We want to get cancer under control by 2021. This bold statement was made by our organisation during our first conference: Understanding Life!
The name was devised by Noble Prize winner Sir Paul Nurse. Because only when we Understand Life, we will be able to cure Cancer. By bringing forward this bold ambition we know that we aim for a feat that is commonly dismissed as impossible. But by our efforts to revolutionise the cancer research world, we will try to achieve the impossible.
We will do so by putting patients first, aiming for excellence in research and looking for new efficient ways to bring treatments to the clinics. And last but not least, to do more on prevention. How was all this devised?
Jan Gerrit Schuurman
Not long ago, in the summer of 2009, I first made plans to travel to the USA with Coen and Peter. We left carrying appointments with three Nobel Prize winners, one of whom had been awarded the Nobel Prize of Nobel Prizes: James Watson, who together with Francis Crick has discovered DNA. Also, we were to meet with one of the greatest thinkers in particle physics and the designer of the first civilian (i.e. medical) nuclear reactor, Freeman Dyson.
Dyson treated us to an extra meeting at the world-famous Princeton Institute for Advanced Studies, where Einstein resided from the time he left Germany in 1933 until his death. He introduced us to Arnold Levine, a flamboyant American who had only one message for us: to be confident that the time was ripe for rapid developments. He convinced us that we could build a cooperative network in Europe, which especially at the present juncture might produce major breakthroughs.
Almost 40 years ago, when President Nixon launched the ‘war on cancer’, he was not so sure. Only now do the latest scientific advances deserve that name, he thinks. In those days, and until quite recently (less than five years ago), hopes for major victories against cancer were unjustified.
We started on our quest, not knowing we were to land in a boyhood dream. We couldn’t have suspected that the message we would be given was not only one of hope, but one of overwhelming perspectives. For years, every expert you could find had been saying it would take science at least another fifty years to find out enough about cancer to get it under control. Now, suddenly, the message was: it’s time to start believing that we have the means and knowledge at our disposal to make cancer a controllable chronic disease within ten years. However, this would require a sea change in the way people think about the nature of cancer and the best way to combat it.
The two Nobel Prize winners Harold Varmus and Paul Nurse were no less enthusiastic. They offered their active counsel and were prepared to field their administrative and scientific expertise – provided we on our side were willing to undertake a herculean effort: to forge the best hospitals and research centres in Europe together into a strong cooperative network.
Can we do that? According to the gentlemen across the Atlantic, we can. And James Watson (81) put it this way: “I want to see results in my Lifetime.” He gave us a signed copy of his autobiography and sent us on our mission. A mission possible!
The way forward
Soon after our visit to the USA, we travelled to Cambridge, Heidelberg, Paris and Barcelona. The conversations with the Europeans were no less encouraging.
But they all said things would have to change. All researchers we met had moved on in their careers and become research leaders. All gave us the same unmistakeable message, albeit in different wrappers.
The Britons emphasised the design and set-up of a new type of hospital, where diagnostics and treatment would take place under the same umbrella encompassing the lab, the ward and even the home. To which we always add: and information should also flow back from the home and the ward to the lab. Still, what the British message boiled down to was the need for a new tradition, a new, numerous group of physician-researchers equally at home in the lab and in the ward.
The French saw things slightly differently. They emphasized the importance of a new culture. Cancer is a complex disease, and every manifestation of cancer (in the breast, the prostate, the intestines et cetera) is unique. As a result, treatment is in many cases also highly complex. In many cases, multiple disciplines (clinicians, cancer biologists, bioinformaticians) will have to collaborate to find a working cure. What the French meant by ‘culture’ was that you can no longer make discoveries as an individual researcher or clinician. And there can no longer be a single principal researcher. Rather, every link in the research resulting in improved diagnosis and treatment requires open and broad collaboration, both within and among hospitals.
The Germans focus strongly on content and organization. They argued that while the treatment of cancer should be individualized, this can only be done in a scientifically responsible way (so that the patient also knows where they stand after diagnosis and treatment) if many more patients are available for research. After all, precisely because the disease is so unique, similar patients are very hard to find. This asks for efficient biobanks, available from the day the diagnosis is made, making it possible to compare new cases immediately to known others elsewhere.
How to be better?
So diagnostics and treatment must be improved. But improved in what way? What it comes down to is that two almost diametrically opposed issues will have to be addressed in a single organic approach. They are individualization and network building. Individualization because no two manifestations of cancer are the same: the underlying disease is different from one individual to the next. And network building so as to be able to utilise the knowledge and experience available within as wide a network of cancer centres as possible for the benefit of an individual patient.
How to be good?
How good is good enough? In other words: at what point can we begin to congratulate ourselves on the result we attempt to achieve with Understanding Life? Nobel Prize winners Paul Nurse (President of the Rockefeller University) and Harold Varmus had a clear vision: to make a bid for controlling cancer. While complete recovery must always be the goal, the minimum we should strive for was to be able to say to almost any cancer patient: you have cancer, and it will be chronic at worst. There is another element I want to mention in reply to the question how good is good enough. Good treatment requires profound cooperation with all patients. I will use the pronoun ‘we’, although I’m not a patient – because I could have been one.
We must both accept and demand that our clinical histories are diagnostically standardized, so that a diagnosis in Madrid can be compared to one made in Paris or Stockholm or Beijing, and so that data is recorded and tumour tissue is stored in accordance with high, uniform standards. Again, this is to enable patients to be compared to each other and for everyone to receive optimal support. If a pancreas cancer patient has been treated successfully in Singapore, this may be relevant for a lung cancer patient in a cancer hospital in Amsterdam. However, for this system to work, diagnostics and data recording will have to be uniform worldwide. That way, the information can be ‘just’ a mouse click away from my own doctor.
Let me be clear: cancer is and will remain a complex disease. There will never be a single remedy. We do not believe in the universal pill or shot that cures all cancer. What we do believe in is to help organize an individualized network.
It’s Understanding Life, stupid!
From our trip to the USA in September 2009 we also brought home a slogan: Understanding Life. The idea was simple enough. In order to treat cancer, you must understand life. But it works both ways. Once we understand cancer better, we will also be closer to understanding life. Cancer can bring us closer to what we essentially are. Thanks to cancer, that ugly, gruesome, life-destroying disease, we can learn about growth and development. Once we get cancer under our thumb, it will not only be something accomplished, it will be something understood.