Last month, on the 60th anniversary of President John F. Kennedy’s famous speech declaring that the challenge of putting a man on the moon was one “we are willing to accept, one we are unwilling to postpone, and one we intend to win,” President Joe Biden delivered a speech of his own about a new challenge for the United States to win – “to end cancer as we know it.”
Earlier this year, President Biden announced that his administration would reinvigorate an initiative he started when he was vice president in the Obama administration – The Cancer Moonshot – an ambitious federal program that will support funding for cancer research and expand equitable access to cancer screening and care, with the goal of cutting today’s age-adjusted death rate from cancer in half and improve the experience of people living with and surviving cancer.
San Diego, with its world-renowned cancer research institutions and robust life sciences industry, is already a leading region in the country in making these goals a reality.
Leading in Equity and Access
Moores Cancer Center – UC San Diego Executive Director of Administration Seanne Falconer said Moores is “uniquely positioned to work towards the new Moonshot goals,” especially the goals of equitable access.
Last month, UC San Diego announced it had received a $16 million grant from the National Institutes of Health (NIH) Common Fund’s Faculty Institutional Recruitment for Sustainable Transformation (FIRST) Program that will fund the hiring of 12 diverse, early-career research faculty in the biomedical sciences.
UC San Diego is also bolstering its junior cancer research faculty in partnership with San Diego State University by co-recruiting researchers from underrepresented groups. Three have been recruited this year.
And diversity in research faculty at Moores Cancer Center will be guaranteed going forward because of a new National Cancer Institute (NCI) requirement to document the center’s plan to enhance its researchers, staff and leadership diversity “to include brilliant minds from historically underrepresented in science groups,” Falconer said.
Working toward reducing healthcare disparities in diverse populations is not new at Moores Cancer Center. As part of the initial Cancer Moonshot program, a Blue-Ribbon panel was created to advise the National Cancer Advisory Board (NCAB) and make recommendations on how to address cancer research and treatment. Among the panel members serving since its inception is Elena Martinez, Ph.D., a UCSD professor in the Department of Family Medicine and Public Health, Division of Preventive Medicine who co-leads the Reducing Cancer Disparities Program at the Moores Cancer Center.
“Moores has long been aligned with the earlier Moonshot goals as outlined by the Blue-Ribbon Panel and is uniquely positioned to work towards the new Moonshot goals, particularly in substantial efforts to reduces health care disparities in diverse populations,” said Moores Cancer Center Director Scott Lippman, M.D.
To address disparities and expand access overall, Moores has expanded clinical trials to speed evaluation of new screening and treatment options for diverse populations including racial, ethnic, sexual orientation and economic demographics as well as people with comorbidities.
As part of the University of California Cancer Consortium, Moores has expanded its clinical trials and quality control efforts.
“We now have community members evaluating clinical trials for mistakes that could make it hard for community members to enroll in the clinical trial, like too many research visits or too many exclusion criteria that would limit the enrollment inadvertently,” Lippman said.
C3 Coalition Benefits
In addition to being poised to meet the Moonshot’s equity and access objectives, San Diego is especially suited to meet the entirety of the objective to “end cancer as we know it” at its three NCI-Designated Cancer Centers –Moores Cancer Center, the Salk Institute and Sanford Burnham Prebys – a group Sanford Burnham Prebys Cancer Center Director Ze’ev Ronai, Ph.D. described as the “C3 Coalition.”
“C3 collaborates on cancer projects using shared, cutting-edge technology resources available on each of the three campuses,” Ronai said, adding that he is hopeful that the new Moonshot initiative will “catalyze initiatives across the different research institutes, biotech companies and pharmaceutical companies on the San Diego Mesa” and “drive new collaborations among the cancer researchers here.”
The C3 are among only 71 NCI-Designated Cancer Centers in the nation and in addition to offering the opportunity to drive research collaborations, the concentration of the centers has helped San Diego benefit from the Moonshot initiative in other ways.
On Sept. 23, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded over $5 million to 11 HRSA-funded community health centers to facilitate access to life-saving cancer screenings and early detection services for underserved populations.
The health centers receiving the Accelerating Cancer Screening awards must work with NCI-Designated Cancer Centers, which will deploy their outreach specialists and patient navigators in the health center’s service area. In the San Diego region, two community health centers – Family Health Centers of San Diego, Inc. and Neighborhood Healthcare in Escondido – each received $500,000 awards.
