Op Ed / Essays

Gaining Ground on Cancer

Monday, April 28, 2008
The Boston Globe

In 1971, President Nixon launched the “War on Cancer,” with the optimistic goal of defeating the disease in eight years with $100 million. More than 35 years and $79 billion later, the war is far from won. While 2002 marked the first-ever yearly decline in U.S. cancer deaths, more than 40 percent of Americans will still contract cancer in their lifetime. What’s more, although effective therapies have emerged for some cancers, other types stubbornly resist therapy, and many patients find treatment itself debilitating.

Given the scale of the problem, advocates like Lance Armstrong call for increased federal funding for cancer research. But, if we have spent so much without defeating the disease, why should we think that further spending will finally conquer the 200 or more diseases we now know as cancer? There are two reasons. First, fundamental research takes time, sometimes decades, and we are only now reaping some of the rewards of the fundamental work triggered by the War on Cancer. The drug Herceptin offers highly effective therapy for women with one type of breast cancer; its development depended on molecular discoveries made at MIT in 1979, amplified and extended by the work of researchers at many institutions since.

The second reason to be optimistic about progress on cancer is that recent innovations have dramatically accelerated cancer research.

In the early 1990s, when fundamental research in my own neurobiology lab opened a new approach to primary brain cancer, gains came slowly, one protein or one gene at a time, and depended on experimental systems that only partially mimicked human disease. Today, thanks to new technologies, researchers now collect and analyze more data in a year than their mentors could in a whole career. Startling new tools from chemical, biological and nano-scale engineering have dramatically shortened the road to new discoveries and new therapies – as we have seen already in revolutionary cardiac treatments like drug-eluting stents.

With these capabilities, we can finally tackle persistent problems in cancer treatment and detection: attacking the tumor specifically, rather than flooding the patient with drugs toxic to normal tissues as well as cancer; or detecting recurrence, not at scheduled check-up intervals, but when the tumor starts making new cells. At last, through the combined powers of biology and technology, we can start to talk seriously about doing for cancer what we have done for AIDS – transforming it from a terminal disease to a treatable chronic condition.

At MIT and elsewhere, for example, researchers are building a new class of anti-cancer “smart bombs,” nanoscale particles filled with cancer-fighting drugs and covered with homing molecules that direct them exclusively to cancer cells. By leaving healthy cells untouched while delivering anti-cancer drugs directly to a tumor, these nanotherapies hold the promise of more effective treatments at much lower doses, with a dramatic drop in side effects like nausea, fatigue and hair loss.

Other MIT research teams are developing minute sensors to lodge at the site of a tumor during surgery. If the cancer recurs, the sensor will detect it at the level of just a few cells, eliminating the agonizing uncertainty between doctor visits and allowing new treatment to begin immediately.

New strategies like these are profoundly exciting, but further progress against cancer, at MIT and leading hospitals and universities around the country, will depend on how much we are willing to pay for it. Federal and industry funding, along with farsighted private philanthropy, have fueled cancer research. Unfortunately, funding for the National Cancer Institute has been flat for the past four years. Further progress will require further investment.

In these increasingly difficult economic times, we rush to ask, “What would it cost?” A better question is “What would it return?” In 1980, HIV-AIDS did not even have a name; soon after, it was projected that AIDS patients would fill every bed in every hospital in America. NIH moved into action, investing $15 billion in research. That’s a lot of money. But as Dr. Elias Zerhouni, Director of the National Institutes of Health observes, that investment saved $1.4 trillion in hospital costs and has given AIDS patients the possibility of a normal life span.

In the same way, for cancer, in all its permutations, there will be only one cure: Research.