Sunday, December 02, 2007

Metastasis research deficit?

The Boston Globe had an article starting on the front page (briefly free, then will require $$) titled 'Critics blast slow progress on cancer: Say costly drugs do little to extend lives'. As with most newspaper articles the piece is short on hard data and longer on quotes. The most data-rich element is a graphic on the front page comparing 5-year survival rates for isolated vs. metastatic cancers (colon 89.8% vs. 10.3%; prostate: 100% vs. 11.9%; lung: 49.1% vs 3.0% & breast: 98.0% vs. 26.7%).

Two data items of interest that are here. First, an author who is "writing a book on the 'dysfunctional' cancer research industry' claims that 0.5% of federal research dollars have gone to studies of metastasis. The other is that 92% of cancer drugs entering human testing fail to make it to market.

If that 0.5% number is correct, it is most unfortunate. Early detection is great, but there needs to more focus on preventing metastases and treating them once they occur. There is a quote from Judah Folkman that some promising initial results have been seen using angiogenesis inhibitors to prevent metastasis, but they are clearly very small studies.

A key point that the article hammers on is that cancer researchers have constantly been promising that cures were around the corner, and yet that hasn't been realized. It cites the 36-year war on cancer, which was promoted as ending cancer by the bicentennial in 1976. More recently, now FDA commissioner Andrew von Eschenbach was proposing eradicating cancer by 2015.

What the article fails to explore is that we can't really know if we are about to have a sharp turnaround. As the article states, the long term survival mark is 5 years -- which means we won't know if the new drugs of 2007 had a real impact until pretty close to 2012. It also fails to explore the idea that extending lives by 'a few months' may be the initial signal, but that further optimization may extend that -- or that drugs are initially tested in desparately ill populations, where the deck may be highly stacked in the tumor's favor. In earlier patient populations, more notable gains may be practical.

Personally, I think that proposing to eradicate cancer by some time in the very near future is a recipe for disaster: again, given that 5-year survival is the key benchmark, eradicating cancer by 2015 would either mean (a) nearly perfect early detection [for cancers where that is nearly synonymous with a cure] and/or (b) eradicating cancer with the drugs in current late-stage testing, since only they could hit the clinics in a big way by 2010 so that 5-year survival could be measured by 2015. The former is just not realistic, and there's no great buzz from the industry that something is there to fulfill role b. Instead, researchers should set more reasonable expectations based on what is realistic. New tools for exploring cancer genomes & personalizing treatment will (IMHO) start making an impact -- but not for 5-10 years as they are tuned & troubleshot.

One other interesting note: amidst bemoaning flat U.S. government support for cancer research, it is noted that various patient-driven organizations are pumping money in or setting up key resources (such as a myeloma tissue bank set up by the Multiple Myeloma Research Foundation). What is interesting, and will hopefully continue, is some of these private organizations trying to invest in proposals that are kind of 'out there'. According to the article, the Komen foundation (breast cancer) has announced plans to invest $600M "to find wild ideas that will break the mold". That's some serious money, and if it is used to fund the 'unfundable' it will probably mean a lot of money going for failures -- and a few spectacular advances. If patients are impatient with research progress, funding what the establishment doesn't is a good way to express that frustration -- and maybe make a huge difference.

1 comment:

Anonymous said...

More doom and gloom for the drug discovery industry:

One of the things that annoys me about Wall Street pontificating about the low productivity of the pharmaceutical industry is that they fail to appreciate complexity. Instead, they make evaluations that are based on the similar business models as those they use to evaluate the automotive or computer chip industries, that is, new "improved" models are expected every year so that the punter keeps buying. Clearly this "utopia" is a long way away. Nevertheless CEOs and the other "MBA-types" who run the companies buy into this delusional philosophy because they don't know any better.