"People say we want a cure . . . but the American people have decided what their priorities are and their priorities don't include cancer," Otis Brawley, chief medical officer of the American Cancer Society, said in a recent BioWorld interview.
That's part of the reason the treatment of metastatic cancer has been a "disappointment" over the last 40 years, according to Brawley.
New cancer drugs may be marketed by drug companies, but a lot of them get their start in academic labs funded by NCI grants. As of now, the NCI can only afford to fund 10 percent of the grants it approves, Brawley said. The money tends to go to conservative choices because "nobody wants to fund an idea that might fail and get accused of wasting grant money," he added.
An example: Brian Druker's early research on Gleevec (imatinib) was turned down by the NIH as too risky and "darn near didn't get funded by the ACS either," Brawley said. Gleevec, now marketed by Novartis for chronic myeloid leukemia and certain stomach cancers, has been hailed as one of the greatest breakthrough cancer drugs and generated $3.7 billion in sales last year.
Not all cancer drugs have been as successful as Gleevec â€" either financially or in terms of efficacy. In fact, not many have. Brawley argued that decreased smoking and increased screening for breast and colorectal cancer have had a lot more impact on cancer death rates than new drugs.
The survival benefit of drugs for metastatic cancers is often measured in "a few days to a few months," Brawley complained. When Tarceva (erlotinib, OSI Pharmaceuticals and Genentech/Roche) was approved for pancreatic cancer based on a survival benefit of less than two weeks, someone mailed Brawley a stopwatch.
That said, biotech drugs are still important, in Brawley's opinion, because developing drugs that improve survival by two or three weeks is a "step toward getting three years." And there are always patients who exceed the averages, achieving results nothing short of miraculous.
With venture capital tough to come by, angel investors seeing their pocketbooks pummeled by the market, and nonprofits struggling to keep their own doors open, that government grant funding is more important than ever. Let's hope somebody besides the folks already in the choir hears Brawley preaching.
War on Cancer photo by Flickr user Danny McL, CC2.0.