Related story: Quick look: Initial moon shots
Fifty years after President John F. Kennedy told the world “we choose to go to the moon” during a speech in Houston, MD Anderson has launched several “moon shots” to prolong and improve patients’ lives while charting a trajectory for curing cancers.
“Progress against cancer has come in small steps, but the time is ripe to lengthen our strides, pick up the pace and gather ourselves to make a giant leap for patients with the type of all-out team effort that fulfilled President Kennedy’s promise only seven years after it was made,” says Ronald DePinho, M.D., president of MD Anderson.
Drawing further parallels, DePinho adds, “the cancer moon shot initiative is goal-oriented, milestone-driven. Kennedy did not say that we will study how to go to the moon; he inspired us to marshal our talents and our will to achieve a specific goal. It is this perspective that defines our initiative. This effort goes beyond discovery, the traditional strength of academia. It’s about taking responsibility to convert knowledge into clinical impact — into treatments for patients.”
A combination of recent conceptual and technical advances in cancer, as well as MD Anderson’s vast capabilities and resources, inspired DePinho to propose the program, unprecedented in its scope and ambition for a single institution.
“Our moon shots seize the opportunity provided by transforming developments in technology and scientific knowledge,” DePinho says. “They’re comprehensive, covering the full care continuum of cancer prevention, early detection, treatment and survivorship.
“They’re integrative, marshalling expertise and technologies from across the institution to focus, at first, on eight cancers poised for accelerated progress. They also are action-oriented by creating professional platforms charged with the task of ensuring the systematic translation of knowledge into new policies, educational material, drugs and diagnostics capable of saving lives.”
Criteria: comprehensiveness and accountability
The original moon shot proposals targeting 13 major cancer types and involving large MD Anderson teams, sometimes numbering in the hundreds, were reviewed by a panel of internal and external experts. Frank McCormick, Ph.D., director of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco and president of the American Association for Cancer Research, chaired the review committee.
Inaugural moon shots were chosen to address eight cancers: melanoma, lung, prostate, breast/ovarian, chronic lymphocytic leukemia and myelodysplastic syndrome/acute myeloid leukemia. This in-depth planning effort identified areas where strategic investment could elevate the remaining cancers to full moon shot status in the future and provide opportunities for some projects to move forward.
To be selected, moon shots had to have prospects for both short-term improvement and major long-term impact. They also had to set specific goals and metrics — such as reducing mortality by 30% within this decade — to gauge performance and ensure accountability. Moon shot organizers were told to build their plans initially by ignoring constraints, such as funding, organizational barriers or industry priorities. Program leaders found this approach to be liberating.
“Traditionally, when people think about research projects, they think about ‘What can I do?’ The moon shot approach was to think about ‘What needs to be done?’” says Michael Davies, M.D., Ph.D., assistant professor in the Department of Melanoma Medical Oncology and co-leader of the melanoma moon shot with Jeffrey Gershenwald, M.D., professor in the Department of Surgical Oncology.
Integration a key word
One result was collaboration among departments whose paths don’t normally cross. “What’s different about the moon shots is the idea of tackling the disease across the full continuum of cancer care. I don’t think that’s really been done before in such a comprehensive and goal-oriented way,” Davies says.
The results are evident in the melanoma moon shot’s aims. “Our goal is to reduce melanoma diagnoses, catch it at an earlier stage when the disease is largely curable and increase survival among those with the most advanced disease,” Gershenwald says.
Moon shot and institutional leaders will set priorities for funding projects, articulate clear milestones, and develop operating and business plans for each moon shot. Implementation will begin in February 2013, focusing initially on the establishment of enabling platforms and launch of high-priority projects. The moon shot initiative will strive to hit its full stride by mid-2013.
The billions of dollars needed for this effort during this decade will be “seeded” initially through philanthropic funds and institutional earnings, followed by grants from foundations, government and industry. In the later years, these efforts are anticipated to create new drugs and diagnostics, providing opportunities for licensing revenues that will be plowed back into the moon shot mission to continue to increase momentum.
According to DePinho, MD Anderson would not be able to think so boldly and ambitiously were it not for its tremendous framework — the fact that the institution:
- sees about 110,000 patients annually,
- has about 10,000 patients on clinical trials,
- completes thousands of tumor profiles,
- has innovative experimental programs, legions of basic scientists working on fundamental mechanisms and accomplished computational scientists,
- has a multidisciplinary team of hundreds who can focus in a comprehensive and integrative way on each cancer, and
- maintains a global academic network involving many major cancer centers around the world.
Moon shots build upon MD Anderson’s collaborative network so that advances will scale to all parts of the globe. This approach is dramatically illustrated in the chronic lymphocytic leukemia moon shot, which has scientific and clinical collaborators from nine U.S. and seven European institutions.
Just one novel project and sample metric — of the many — for these shots are featured here, as examples of this new approach to science-driven patient care. Each plan has multiple projects, metrics and milestones. These projects will start when funding and resources have been provided.
The moon shot approach, the platforms developed and their progress against targeted cancers will spill over into the understanding and treatment of other cancers. Ultimately, the goal is for all cancers to become moon shots.
“Breaking out of the traditional, academic research and discovery silos into the Moon Shots Program has been very important,” says Guillermo Garcia-Manero, M.D., professor in the Department of Leukemia.
“Recent discoveries identified the BRAF mutation, prominent in melanoma, as present in leukemia and a Nature paper found mutations common to leukemia in breast cancer. This integrated approach has fostered cross-disciplinary communication so we can use the lessons learned from other cancers. This program enables and rewards that kind of collaboration.”