Cancer Moonshot renewal could bring ambitious goals within reach

Johns Hopkins cancer researcher Elizabeth Jaffee, who co-led the Cancer Moonshot Blue Ribbon Panel in 2016, discusses how far cancer research has come in the past five years and where it's headed in the next few decades

Just over six years ago, in his final State of the Union address, President Barack Obama called on then-Vice President Joe Biden to lead an effort to "end cancer as we know it."

The so-called Cancer Moonshot initiative brought new energy and urgency to the fight against cancer, uniting researchers, clinicians, policymakers, and advocates in common cause.

Last week Biden, now in his second year as president, sought to reignite the Moonshot effort by announcing some ambitious goals: to reduce the death rate from cancer by at least 50% over the next 25 years, to improve the experience of people and their families living with and surviving cancer, to increase access to cancer screening, and in so doing, to end cancer as we know it today.

Johns Hopkins oncology researcher Elizabeth Jaffee was among those in attendance at the White House for Biden's announcement. Jaffee, deputy director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, previously served on the National Cancer Advisory Board and co-led the Blue Ribbon Panel of experts that prioritized which initiatives would be pursued with the $1.8 billion in funding appropriated by Congress in December 2016. She is also one of the world's leading investigators of immunotherapy for pancreatic cancers, a personalized approach to treatment that has grown significantly over the past five years and shows tremendous promise.

"A decade ago I would have told you that the goal of reducing cancer deaths by 50% within 25 years was too optimistic," Jaffee said. "However, the last decade has seen significant progress."

The Hub spoke with Jaffee about the significance of Biden signaling a renewed commitment to cancer research, about how far the cancer research community has come since the Moonshot was announced in January 2016, and about whether the new goals outlined last week are within reach.

You were at the White House for President Biden's announcement last week—what stood out to you, and how realistic is the goal of reducing cancer deaths by 50% within 25 years?

I was honored to be invited to the White House to hear first-hand President Biden's announcement about the next version of the Cancer Moonshot Initiative. For me, it was an energizing event, especially after two years of dealing with the pandemic. It reminded us all that cancer is still the second leading cause of deaths for Americans and it is not that far behind the No. 1 cause, heart disease.

A decade ago I would have told you that the goal of reducing cancer deaths by 50% within 25 years was too optimistic. However, the last decade has seen significant progress. Targeted therapies like Herceptin for breast cancer and Gleevec for a form of chronic leukemia, and immunotherapies such as immune checkpoint inhibitors and engineered T cells, have turned about 20-25% of previously deadly cancers into chronic diseases. The science behind cancer biology has progressed rapidly due to the increasing number of new technologies that allow us to understand changes in human tumors using very small amounts of biopsied tumors. Therefore, it is not unreasonable to think that we can reach a 50% reduction in death rates from cancer in the next 25 years.

What progress has been made since the Cancer Moonshot was first announced in 2016?

Funding for the Cancer Moonshot is now in its fifth of seven years. Unfortunately, the amount of funding is less in its final years as was planned from the start. The good news is that there has been significant progress during these last five years. Most of the priorities established by the Blue Ribbon Panel that I co-led have been supported by these funds. As examples, we prioritized developing The Human Tumor Atlas Network, which catalogues genetics and single cell data for deadly cancers that did not receive as much funding in the past, including pediatric tumors, glioblastomas, and pancreatic cancers, to name a few. The inflammatory responses within the tumor microenvironment of many cancers are also being studied and organized into the Atlas. Large multicenter groups are working together and these data will be available to the greater cancer community as they develop.

Health disparities research is another area that has received funding to support community outreach programs. Cancer screening programs are being supported as well—with an emphasis on colorectal cancer screening due to the increased incidence in younger individuals and the relatively low uptake of currently available methods.

Also, the Oncology Center of Excellence at the FDA was born from this and has made a big difference in the rate of cancer drug approvals. The FDA more than ever has been contributing to the national discussions about cancer drug development.

Less tangible but just as important, I believe the Cancer Moonshot energized our greater cancer community and has brought all sectors—government, academia, industry, foundations, and advocacy—closer together and made us more team-focused than ever before.

What is the focus of your research and the work happening in your lab? How promising is immunotherapy in particular as a cancer treatment, and what progress has been made in this area?

My laboratory continues to focus on developing novel immunotherapy treatments for pancreatic cancers. For some cancers, immunotherapies including immune checkpoint inhibitors and CAR T cells have turned deadly cancers into chronic diseases. About 15-20% of cancers including malignant melanoma and non-small cell lung cancers respond to current immunotherapies.

However, pancreatic cancer remains among the deadliest cancers and will become the second leading cause of cancer deaths in this decade. Until recently, immunotherapy has not played a role in this cancer. But during the past few years we have made great progress in understanding how pancreatic cancers avoid immune recognition, and in some cases, have developed strategies that can result in real treatment effects. I work with an expert group at Hopkins and together we are testing these new strategies in our patients. New technologies have allowed us to uncover the cells and signals expressed on these cells that inhibit immune recognition. Our clinical trials are testing ways to bypass these inhibitory signals. We are not there yet, but with what we are learning, we are optimistic that we will have some important breakthroughs soon.

Looking forward 20 to 25 years, how do you think the way we think and talk about and experience cancer might be different? Barring a cure—whatever that means—what is within reach?

We are truly in a new technologic revolution in biomedical science. The technologies available today to detect and treat cancer, to uncover pathways involved in cancer development and progression, and even to disseminate information have rapidly advanced and continue to do so. These advances are already changing how we treat cancers. The field has moved away from treating cancers based on organ site of origin—that is, a specific chemotherapy for a given cancer type such as breast cancer—to treating cancers based on their molecular and protein expression—Herceptin for HER-2/neu expressing cancers, PARP inhibitors for DNA damage repair deficiencies, and anti-PD-1 immunotherapy for microsatellite instability high or high tumor mutation burden cancers.

In addition, we are developing new ways to conduct telemedicine, perform remote diagnoses, and administer remote treatments, all of which will hopefully improve the patient experience and offer easier access to care and fewer toxicities. These advances may also provide solutions to existing health disparities due to geographic and socioeconomic barriers.

With these advances I hope we will continue to reduce mortality because more patients will get timely and effective care. Also, new technologies should provide new ways to screen and detect cancers earlier when treatments have a better chance to prevent progression, morbidities, and death. It will take longer, but I do envision cancer treatment becoming even more patient-specific, utilizing information on each patient's cancer to design the best treatment plan, and one that can be modified if the cancer returns or progresses.