers; the rest show up on their own to patients' peril. Finding ways to melt away recurrent and metastatic disease—the way cancer kills—will be the ultimate gift of science. Strategically ramping up work in cancer genomics and a newer area of exploration, cancer stem cells, is what success will require, provided the money, talent, and technological resources are there.
Deranged genes. Cancer is a disease of deranged genes. But as we've slowly deciphered them, we've been surprised. Many cancers that go by the same name and look identical under the microscope have different genetic profiles, explaining why some tumors respond to therapy while others of the same ilk do not. But more than providing a better crystal ball for what will work, tumor genomes are blueprints for new drug design. Herceptin, made to block a gene pathway found in up to 30 percent of breast cancers, helps women who have that gene. Gleevec, which targets genes found in chronic myelogenous leukemia, may not help all blood cancers but is a lifesaver for a rare stomach cancer that bears genetic similarity.
The Cancer Genome Atlas program, started at the National Institutes of Health in 2005 to map individual cancer genomes, was envisioned as revolutionary: It would blow open the instruction book on cancer. There would be no more hit-and-miss therapies. But a cultural resistance to strategically directed big science and a flat budget turned the program into a "pilot" to decode just three cancers, leaving 200 others waiting in the wings. This is no way to win a war.
Nor is it a way to break open the emerging domain of cancer stem cell research, which could be every bit as critical as cancer genomics. Adult stem cells are present in all organs for tissue renewal or repair, but a variant has turned out to be tumor-initiating. These cancer seeds were first identified in leukemia, breast, and brain cancers a few years ago and now have been pulled out of numerous cancers—pancreas, prostate, colon, and ovary. Cancer stem cells spin off fast-growing tumor cells that make for the bulk of the tumor, and they can lie dormant and more easily evade chemotherapy or radiation. This would explain why tumors so inexplicably reappear years after successful treatment. Since cancerous stem cells have their own gene profiles that bring special properties like motility, they can roam throughout nearby tissue, into the bloodstream, and to distant body organs.
With unique markers on their surface and a set of different gene pathways, which are normally turned on in embryos but silent in mature cells, these cancer stem cells offer a world of opportunities for both early detection and new cancer drugs. For the first time in a long time, cancer researchers are talking about a cure. Even for metastatic disease.