“This partnership between NCI-Designated Cancer Centers and HRSA’s health centers will bring to bear the significant expertise of the cancer centers in engaging the communities they serve and will help provide underserved and rural patients access to follow-up care, including screening and cutting-edge clinical trials,” said NCI Acting Director Doug Lowy, M.D. “This landmark interagency collaboration represents the kind of innovative partnerships that will further advance the Cancer Moonshot and end cancer as we know it.”
HHS’s department-wide engagement strategy for cancer screening is focused on making up for the estimated 9.5 million missed cancer screenings during the pandemic – a Moonshot goal President Biden announced last month. The strategy intends to identify barriers and solutions to increase access to early cancer detection and preventive health.
Since the initial Cancer Moonshot announcement, a major component of the initiative was funding for cancer research. In 2017, President Obama signed into law the Cures Act, providing $1.8 billion for cancer research and policy initiatives.
“The funding provided by the Cures Act of 2017 “opened the doors to breakthrough findings in so many aspects of cancer research and policy including immunotherapy and precision medicine, cancer prevention, the expansion of AI into cancer treatment, diagnostics, and the exploration of the microbiome – just now leading to [Center for Microbiome Innovation at UC San Diego Director] Rob Knight’s group exciting findings in the mycobiome,” Lippman said. “This was definitely an investment that resulted in significant advances in survivorship.”
Regarding the Moonshot initiative, Lippman said, Moores’ researchers have been involved in “so many ways,” but highlighted a Moonshot program the center is leading.
“Moores is the premier site for the Precancer Genome Atlas (PGCA) and we have been working in conjunction with the precancer aspect of the NIH Human Tumor Atlas Network (HTAN) since we chaired the PCGA kick-off think tank in 2017 at NIH,” he said.
In 2019 the Moores team presented update at an HTAN meeting in Bethesda, Maryland on the PGCA to build a web-based catalog of pre-cancer evolution of each tumor as it evolves from a precancerous lesion to advanced cancer, Lippman said.
“We are also finding unexpected multi-omic insight into the immune reaction in precancer lesions that can predict response to immunotherapy in later stage disease,” he added.
Travis Young, Ph.D., vice president of biologics at Scripps Research drug discovery arm Calibr, said research at Calibr into innovative cellular immunotherapies, like the switchable CAR-T cells, will be instrumental in reaching the Cancer Moonshot goals.
“The San Diego scientific community has uniquely built outstanding expertise in this area,” he said. “Scripps/Calibr, UCSD, the Alpha Clinic, and numerous local biotechs all work on cellular therapies with potential to be transformative medicines.”
Young said the cellular therapy field is “still in its infancy” and there is more work to be done producing cellular therapies than there are people skilled and trained to do it.
“A key focus of the Cancer Moonshot, therefore, is development of manufacturing solutions for cellular therapies,” he said. “Bringing funding and awareness to this emerging field is essential for realizing the potential of cellular therapies and to improve patient access, reduce costs and expand the number of diseases it can treat.”
Ronai said the reinvigorated Caner Moonshot initiative will have a direct impact on Sanford Burnham Prebys because cancer research is its largest focus area.
“Our goal at the Cancer Center is to pave the road between basic discoveries and clinical studies, and we’re able to do this thanks to our Conrad Prebys Center for Chemical Genomics, which is the most advanced drug discovery enterprise in the nonprofit sector,” he said. “Here, we screen for small molecules that target the vulnerabilities of cancer cells. We believe these small molecules are the cancer therapies of the future.”
Research from Sanford Burnham Prebys impacts the broader cancer research community by laying the groundwork for treatments that progress to clinical trials, Ronai said, and will also have a positive impact on the Moonshot’s goal to increase the pipeline of new cancer drugs.
Equitable care and new cancer drugs are just pieces of the Moonshot’s ultimate goal of cutting cancer deaths in half.
According to Lippman, the Moonshot is already making an impact through cancer prevention measures championed by the initiative like HPV and HepB vaccinations, which have seen an increase in uptake leading to subsequent reductions in cervical and liver cancer. The Moonshot is also supporting efforts to provide early-detection of colorectal cancer.
Ronai said recent innovations in technology are providing “unparalleled resources for guiding the research and clinical efforts” needed to achieve the halving cancer deaths.
“The goal set by the President is certainly ambitious, but notable progress towards reducing cancer death significantly over the next 25 years is achievable,” he said.
Ronai pointed out that the 2017 Cures Act had already provided support for numerous cancer programs across the country with funding to get clinical trials started sooner and improve the trials themselves by fueling new, collaborative initiatives between institutions.
“Group efforts, combining diverse disciplines and expertise, are more impactful in solving important problems in cancer,” he said. “I hope that funding from this initiative will continue to inspire such collaborations across institutes and across disciplines, particularly here on the San Diego Mesa.”