Respectful Insolence

Cancer research: Is now our time?

The following is a rather curious promotional video that was shown at the plenary sessions of the AACR 2010 meeting. I first saw it yesterday, and thought my readers might be interested in it while I’m winding my way home:

It’s basically a compendium of various facts about cancer and cancer research with a rather obnoxious techno soundtrack to make it “hip” in the way that middle-aged white guys think is “hip.” (Believe it or not, the AACR actually played this loud enough to feel the bass.) Annoying music aside, though, the graphics in the video compellingly boil down a large amount of information, both promising and not, packed into less than five minutes. For example, the toll of cancer is listed, but so is the massive improvement in life expectancy of children with acute lymphoblastic leukemia since the 1960s. On the other hand, the video points out that only 3-4% of adults with cancer participate in clinical trials, largely because, although 85% of adults express interest in clinical trials when asked, only around 9% are ever asked. This is a travesty, and we have to do better.

More interesting to me were a couple of other citations. For instance, there are 17,590 citations for articles in the peer-reviewed scientific literature about cancer, but there are zero—yes, zero–FDA approved therapies that target p53-mutant cells. Similar numbers apply to the oncogene ras, which theoretically should be easier to target than p53. One little fact that left me shaking my head was a statement that about half of all scientific papers are about less than 10% of all genes. Well, duh! Those are in general the scientifically interesting genes. On the other hand, it is rather depressing to note in this video something that’s been noted in many places, namely that the average age at which an investigator gets his or her first NIH R01 grant used to be 34 in 1980. Now it’s 42. (I got my first R01 when I was 42, actually.)

One of the coolest tidbits of information was the explosion in cDNA microarray data, with the first one published in 1995. Now there are over 300,000 deposited in a government database to hold such data. In case you’re not familiar with cDNA microarrays, they are a tool for measuring the levels of expression of every gene in the genome simultaneously, and their results are now tools for data mining and identification of potential genes involved in various processes of cancer that are freely available to all investigators through the NCI GEO database. Meanwhile, in 2008 there was only one cancer genome sequenced; now there are 100.

All in all, it’s a rather curious promotional video. It’s not all rah-rah, but it does show enormous progress in some areas, concluding that 2010 AACR Meeting is the time and the place–but for what, I’m not sure. After all, there’s only so much one meeting can do. Overall, this year’s meeting was in general quite good, with a lot of interesting and promising science; certainly it was better than last year’s meeting, which was a disappointment to me. But I don’t know that this meeting will have any more effect on the war on cancer than any previous meeting. After all, progress against cancer is a slow, incremental process, with occasional spurts of progress and often long periods of seemingly no progress. (It’s not unlike punctuated equilibrium in that way.) In any case, if there’s one thing that contributes to disappointment at our progress in cancer therapy thus far, it’s the expectation that there will be a “magic bullet” or huge breakthroughs. One theme of this meeting is that this is the best time ever to make progress in cancer research, given the quantity and sophistication of the tools we now can bring to bear on the problem. That may well be true, but cancer won’t yield its secrets easily. It hasn’t in the past, and there’s no reason to expect that it will in the future.

That is not a pessimistic view, simply a recognition that cancer is not a single disease. It is many, and it is a protean foe. There will be no “cure for cancer,” but that doesn’t mean there won’t be a cure for a cancer or many cures for many different cancers.

Comments

  1. #1 Paul Browne
    April 21, 2010

    All good points Orac, the idea that there can be a single “cure for cancer” is still far to common, and is pretty ubiquitous among cranks and quacks.

    Your comment that ‘In any case, if there’s one thing that contributes to disappointment at our progress in cancer therapy thus far, it’s the expectation that there will be a “magic bullet” or huge breakthroughs.’ is timely.

    A couple of weeks ago Arthur Levinson had an editorial in Science arguing for the regulations on cancer therapy trials to be changed to facilitate more trials of combination therapy for cancer, especially for agents that are intended from the start to be used in combination.

    http://www.sciencemag.org/cgi/content/full/328/5975/137

    Everying I’ve read about cancer therapy over the past decade points to combination therapy being the way to go for many cancers, I do hope the FDA follows his advice.

  2. #2 attack_laurel
    April 21, 2010

    On the other hand, the video points out that only 3-4% of adults with cancer participate in clinical trials, largely because, although 85% of adults express interest in clinical trials when asked, only around 9% are ever asked.

    This is where we who work with the active and veteran military population have an advantage over people working with the general public; it’s easier to ask people to participate. However, for anything more complicated than a simple registry, we get a low response rate, and for drug trials, it can take more than a year to get a large enough number of subjects for a meaningful study. While most people are willing at first, the extra time it takes out of their life is a deal-breaker for follow-up, especially for non-active military.

