Kim Norris

As a participant of AACR's Scientist-Survivor program last month, one of Kim's assignments was to write an article about her experience during the conference and then submit it for publication through either a newsletter, publication or web site.  Below is Kim's article.

The Latest Battle in Cancer Research

Molecular Science Research vs Organ Specific Research

In the beginning of April, I was invited to attend the American Association of Cancer Research (AACR) 96th annual meeting in Washington DC.  As one of nearly 40 cancer advocates from all over the world, I participated in a special program called the Scientist-Survivor Program.  The AACR selects a group of cancer advocates representing different cancer sites with the goal of exposing these advocates to the world of science.  The program tries to ease the advocates into the world of 30,000 cancer researchers and clinicians attending and presenting at the conference.

As a part of the Scientist-Survivor Program the advocates were encouraged to select an area of interest to help give us a focused context before venturing out into the various scientific presentations.  We were also introduced to a group of scientists and clinicians who acted as our mentors throughout the duration of the program and with whom we could turn to for further clarification and understanding during our scientific journeys throughout the conference.  I knew immediately the area of research that was causing me great confusion even before attending the AACR conference, and I looked at my participation in the Scientist-Survivor program as an opportunity to gain clarity and understanding around this area of research.  I discussed my issue with several mentors and with their encouragement I set out into the world of the researchers and clinicians to find the answers.

My area of confusion has to do with what appears to be a continuing battle between two differing approaches for cancer research.  I have heard the first approach referred to in different ways including basic science or molecular biology.  This approach encompasses such things as nanotechnology and the cancer genome project.  The second approach is referred to as disease specific or organ specific research such as lung, breast, colon, etc.

As a lung cancer widow and as one of UCLA’s lung SPORE (Specialized Program of Research Excellence) patient advocates, a program that specifically researches lung cancer, I have always supported and understood organ specific cancer research.  I also know and understand that the organ specific researchers focus on cancer cell characteristics at the molecular level.  So why do I seem to hear about these approaches as an either/or battle, especially as it relates to funding opportunities?     

My basic understanding before attending the AACR conference was that the dispute is based on the premise that cancer is comprised of more than 200 different diseases, each with its own set of rules and characteristics.  Within each organ site where cancer cells begin to grow, the rogue cells look and act differently from organ site to organ site.  This explains why it is so important to understand the origin of a specific cancer and why prevention and treatment varies from organ site to site.  It also explains why there are many different diagnostic tests.  Each cancer type throws off different substances into the body that may be measured or tracked such as the PSA test for prostate cancer.  Just writing about these differences once again reminds me of the enormity of understanding called for in overcoming this disease.

I knew that traditionally cancer research has been organ specific.  Lung cancer researchers become experts on understanding the lungs and the different types of cancer associated with the lungs.  Breast cancer researchers become experts on breast tissues, cell types and women’s hormones and how they all come into play around the different types of breast cancer.  The criticism of organ specific research is that on a molecular level some researchers believe opportunities may be missed where one type of organ specific cancer discovery may work for another organ specific cancer.  For example, research at both UCLA and the University of Pittsburgh is currently focused on estrogen receptors discovered on some lung cancer tumors and the role of proven breast cancer treatments in the treatment of these specific lung cancers.  Although this research is very promising, it does not mean that lung cancer and breast cancer can be treated the same way.  The breast cancer treatment being used is a very specific targeted therapy and is being combined with other lung cancer specific targeted therapies.  Without the detailed understanding of the unique characteristics of lung cancer, the breast cancer targeted therapy would not work on its own in the treatment of lung cancer.  

On the flip side, I continue to hear about a growing belief that at the deepest molecular level, all cancers have a commonality and therefore rather than looking at specific organ sites, researchers should be looking into the deepest pathways of cells at the molecular level.  For example, understanding angiogensis, the supply of blood vessels to a tumor, was developed without necessarily thinking about a specific organ site but instead focused on some basic understandings of the need for solid tumors to receive a blood supply in order to grow.  Recently, Genentech’s new anti-angiogenisis drug Avastin has made headlines for its success in treating certain colon cancers and is now in trials with other organ specific cancers.

During my quest, one question I set out to get answered is, once molecular level researchers discover a new pathway, how do they determine which of the over 200 cancer types to test it on?  I received various answers including “we just pick some”, which seems like the old dartboard method to me, or we test them on all cancer types to see which, if any, respond.  This answer was usually from the large biotech companies who base their business model on the molecular level model rather than the organ specific model and can more readily afford to test their newly discovered pathway on all cancer types.  The problem I have with these answers is the randomness in which treatments are developed for organ specific cancers.  What if a specific organ cancer type has a very unique molecular characteristic that would only be found by studying the specific characteristic of that organ cancer type?  If that were the case, it is possible the molecular model research may never find the unique pathway for that specific organ type. 

Lung cancer is a great example of this flaw.  Based on a basic business model, it would seem the biotech companies would be fighting each other to discover an effective treatment for lung cancer.  The incident rate for lung cancer is third only to breast and prostate cancer and it is the leader in cancer mortality surpassing breast, prostate, colon, liver and kidney cancer combined.  In a basic supply and demand business model, the demand for lung cancer treatment is obvious yet the biotech companies continue to by-pass lung cancer leaving it with an unchanged 15% five-year survival rate.  Much of that resides in the complicated characteristics unique to lung cancer that can only be addressed by understanding the specific nature of lung cancer through organ specific research.

The closest answer I could up with in exploring this research question is that it appears to be the biotech companies that are promoting the molecular level model because it suits their business/profit model.  Organ specific research is left to the institutional researchers who have more grant opportunities based on organ specific research.  Although I was bound and determined to understand this difference in research approaches I must admit to feeling like I have only scratched the surface.  My conclusion, which is tentative at best, is that they are not mutually exclusive.  In fact, I think we need both research models simultaneously so they feed on each other’s discoveries.

If this is true, why do I feel conflict between the two models?  Easy.  It’s the money!  The National Cancer Institute (NCI) is shifting money away from organ specific research in order to fund the molecular research model such as nanotechnology and the cancer genome project.  This means that many great organ specific research grants are not being funded.  With Congress threatening to decrease the 2006 budget for the NCI, this becomes a major issue.

Regardless of what Congress does, perhaps the NCI should slow down its molecular research funding and make sure there is available funding for the organ specific research.  The role of the NCI should be to encourage both research approaches and to act as the liaison to ensure all cancer researchers are taking full advantage of the rapid rate of discoveries.