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A Candid Conversation with AACR President José Baselga

Eastman, Peggy

doi: 10.1097/01.COT.0000473098.48702.f0
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In a telephone interview in conjunction with the new American Association for Cancer Research Progress Report (see accompanying article, cover). AACR President José Baselga, MD, PhD, expressed optimism about the future of cancer research, but stressed the need for greater and more consistent federal funding levels to achieve higher goals for patients. Baselga is Physician-in-Chief of Memorial Sloan Kettering Cancer Center.

“We are going big; we want to make sure that our message is being clearly and widely presented,” he said of the AACR's mid-September launch of the report, its Congressional reception and briefing, and the Rally for Medical Research on Capitol Hill. “I'm so proud of what the AACR is doing.”

“The numbers are staggering. We are so close to making more advances that we cannot lose steam right now; it would be wrong,” Baselga said of the toll cancer takes in the United States and globally. The report shows that cancer accounts for one in four American deaths and one in seven deaths worldwide.

‘Pleased’ is a Complicated Word

Asked if he is pleased with the current pace of cancer research advances, Baselga said, “Well, ‘pleased’ is a complicated word, because, you know, for people like us we have a sense of urgency. We cannot be pleased.”

He added: “I think the question is, am I convinced that we are making progress?, and the answer is yes. Am I convinced that there is an acceleration? The answer is yes. Am I excited about what I am seeing ahead of us and by what's been happening just in the last couple of years? The answer is yes.”

He continued: “If you were to ask me where we are, I think we are perhaps at the moment in the whole history of oncology where more advances are occurring. I do have a sense of optimism and confidence that we are making strides in our fight against cancer.”

25% Decrease in Real $$ for Research

Asked if the seven percent federal cancer research funding increases the AACR has requested would markedly increase the pace of advances against cancer, Baselga said: “It would pick up very dramatically, because we have to realize that over the last 10 years we had a 25 percent decrease in real dollars for research.

“Imagine any economy that has dropped by 25 percent. It would pick up—with one provision, I think.” That provision, he said, is that the federal funding commitment to biomedical research “has to be sustained over time.” To get a funding peak one year does not work, he emphasized. “Research needs the stability of commitment.” Without that sustained stability, he said, “People are not going to go into science.”

For a young man or woman considering career choices, “if you're an incredibly smart person and you know upfront that the funding line is eight percent of submissions, it's unbearable. If we build confidence that over the years there's going to be a sustained increase in funding, I think it would do wonders.

“It would: (a) fund very important research that is right now not being funded, and (b) attract the best minds we have back into science. There was one point at which the best minds we had were in science, and that now is under tremendous threat.”

Even for people who really love biomedical research, he said, “They have to be realistic” and choose career paths that will allow them to be successful. He decried the fact that today there are experienced biomedical researchers in the best universities who cannot get funded—“it is incredibly worrisome.”

Precision Medicine Oversold?

Asked if the concept of precision medicine in oncology is being oversold to the general public, Baselga said, “That's a great question. You know, whenever a catchy word is being used, there is the risk of that word being used in so many situations... I think that there is the risk that this concept has been oversold. I've seen people talking very lightly about precision medicine, and we do need to be conscious that it's something that has to be used appropriately. But this applies to everything; it applies also to the new therapies. You can see people hyping it to the extreme, and we need to be cautious.”

Hype aside, Baselga noted, “That does not eliminate at all the excitement that we have for precision medicine, because it really is a path forward. Now, is this done? No. It is not done. Do we have to oversell it? No. We have to communicate responsibly what we are trying to achieve, and this is going to be a long, long process.

“We are not going to be curing cancer overnight or in the next five years. This is not the way it's going to be. It's too big a problem. But precision medicine as we define it does represent an important step forward. It is the first time we're using genomic data from tumors to try to understand what's driving them, to try to design therapies that are more precise, to try to design combination therapies, and to try to monitor what's happening in real time—and this is an advantage. This is an advance that is very, very obvious.”

Change in Phase I Trials

Baselga cited and praised “all these clinical trials that we are using now against genomic-driven mutations that are very exciting... Real people benefit from them.” It used to be, he said, that not very many people would benefit from participating in Phase I clinical trials, “but this is different now.”

He cited the new NCI-MATCH (Molecular Analysis for Therapy Choice) precision medicine clinical trial, in which his institution is participating, as an example of an innovative clinical trial against genomic-driven mutations. He noted that he and his colleagues recently published results of a trial showing responses in patients with cancerous tumors expressing BRAF gene mutations who had no previous effective therapies, responses which are very gratifying.

So, Baselga summed up of the promise of precision medicine: “This is an advance; there's no question.”

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