With hundreds of types of cancer in the world, there are a handful of rare cancers. These have a small percentage of the population that are diagnosed yearly, and often times start in unusual places in the body, or require different types of treatments. They are not common, and do not always receive widespread awareness, due to the lower occurrence. That can lead to a cancer being difficult to detect, less likely to prevent (when possible), and fewer treatment options.
The National Cancer Moonshot Initiative is doing a lot to change the way we deal with rare cancers, one of which being mesothelioma. Mesothelioma is a very rare cancer, with only around 3,000 people in the United States being diagnosed each year. Although few are diagnosed with this cancer, there are approximately 43,000 people dying from it annually in the world.
Mesothelioma is caused by exposure to asbestos, a naturally occurring, toxic fiber that is commonly used in construction and building materials. When disturbed and airborne, inhaled asbestos becomes a carcinogen, and it sticks to mesothelium tissue. This tissue can be found in a few locations in the body, and the location denotes the specific type of mesothelioma.
The most common type is pleural mesothelioma, which starts in the lining of the lungs. This type accounts for about 80% of new mesothelioma cases. The second most common is peritoneal mesothelioma, starting in the abdomen, which occurs in about 15-20% of mesothelioma patients. Pericardial mesothelioma occurs in about 1% of cases and develops in the heart. The rarest type of mesothelioma is testicular. There have been less than 100 reported testicular mesothelioma diagnoses, and very little is known about how it develops or how to treat it.
Generally speaking, mesothelioma carries a poor prognosis. When diagnosed, most people are given about 12-24 months to live. This is in partly due to the long latency period of mesothelioma (10-50 years), which makes it extremely difficult to detect until the later stages. Common treatments include surgery, chemotherapy and radiation. However, the Cancer Moonshot Initiative and additional research could help drive major improvements for mesothelioma patients, along with others diagnosed with rare cancers.
National Cancer Moonshot
The National Cancer Moonshot 2020 is a national initiative led by Vice President Joe Biden. The goal of this initiative is to stimulate cancer research, achieving ten years’ worth of progress in only five years’ time. Investigators and physicians at UCHealth and the University of Colorado Cancer Center are focused on helping the goals of the National Cancer Moonshot become reality by caring for patients in new and innovative ways.
In order for this initiative to be successful it will rely on a few different factors: money, people, and information.
The first piece to the puzzle is funding. The initial budget for the Cancer Moonshot is $1 billion and will include an initial investment of $195 million towards the National Institutes of Health (NIH), along with $755 million in mandatory funds for cancer-related research activities at NIH and the Food and Drug Administration (FDA). Another huge funding focus is through the Departments of Defense and Veterans Affairs, as they increased their investments through funding Centers of Excellence. This puts focus on specific cancer types and conducting studies to help determine risk factors and better treatments.
Next, we need people. The Task Force, chaired by VP Biden and led by Executive Director Greg Simon (cancer survivor, former president of FasterCures), will focus predominantly on the investments, incentives, private sector efforts, patient initiatives and other such means of supporting cancer research and progress.
This initiative could not be successful with the Task Force alone. This group will be consulting with the Blue Ribbon Panel and other experts and representatives from a variety of different areas including, but not limited to: academia, large businesses, non-profit organizations and state and national government agencies. The National Cancer Advisory Board (NCAB) will be consulted, along with the cancer patient community. These efforts focus on collaboration. No single group can make the Cancer Moonshot impactful. It will take a cohesive blending of resources to be successful.
Collaboration does not stop with people. Data must be shared collaboratively in order to advance at the rate our nation hopes for. “The cancer initiative will encourage data sharing and support the development of new tools to leverage knowledge about genomic abnormalities, as well as the response to treatment and long-term outcomes.” For this to work, data must be securely stored, analyzed and shared.
The National Cancer Institute’s Genomic Data Commons (GDC) is an interactive and searchable database that, when complete, will allow doctors to access the most up to date information about treatments across the country. There is nothing currently in place like the GDC platform. The hope is that this data share will result in clinical advancements, with a genomic trail leading to new breakthroughs.
Data sharing improvements are aimed to advance many different aspects of cancer. One area that largely affects mesothelioma is early detection. Genomic and proteomic technologies have honed in on the sensitivity of detection methods, making certain methods possible. Often times, biopsies are used to detect cancer, however, biopsies do not always contain enough tissue necessary to make a proper diagnosis. Biopsies can also be very painful.
A new blood test for cancer called “liquid biopsy” could potentially replace the need for a traditional biopsy. This method would cause less discomfort and be more convenient for the patient–and surely less invasive than an endoscopic biopsy. The blood taken in a “liquid biopsy” would be analyzed for DNA mutations or other changes that might indicate cancer.
Another extremely important aspect of the Cancer Moonshot is treatment, and while chemotherapy, radiation and surgery still act as viable treatment options, efforts will be made in other treatments such as immunotherapy. Immunotherapy essentially uses the patient’s own immune system to help fight the cancer. It can either use the person’s immune system to work smarter and harder to attack cancer cells, or man-made proteins can be added to the mix to stimulate this process. While there are many types of immunotherapy, an emphasis will be placed on immune checkpoint inhibitors which are drugs that help the immune system recognize and attack cancer cells, by “taking the brakes off” the immune system.
Giving Hope to Rare Cancers
The Cancer Moonshot Initiative will play a large role in giving a new hope to rare cancers like mesothelioma. With better early detection methods and improved treatment options, there will be a sense of hope that those battling rare cancers can beat what they once thought of as a death sentence. While the Cancer Moonshot will take lots of funding, collaboration and nationwide efforts, it will eventually get us to a place that was once thought to be impossible. Remember, our nation once thought it would be impossible to walk on this moon. The Cancer Moonshot could be “one small step for man, one giant step for mankind”!