    It is a conundrum. But we persevere.

  3. #3 Joe D
    April 21, 2010

    “in the way that middle-aged white guys think is “hip.”"

    In the way that PR execs think is “hip”, you mean? (Granted, a large overlap.)

  4. #4 cass_m
    April 21, 2010

    Perhaps with your change in health care it will be easier to enroll participants.

  5. #5 phoenixwoman
    April 21, 2010

    How many of the breakthroughs can be linked directly to advances in computer processing power? I imagine crunching DNA data goes a lot faster on a machine with a Pentium D quad-core than on one with an 8088.

  6. #6 christophe-thill.myopenid.com
    April 21, 2010

    Oh, by the way, talking about cancer…

    The great writer Norman Spinrad has apparently been diagnosed with stomach cancer. I feel sorry for him, but I’d also lke to know whether the prospects can be good, or bad, or in-between…

  7. #7 Jeff Read
    April 21, 2010

    I actually like that music… makes me think of PlayStation games from 1996.

  8. #8 Lessa
    April 21, 2010

    I wasn’t surprised to find the clinical trials participation was so low. My husband was asked to participate in two clinical trials on his first day of chemotherapy. Being a research scientist himself, he would have been happy to help but was just overwhelmed by the new diagnosis, the information overload that goes along with starting chemo, etc. etc. He just didn’t have the emotional strength to track his nausea every hour for an entire weekend. (Not to mention no baseline to compare to since it was his first cycle.) So he couldn’t complete his participation. There are psychological factors to be considered when designing a drug trial.

  9. #9 David D.G.
    April 21, 2010

    On the other hand, it is rather depressing to note in this video something that’s been noted in many places, namely that the average age at which an investigator gets his or her first NIH R01 grant used to be 34 in 1980. Now it’s 42.

    That’s just because medical science is enabling us to live longer; 42 is the new 34!

    ;^D

    ~David D.G.

  10. #10 Wehaf
    April 21, 2010

    On the other hand, the video points out that only 3-4% of adults with cancer participate in clinical trials, largely because, although 85% of adults express interest in clinical trials when asked, only around 9% are ever asked. This is a travesty, and we have to do better.

    As a patient, how does one search out clinical trials that might be good fits? Is there anything one can do? I am asking partly out of abstract curiosity, but also for a very personal reason – a close family member has stage IV breast cancer, with metastasis to the bones, lungs, and brains. Short of a clinical trial, there is nothing to offer her any hope. How do we know if her doctors are aware of all or any suitable clinical trials currently enrolling patients? If they aren’t, how do we find such trials?

  11. #11 Travis
    April 21, 2010

    Wehaf, I am not very familiar with finding clinical trials but a starting point might be:
    clinicaltrials.gov

  12. #12 Wehaf
    April 22, 2010

    Travis, thank you.

  13. #13 diora
    April 22, 2010

    “, largely because, although 85% of adults express interest in clinical trials when asked, only around 9% are ever asked”

    So true. My mother is in clinical trial of PF-02341066 for stage 4 lung cancer (for those with ALK mutation). It’s helped so far – some improvement initially then kept things stable, but now it looks like it might be stopping working (not clear yet). Regardless, it gained my mother a few months so far but these were relatively good months compared to how she felt before and with virtually no side effects to speak of.

    The thing is – we only found out about both the trial and the fact that my mother has this mutation by accident. We went to a consultation to a major cancer center in about 2-hour drive, where the doctor there decided to send my mother’s original biopsy material to test for mutations. Then they called us a few months later. Had we not went there we wouldn’t even know. Had we went there sooner when my mother was feeling better, the quality of life during the time the drug works would’ve been better. There are some people who had a much better response than my mother.

    While this mutation is rare, I’d imagine there are quite a lot of people out there who could be helped by these trials and aren’t aware of it.

    @Wehaf – you may also check some major cancer centers’ e.g. Sloan-Kettering website.

  14. #14 Caro
    April 24, 2010

    Thanks for the post. Research is so important, and I’m glad that I can participate, even though it is because I have inherited a mutation in CDKN2a that puts me at an elevated risk for melanoma :P We already knew that we were a melanoma family, and I’ve grown up with meticulous checking of nevi, but now we not only know why, we can also participate in research about it. In fact, I’m pretty sure http://www.ncbi.nlm.nih.gov/pubmed/18023021 this trial was the reason we discovered we had the mutation in the first place :)

  15. #15 Wehaf
    April 25, 2010

    @diora – thank you as well; I will do so.