Cancer moonshots have a familiar ring to it. I realized it when I heard a particular company tying up with “universities and world-class researchers” for finding the “cure to the cancer” and putting an end to what has been described as the “global problem” and a “scourge for the humanity”. These are laudable goals, but it divides the jury on these methods.
Cancer prevention is an under-funded and under-researched area. If the rates of cancer fall, the projections for “returns on investments” falls disproportionately. If the obesity crisis in the US wasn’t bad enough, there would be no spin-off specialists like bariatric surgeries. If people live healthier lifestyles by eliminating red meat (incidentally would also impact climate-change theorists), it would be the end of colonoscopies and other arm-chair think-tanks.
This is a highly cynical view of the “industry” but moonshots with high rates of failure are also subject to reason and its wider utility/applicability across scientific domains. I remain a steadfast believer in translational science and medicine. Moonshots should allow preventive approaches and better identification of sequences leading to cancer. It should empower the lower rungs of healthcare delivery to identify and spot out the “warning signs of cancer”. Research should be broadly applicable that should percolate to areas that are resource constrained.
What can we define an epochal event in radiation oncology? Two. One was the transition from 2D era to conformal therapies and modulation. The other is the development of MRI-Linac. The second represents a broad culmination of the moonshot approaches and direct benefit to patients. I am excited by possibilities of functional imaging and on-board adaptive radiation (including the clinical target volumes) but that would require faster acquisition times and more on-board processing than is workable.
When the same concern arises in such wildly different contexts, we may be worrying about a common problem: a systematic preference for marginal gains over long shots. It’s not hard to see why. It is much more pleasant to experience a steady trickle of small successes than a long drought while waiting for a flood that may never come.While marginal gains add up, they need to be refreshed by the occasional long-shot breakthrough. Major innovations such as the electric motor, the photovoltaic cell or the mobile phone open up new territories that the marginal-gains innovators can then explore.Why moonshots elude the timid of heart | Financial Times
Last, but not the least. Radiobiology holds the key to a successful cancer therapeutic approach, and that would be my moonshot theory. We need to move beyond the LQ model to refine our understanding of complex molecular phenomenon of cancer cell kill and make it more widely accessible to future generation of trainees.