Nixon letter to Mary LaskerOne of the monumental achievements of Mary Lasker’s advocacy in support of biomedical research was the signing of the National Cancer Act in 1971, which became known as President Richard Nixon’s “War on Cancer.” The act injected $1.59 billion over three years into cancer research and control, granted a broad authority to the director of the National Cancer Institute (NCI) to plan and develop a National Cancer Program, and established a presidentially appointed 18-member National Cancer Advisory Board, which advises the NCI director.

In the years after the act was passed, researchers and clinicians made impressive strides towards understanding the biology of cancer. In the 1970s, five scientists — Harold Varmus, Michael Bishop, Raymond Erikson, Robert Gallo, and Hidesaburo Hanafusa — found evidence to suggest that cancer is caused by mutations in genes that are part of our own DNA — oncogenes. For this groundbreaking discovery that changed the course of cancer research, they received the Albert Lasker Award for Basic Medical Research in 1982. Bishop’s award ceremony acceptance speech revealed that even in a moment of triumph, some of the most brilliant scientists were acutely aware of the depth of the challenge in achieving cures for cancer:

Will we be able to parlay these revelations into a strategy for the control of cancer? The issue remains in deep doubt. The road ahead seems long and daunting. And the outcome is not solely in the hands of scientists.

Today, thanks to decades of sustained investment in cancer research and to the heroic efforts of scientists, clinicians, and advocates, thousands of people are able to manage their cancer diagnosis and extend their lives, or even live normal lifespans. However, many are still awaiting solutions, as cancer remains the second leading cause of death in the United States. This is why, when in January President Obama announced the National Cancer Moonshot Initiative, proposing to invest $1 billion for finding new therapies for cancer, the news was met with excitement.

“We believe the time is right for a renewed surge against cancer because, thanks to the coalescence of new scientific insights and technological innovations, prospects for success are greater than ever,”

wrote Douglas Lowy, the NCI’s acting director, and Francis Collins, the director of the National Institutes of Health (NIH), in a recent article published in the New England Journal of Medicine.

Obama’s moonshot aims to accelerate cancer progress by removing some of the barriers in cancer research, enhancing data access and sharing, and facilitating collaborations with researchers, doctors, industry, philanthropies, and patients. The $1 billion proposal includes $195 million in new cancer activities at the NIH for 2016 and an additional $680 million to the NIH and $75 million to the Food and Drug Administration (FDA) for new cancer-related research in 2017.

The announcement of the initiative has provoked a vigorous national debate on how to make the most of this investment. Stakeholders from both the executive branch and the scientific community have engaged in a formal discussion through the establishment of a White House Task Force and a Blue Ribbon Panel of scientific experts. The recommendations of the panel will be provided to the National Cancer Advisory Board, and the Task Force will produce a final report to be delivered to Obama by December 31.

The Task Force is chaired by Vice President Joe Biden and consists of the heads of major executive branch departments, agencies, and offices including the NIH, the NCI, the National Science Foundation (NSF), the Departments of Defense, Commerce, and Health, the National Economic Council, and others. The Blue Ribbon Panel will provide scientific guidance from thought leaders in the cancer community. The panel includes Jim Allison, who discovered and developed immunotherapies that have substantially prolonged the lives of thousands of people with advanced melanoma. It also includes Charles Sawyers, who was a key contributor to the development of one of the first successful targeted molecular therapies for cancer. Both scientists have been honored with a Lasker~DeBakey Clinical Medical Research Award.

A major challenge that lies ahead for the Cancer Moonshot is whether Congress will approve the proposed budget for 2017 that will support its activities. The new money would have to come out of the so-called mandatory funds, which is money that is not part of the approved budget agreement struck in December 2015. Rather, Congress will have to find new resources.

If alleviating human suffering alone is not sufficiently convincing reason that $1 billion for cancer research will be money well spent, one can look at the economics of cancer care. According to the American Journal of Managed Care, during 2010 alone, the United States spent an estimated $125 billion on care for cancer patients. Once again we are reminded of Mary Lasker’s words: “If you think research is expensive, try disease!”

After Nixon launched his war on cancer, it took several decades of building knowledge about cancer before new therapies began to emerge. In the 1990s and early 2000s, three scientists — Brian Druker, Charles Sawyers, and Nicholas Lydon — developed a treatment for chronic myeloid leukemia that converted this previously fatal cancer into a manageable chronic condition. Their work provided a model for targeted molecular therapy drugs that interfere with specific molecules involved in the growth, progression, and spread of cancer. Dozens more such drugs were approved by the FDA in subsequent years, and Druker, Sawyers, and Lydon received the 2009 Lasker~DeBakey Clinical Award for their tremendous contribution to cancer therapy.

Thanks to advances in cancer research leading to new therapies and prevention strategies, overall people today live six times longer after their cancer diagnosis than they did 40 years ago. US cancer mortality rates have decreased by 23% over the past quarter-century. Scientists no longer doubt that new knowledge about cancer will lead to new therapies. The question today is what it will take to achieve the promise of this new moonshot — to “eliminate cancer as we know it.”