Michael A. Caligiuri, MD: Looking Forward to Progress for All Fueled by Big Data
Michael A. Caligiuri, MD
AACR President, 2017–2018
CEO, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
Since I was in medical school in the late 1970s, I have seen a transformation in cancer care. We have gone from having just a small number of drugs for treating most patients to being able to face the disease head-on with a range of therapies, not only surgery, radiotherapy, cytotoxic chemotherapy, but also molecularly targeted therapy and immunotherapy.
This change in cancer care is a result of tremendous advances in basic and applied research. Just as you need to understand how an engine works to fix a car, you need to understand how a normal cell works and what happens when it becomes malignant to treat a cancer. That is what has happened in the last few decades. We have learned an enormous amount, at a very mechanistic level, about how normal cells behave, why they sometimes grow uncontrollably, and why they sometimes invade the surrounding tissues. This knowledge has led to advances in cancer treatment and prevention that are saving lives today.
As we move forward, I foresee the collection, accumulation, and analysis of big data as holding the key to the next transformational breakthroughs. If you think about what a business such as Amazon does when you buy a book, that is what we hope big data initiatives like the American Association for Cancer Research (AACR)
Project Genomics, Evidence, Neoplasia, Information, Exchange (GENIE) will do for the cancer field. After you select a single book to order on Amazon, you immediately see suggestions for other books you might be interested in, and the fact is you often would like to read those books. Amazon can do this because there are millions of people in its database. It finds thousands of people who have ordered the book you selected, analyzes the other books these people have ordered, and suggests the most common books to you.
In the next few years, as initiatives like AACR Project GENIE collect and accumulate data, we will be able to identify very small but uniform groups of patients that will provide researchers with opportunities to develop new treatments much more quickly than ever before. It may also allow patients and physicians to find patients like themselves and those they are treating, respectively, and learn what treatments these individuals have had.
In the longer term, as we learn more about how our DNA predisposes us to certain cancers or to tobacco addiction, we should be able to start to develop pharmacologic interventions that can help prevent cancer when used alongside behavioral interventions.
One of the challenges we face going forward is how to ensure that everyone benefits equally from the groundbreaking advances in cancer treatment and prevention that we are making. Cancer health disparities are already a huge problem. For example, African-Americans have the shortest survival for most cancers compared with those in other racial and ethnic groups in the United States. We need to do more to understand the reasons for disparities such as this and we need to address them. We know it is a complex, multifactorial problem that involves genetic, behavioral, and socioeconomic factors among others, and it will require a multifaceted, evidence-based approach to solving the problem.
Achieving our goal of creating a cancer-free world will require consistent, annual, above-inflation increases in the budget for the National Institutes of Health (NIH). Without this we will have less and less buying power, which will dampen the pace of progress. We will also lose some early-career investigators from the field. When I received my first R01 grant from the National Cancer Institute (NCI), the institute funded the top 20 percent of grant applications; in 2016 they funded around 10 percent. My first grants were rated in the 15th percentile, which means that in today’s environment I would not have received funding and my contributions and the contributions of the 100 students that I have trained would have been erased.
We aren’t asking for a doubling of the NIH budget or 50 percent of R01 grants to be funded, just real, above-inflationary growth and funding for one in every five R01 grant applications. This strategy will ensure that we move toward our goal of preventing and curing all cancers.
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