Ending Cancer Deaths in Young People ‘Doable’ With Budget (1)

Cancer won’t be a death sentence for most young and otherwise healthy people if a new health research program proposed by President Joe Biden becomes reality.

“I don’t expect to end all cancer deaths, but I think that eradicating a vast majority, especially in young and otherwise healthy people, I think that is doable,” said Ned Sharpless, director of the National Cancer Institute, said Sunday at the American Association for Cancer Research’s annual meeting

The boost from Biden’s plan would shrink what would have taken 10 to 15 years down to five, he said.

Sharpless’s remarks came just two days after the White House released a budget request with $6.5 billion to create the Advanced Research Projects Agency for Health, or ARPA-H. The new program would be housed within the National Institutes of Health, modeled on initiatives at the Pentagon and the Department of Energy that paved the way for the internet and GPS. It requires approval from Congress.

Sharpless offered some of the first comments from an NIH official about ARPA-H following the budget request. ARPA-H will provide the NIH with capabilities such as rapid and nimble contracting and special authorities for managing projects in a directed way. The agency is well-equipped to take on ARPA-H, especially after the Covid-19 pandemic forced the agency to work in novel ways to spur vaccine and drug discovery, he said.

A big boost in funding for targeted research on biotech innovations would be “transformational” for bringing new cancer therapies to patients, said Nancy Goodman, founder and executive director of Kids v Cancer, a pediatric research advocacy group. Pediatric cancer lags behind adult cancer in terms of research and therapies, she said, but investments in programs that already exist can go a long way toward helping both groups.

Goodman is pitching a “biotech acceleration” program for the new ARPA-H that would streamline and fund academic research to hasten the movement of new ideas into actual development of drugs and therapies. She says if the government takes charge of “doing the piece the industry can’t do,” drugmakers can take over at the next stage.

Among her proposals is standardizing academic inquiries to ensure researchers optimize their experimental drugs and therapies for use in people, make recommendations for production, and hold the first clinical trials in humans. After that, she said, the pharmaceutical industry can move in, knowing there will be benefits “once they’re seen in a bunch of kids.”

The U.S. government’s success in pushing forward a Covid-19 vaccine through Operation Warp Speed shows the power of marrying the private sector and academic research, she said. The NIH already has programs that could be scaled up and targeted to hasten the production of drugs that inhibit proteins that are linked to the development of cancer and boost cancer genomics.

Defined Goals

The links between cancer and aging make eradication of all cancer deaths an unrealistic goal anytime soon. Rather, the goal should focus on ending cancer in young people, according to Sharpless.

“When I think of the tragedy of cancer, I think of people that I’ve actually known,” Sharpless said. He mentioned a six-month-old who died of a very rare, fast-growing tumor of the brain and spinal cord and a young mom with metastatic breast cancer who wanted to live a few more years to see her children go to college.

“Even that modest goal was one that we were unable to meet,” he said.

It’s time to define more precisely what it means to “end cancer as we know it,” he said. “This is a place I believe for solid metrics as opposed to gauzy, ill defined goals.”

Cutting cancer mortality in half from its peak in the 1990s, when it was at about 215 deaths per 100,000 population, would indicate researchers are on the right track. That rate has steadily declined to about 149 deaths per 100,000 in 2018, but it would take until 2040 to reach the halfway goal under the historical rate of decline of 1.8% for men and 1.4% for women.

That decline increased from 2017 to 2018 to 2.4%, but it would still take until 2031 to halve the mortality rate.

“That’s not good enough,” Sharpless said. “But if we continue to accelerate this rate decline using all of our new many tools in prevention history and new therapies, I think we can get there in 2026.”

That will require an average reduction in cancer mortality of about 4% per year, which he acknowledged won’t come from a single breakthrough but will require a concerted effort with many complex parts coming together.

Early Detection

One way to use a vehicle like ARPA-H is to build a large national study or series of studies for multi-cancer early detection tests. Researchers would use blood-based screening tests with the goal of finding early cancer in healthy adults, which could advance cancer diagnoses, screening, and treatment.

ARPA-H will focus on other disease groups, but Sharpless said he expects cancer to be a big part of that $6.5 billion effort. The NCI is the largest of the NIH’s 27 institutes and centers.

“To put that in perspective the entire cancer moonshot, which was really a transformative initiative, was $1.8 billion. So this is larger than that by a good measure,” he said. The biomedical innovation law 21st Century Cures Act (Pub. L. 114-255) provided that money as one of several special funding sources that led to 240 new programs and initiatives. That money will expire in 2023, and Sharpless said he doesn’t expect ARPA-H to pick up the moonshot but to expand in other directions.

“ARPA-H as envisioned might be a better fit for different kinds of projects because of novel capabilities,” he said, adding an important question is figuring out what will work well with the ARPA-H format versus the ongoing programs at the NCI.”

—With assistance from Fawn Johnson