Prepping the launch pad for his cancer moonshot initiative, Vice President Joe Biden held a roundtable discussion at Memorial Sloan Kettering yesterday with nine members of the New York City cancer community, including several MSK doctors and nurses. MSK President and CEO Craig Thompson moderated the conversation.
The visit was the latest in Mr. Biden’s efforts to “change cancer as we know it” through an ambitious national effort dubbed the cancer moonshot. “We’re thrilled that you agreed to be at mission control,” Dr. Thompson said in his opening remarks.
During the hour-long conversation, the vice president homed in on several key topics that have emerged since President Barack Obama announced the moonshot initiative earlier this year: increasing access to and enrollment in clinical trials, collecting and sharing cancer data, and breaking down barriers to scientific collaboration.
Sharing the Wealth
Noting that most cancer patients in the United States receive care in their local communities, the vice president asked the assembled guests what creative approaches they are taking to bring the latest cancer insights to the community setting.
MSK gynecologic surgeon Carol Brown pointed to efforts to enlist community oncologists as co-investigators on clinical studies. She said this would help to increase both awareness and incentives to enroll patients in clinical trials — thereby addressing the gap in care that can separate academic medical centers from community oncologists. Dr. Thompson offered up MSK’s growing network of outpatient locations in New Jersey, Westchester, and Long Island as another way MSK has sought to elevate the quality of care in the community setting.
Dr. Brown, who is Director of MSK’s Office of Diversity Programs in Clinical Care, Research, and Education, also discussed efforts to reduce disparities in healthcare outcomes among minorities by increasing the percentage of minority populations that enroll in clinical trials. She noted that trials offer some of the most promising therapeutic options, yet rates of participation, especially in underserved and minority communities, are low.
Nationally, the average patient enrollment on clinical trials is 3 to 5%. At MSK, nearly one-third of patients participate in clinical trials. One way MSK has managed to achieve such high levels of enrollment is through efforts to automatize the process that alerts doctors to possible trials for their patients. Dr. Thompson told the vice president that MSK leaders including Physician-in-Chief José Baselga, physician-scientist Charles Sawyers, and head of clinical research Paul Sabbatini would be on board to help disseminate this model to other centers.
For about three decades, National Cancer Institute–designated cancer centers — comprised of MSK and 68 other academic centers — have helped to shape and distribute best care practices to the wider oncology community. The challenge in recent years, as Dr. Thompson noted, is the “tsunami” of new information emerging every day that could potentially change clinical practice. Guidelines issued in print and updated every six months often are outdated as soon as they are published.
Potential solutions to this quandary are systems designed to analyze large data sets and distill simple lessons. MSK’s partnership with IBM Watson and its participation in Project GENIE are two such efforts. Another is Flatiron Health, with which MSK is also collaborating. Flatiron founder Nat Turner, who participated in the roundtable, noted that big data systems are equipped to help answer some of the most burning questions in oncology today, such as why only a small subset of patients respond to current immunotherapy drugs.
According to Mr. Turner, no one institution — including MSK — has enough information to be able to answer this question. That’s why his company has recently partnered with the Food and Drug Administration to gain access to data from thousands of patients at multiple centers. Mr. Turner believes that solving this problem in immunotherapy is where “big data” is going to have some of its first big breakthroughs.
Be More Like NASA
Near the end of the roundtable discussion, Mr. Biden returned to a topic obviously close to his heart: data sharing. He reported being “stunned” to find out how many barriers currently hinder the free sharing of information among researchers and centers. He pointed to pay walls at scientific journals that put the results of publically funded research out of reach of those unable or unwilling to pay, and to duplicative research efforts at different centers that seemingly reinvent the wheel. He contrasted this situation with that of astronomers who routinely collaborate on common goals and share their data freely and immediately — a fitting comparison, given the moonshot analogy.
The vice president ended the roundtable with a warning and a request: “We don’t go away easily,” he said. “We’ll be calling and asking for help.”
Earlier in the day, Mr. Biden took a tour of leukemia researcher Ross Levine’s lab at MSK. Dr. Levine’s lab is one of several that make up a new Center for Epigenetics Research at MSK. Epigenetics, MSK scientists believe, has the potential to revolutionize the treatment of several cancers, including leukemia.
Additional reporting contributed by Julie Grisham.