From blog post to ASCO session

“Cancer Moonshot” is almost a common phrase in the United States. When then-Vice President Joe Biden first announced the $1.8 billion initiative in 2016, he set himself the lofty goal of “ending cancer as we know it. The Cancer Moonshot was primarily focused on genomics, precision therapy, immunotherapy and artificial intelligence.

At that time, I was a medical oncology intern and was not yet active on social media or in publishing. I started writing a blog in cancer in 2016, April called Last month in oncology with Dr Bishal Gyawaliwhere I summarized the top oncology news from the past month and provided my own unbiased commentary.

In November 2016, I came across a very strange press article. He said a leading US cancer center and a billionaire were in a legal battle over who owned the term “moonshot”. The trial bothered me. I didn’t understand why owning the term “moonshot” was so important. The contest, in my opinion, should be about who helps more patients, closes disparities in cancer care, and alleviates pain and suffering, not who owns a term.

The news made me think of one of my patients in Nepal which had ovarian cancer. His best shot was a treatment with carboplatin and paclitaxel. But to afford these drugs, she was forced to sell her house.

The side-by-side comparison was alarming. I have seen a patient in a low-income country struggling to pay for necessary care against a rich country pumping money into lunar initiatives with dubious value and people fighting over who owns the term itself. As I reflected on this patient and this difficult situation, I wrote the following lines in a Blog of December 2016:

[W]We should focus on ways to improve outcomes in cancer patients, rather than wondering who coined the term “cancer moonshot.” When public health continues to be ignored, when cancer remains a killer, when more than 90% of cancer patients worldwide cannot afford cancer treatment, where does the term “cancer moonshot” belong? has no importance. Forget the moon; back to the reality of blood and flesh on the ground.

I would instead support a “cancer field plan” that focuses on campaigns to reduce smoking and obesity, promotes exercise and healthy eating, and encourages research that can be immediately applied to all communities. world. “Cancer groundshot” is the term. Do not hesitate to use it.

In October 2017 I was invited to give a talk at the Royal Society of Medicine World Oncology Meeting. I chose this place to develop the concept of a fundraiser against cancer. In my speech, I emphasized that we must prioritize initiatives that help every patient get the care they need. When 90% of patients in low-income countries do not have access to radiation and 50% do not have access to timely surgery, I was clear that we could not “immunotherapy get us out of the global burden of cancer”. If we invested a fraction of Moonshot’s money in field activities – surgery, Radiotherapy facilities, curative treatments, proven and cheaper drug therapies, painkillers – we would save more lives. I received an extremely positive reception from the public.

At that time, I had completed my training and was working as a medical oncologist in a government hospital in Nepal. I was in final discussions to move to Harvard for a fellowship in a few months. But by a twist of fate, I was introduced to Chris Booth, MD, of Queen’s University, Kingston, Canada by Ian Tannock, MD, and Richard Sullivan, MD. While I was still in Nepal, we communicated by telephone. Two things happened on that call. First, it marked the beginning of a long friendship. We are now colleagues working together in the same clinic at the same facility. And second, we discussed turning my Royal Society speech into an article. This led to my first official publication in the field of cancer, published in The Lancet Oncology in 2018.

Subsequently, the idea began to come to life on social networks. Unlike some of my other slightly more controversial ideas, such as ramucirumab is not a good drug – everyone seemed to be behind this concept. Oncologists, policy makers, regulators and laypeople alike could all see the merits of the soil cancer philosophy and believed that this initiative needed as much priority and funding as moon cancer to truly “end cancer as we know it”.

Since then, the idea has continued to gain ground. I have given dozens of talks in the field of cancer, both in high and low income countries and at meetings including cancer, the AORTIC International Cancer Conference in Africa, ASTRO (American Society of Radiation Oncology) and the European Cancer Summit. I co-wrote a chapter on the concept of the ASCO 2022 educational book. And on the 5th anniversary of cancer moonshot, Nature posted my take on a cancer field photo. When I was invited to the ASCO 2022 Annual Meeting to chair a cancer field educational session on June 3, it made me reflect on this journey that I am sharing today.

Despite the momentum behind the groundbreaking fight against cancer, I know this is just the beginning. Speeches and articles do not save lives. We need concrete actions, and I hope that these discussions and these documents will create momentum and encourage effective policy that will save lives.

I tell this story not to emphasize how fantastic my idea is, but to emphasize that no matter where you are in today’s world, you can make a difference. I hope to encourage the global community of young oncologists to say that, whatever their background, they can make a difference.

Bishal Gyawali, MD, PhD, is an Associate Professor in the Departments of Oncology and Public Health Sciences and Scientist in the Division of Cancer Care and Epidemiology at Queen’s University in Kingston, Ontario, Canada, and is also an Affiliate Professor in the Program on Regulation, Therapeutics and Law in the Department of Medicine at Brigham and Women’s Hospital in Boston. His clinical and research interests are in cancer policy, global oncology, evidence-based oncology, financial toxicities of cancer treatment, clinical trial methods and supportive care. He tweets at @oncology_bg.