1. May, Brandon

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"We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard." These immortal words from President John F. Kennedy have inspired millions of people worldwide since they were first heard in 1962 during a talk at Rice University in Houston.

Moon Shots program; ... - Click to enlarge in new windowMoon Shots program; MD Anderson Cancer Center. Marina Konopleva, MD, PhD, Professor of Leukemia serves as co-leader of a clinical trial that involves a novel small molecular discovered in the Moon Shots Institute for Applied Cancer Science.

This speech was given to facilitate greater support and involvement in the Apollo program, which was focused on getting the first person on the moon. Not only has this one quote inspired others to initiate positive changes in their personal lives, but many professional ventures have been accomplished due to JFK's resonating words. The Moon Shots Program, a collaborative, multidisciplinary initiative from The University of Texas MD Anderson Cancer Center, Houston, is one such endeavor. This program has focused on accelerating the advancements of medical and scientific discoveries involved in cancer while optimizing research and treatment initiatives to improve survival and overall cancer care.


Facilitating Improvements in Cancer Care

Currently in its fifth operational year, Moon Shots is comprised of multiple programs and platforms that have provided significant discoveries and legislative efforts focused on improving the care of cancer patients. Many of the initiatives of the program have focused on early cancer prevention, identification, and intervention in an effort to improve outcomes. Approximately 150 clinical trials at MD Anderson have been initiated thanks to the program, many of which are studying new drug compounds and strategies for improving existing efficacy rates of novel therapeutics.


"We know only so much about disease, and we realize there is a barrier to clinical knowledge due to clinical research," said Giulio Draetta, MD, PhD, the program's Co-Leader and Professor of Genomic Medicine and Director of the Institute for Applied Cancer Science (IACS) at The University of Texas MD Anderson Cancer Center. "In the creation of the program, we discussed bringing together different clinical perspectives as well as the use of philanthropic funds to drive specific themes in oncology and to encourage others to work together in our institution to get results."


The Importance of Multidisciplinary Care

The leaders of Moon Shots are in full agreement that a multidisciplinary approach, compared with a strategy that siloes off each individual researcher or clinical team member, is essential for improving care for cancer patients. "You need a variety of expertise," said Draetta. "It is important to add people who have expertise in tumor biology, drug discovery, and disease prevention, as well as those who are experts in reaching out to the community. This is the spirit of collaboration."


A multidisciplinary approach to cancer is a particularly important aspect of care, given the molecular complexity of the disease, and represents a specific aspect of Moon Shots. In a published statement from Draetta, Moon Shots has enabled a more granular, myopic focus "toward novel discoveries that, quite simply, would not have occurred without such focus."


According to Andy Futreal, PhD, Department Chair and Professor, Department of Genomic Medicine, MD Anderson Cancer Center, "The [Moon Shots] is ambitious, but we've begun to see what our core strengths are. Much like how we take care of patients at MD Anderson, our focus [in Moon Shots] is on multidisciplinary care to treat the individual patient and their varying levels of complexity.


"Cancer is a very complex problem-why don't we treat it the same way in the research space as well as in the clinical model?" Futreal added that rather than working in siloes, multidisciplinary approaches can elevate cancer care and directly impact outcomes. This elevation, however, relies on communication between departments, especially in regard to patient data. "You can bring all the people together in a room," he noted, "but if you don't bring power to the meeting-data sharing, for example-you can't get the work done."


Cancer Prevention at the Legislative Level

"This is a new program," said Futreal, "but we're beginning to see themes emerge." One such emerging theme-immunotherapy-has been no surprise to most oncologists and cancer researchers. Additionally, prevention has become another theme that has emerged from the program. The idea of prevention has become such a primary concern that the leaders of Moon Shots have gone so far as to influence state legislature regarding use of carcinogenic devices (i.e., tanning beds).


"One of the things that is important is the initiatives around prevention, such as topics that foster education around tanning beds," stated Futreal. He added that prevention and early diagnosis is perhaps the most obvious direction for impacting cancer, particularly as it relates to carcinogenic substances, devices, and lifestyle behaviors. "Think smoking and UV protection. We want to think about how to influence U.S. legislature to ban tanning beds for people under 18." The leaders of the program were able to take the data available on tanning beds and work directly with Texas legislation. "The program is trying to bring into the equation cancer control, prevention, and the opportunity of early identification and intervention," Draetta added.


Tobacco represents another area where the Moon Shots team has focused, and rightly so. Despite the common knowledge of the devastating effects of tobacco, this substance continues to be a pernicious health threat. Due to the efforts of Moon Shots, Draetta reported, MD Anderson has initiated a ban on smoking on campus as well as a smoking cessation program for all current employees.


Current Focus & Directions

In 2015, the leaders of Moon Shots expanded the initial program to include 13 disease-focused initiatives. These initiatives include involving a multidisciplinary study of B-cell lymphoma, breast, colorectal, glioblastoma, leukemia, lung, melanoma, ovarian, pancreatic, prostate, and HPV-related cancers. Additionally, a total of 10 study platforms were established, including cancer prevention and control, proteomics, adoptive cell therapy, immunotherapy, and the Translational Research Accelerator.


Regular internal and external peer-review is used for the program's individual components in an effort to prioritize the endeavors that are likely to make the most significant impact for cancer patients. Overall, these platforms have been important for providing a translation of big data and scientific discoveries for the ultimate advantage to the cancer patient. Currently, philanthropic funding for supporting priority research and the infrastructure of the program has totaled more than $451 million.


One of the platforms of the Moon Shots Program is the IACS, which has facilitated advancement of a novel therapy (IACS-10759) to clinical trials for acute myeloid leukemia (AML) patients. In October, a phase I clinical trial of IACS-10759, which disrupts cancer cells' energy production, was opened to AML patients. Laboratory discovery of the therapy as well as the implementation of the clinical trial has been run entirely within the IACS platform. Future clinical trials are projected.


The Take-Home Message

Since its inception, Moon Shots continues to trigger interest at the local, national, and international levels. "We're trying to influence conversations," Futreal noted, "to help people understand how you make a shift." This shift into more optimized patient care has to work at multiple levels, with the underlying intent on bringing multiple teams from different backgrounds together to tackle the problem.


While this program isn't necessarily about the "coolest" science out there, Draetta and Futreal indicate that this collaborative effort may still provide long-lasting benefits to cancer care due to its direct and widespread impact on treatment in patients with varying cancer types and severities.


Brandon May is a contributing writer.


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