Who’s Running the Moonshot (and how many are there)?

Followup media coverage of President Barack Obama’s call for a “moonshot” to cure cancer has pointed out an interesting fact. It looks like there are two moonshots, and one of them is headed up by Big Pharma.  

biden moonshot at davos

Making the moonshot a global one  

The New York Times focused on Joseph Biden’s relationship with Dr. Patrick Soon-Shiong, who coined the term moonshot and gave Biden a two-page paper, titled in part “The Moonshot Program to Develop a Cancer Vaccine.” From the article:

One day last winter, desperate as his son fought for his life against a killer brain cancer, Vice President Joseph R. Biden Jr. and his family reached out to one of America’s most famous, and controversial, doctors for help.

The doctor, Patrick Soon-Shiong, a billionaire medical entrepreneur and investor who made a fortune developing an important cancer drug and now has broader ambitions for fighting cancer, flew to Washington from California to meet with the vice president’s family. That would open a series of meetings over time with the vice president as well as with Beau Biden, the ailing son.

In the end, Beau Biden died of his cancer in May. But the vice president and the cancer doctor have developed a relationship that is powering the next stage of Mr. Biden’s public life. Having concluded that he did not have enough time to defeat Hillary Rodham Clinton for the Democratic presidential nomination, Mr. Biden is instead embarking on a campaign perhaps more daunting: finally defeating cancer.

The Economist observed that not one, but two moonshots have been announced recently. A day before Obama announced his at the State of the Union, a group called the National Immunotherapy Coalition, headed up by Dr. Soon-Shiong, had some news of its own.

The article also notes confusion about the two competing moonshots, criticism of Dr. Soon-Shiong, and encourages more focus, cooperation, and clarity from both camps. From the article:

Early drafts of Dr Soon-Shiong’s press releases sent out in the second week of January show that he had intended this coalition to be broader. For example, the FDA was named in a draft release received by some coalition members along with a proposed quote from an official reading “the FDA is ready to be part of this historic coalition where we can provide clinical trial guidance”. There was no mention of this agency in the final announcement. Prior to launch, two pharma companies said they had not actually agreed to the coalition, despite being named in draft notices sent out to the press. Dr Soon-Shiong’s spokeswoman says that shortly prior to launch, three pharma companies asked to be removed from the announcement.

Cancer patients could be forgiven for frustration at the confusion. Dr Soon-Shiong has a clever idea to advance cancer care: he wants to complete randomised trials in all stages of cancer with different kinds of immunotherapy drug in 20,000 patients. Lives are at stake. It isn’t clear what happened but when asked if Dr Soon-Shiong had failed to carry along the agencies or companies that were intended to be part of the coalition, his spokeswoman said that Celgene and Amgen had confirmed their participation and the idea was moving ahead, “full steam… we expect to be able to announce additional members of the coalition”.

On January 19th, it was announced that Mr Obama would soon issue a memorandum to help the administration carry out Mr Biden’s moon shot to cure cancer by calling on agencies including the FDA, NIH and the DoD to coordinate government efforts with the private sector. One news report noted that, “Presidential memo to launch cancer moon shot”. Hopefully it will become clear in the coming months exactly who is calling the moon shots.

Fast Company, a West Coast-based business culture magazine, also zeroed in the private sector immunotherapy angle, and the big money behind it. From the article:

(Dr. Soon-Shiong’s) project, formally announced on January 11, is a switch from chemotherapy to immunotherapy; from killing cancer cells directly to helping the body’s immune system kill cancer. It is focused on personalized genetic sequencing to develop custom treatments for each patient. And the time frame is at least as aggressive as the race to the moon. Within five years, it aims to not only design but also implement clinical trials of new immunotherapies for 20 tumor types in up to 20,000 patients. By 2020, these trials are expected to get as far as phase 3—widespread participation on an unheard-of timeframe.

Though it’s a nonprofit, MoonShot 2020 is led by big pharma firms like Celgene and Amgen, and biotech companies including NantKwest, Etubics, Altor Bioscience, and Precision Biologics. Participating hospitals and universities include Massachusetts General Hospital, Johns Hopkins University, the University of Miami, the University of Utah, and the Tufts Cancer Center.

I’m in a clinical trial sponsored by Bristol-Myers Squibb, so I know that big pharma will be part of any cancer cure. It’s these companies that invest in the R&D that keeps the biotech sector afloat, and they provide the experimental treatments for patients like me who are running short of options in their fight against cancer. I also suspect that the government role in the moonshot will be to dole out increasingly scarce research funds more strategically. There will be inevitable overlap with the private sector, though, and I hope the relationship doesn’t get too cozy, and has a strong regulatory component to it.

A successful cancer moonshot can’t just benefit a few. What good is a successful targeted gene therapy if it’s so expensive that most insurance won’t cover it? It’s important for this mission to be about extending life, of course, but at a reasonable cost as well.

Drug companies should be rewarded for the effective and life-extending treatments they develop. But the executives running these companies, such as Dr. Soon-Shiong,  should think less about profit maximization and more about developing compassionate pricing models. A successful moonshot would give cancer patients all over the world and across all income levels affordable access to the latest immunotherapies. And just as in the U.K., drug pricing in The States should be negotiated at the federal level, to determine a profitable yet fair price for new cancer treatments. That would be a moonshot to be proud of.



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