John Steele in Nautilus:
Patrick Soon-Shiong wants to turn cancer treatment upside down. On January 12, Soon-Shiong and a consortium of industry, government, and academia announced the launch of the Cancer MoonShot 2020, an ambitious program aiming to replace a long history of blunt trial-and-error treatment with what amounts to a training regiment for the body’s own immune system. That system, Soon-Shiong argues, is perfectly adept at finding and eliminating cancer with exquisite precision—if it can recognize the mutated cells in the first place. Helping it to do so could represent a powerful new treatment for the disease, akin to a flu vaccine. Soon-Shiong has hit home runs before. This past July, one of his firms underwent the highest-value biotech IPO in history. A cancer drug he developed, called Abraxane, is approved to fight breast, lung, and pancreatic cancers in more than 40 countries. Soon-Shiong’s path from medical school in South Africa through residency in Canada, to UCLA professor, NASA researcher and corporate CEO has given him the bird’s-eye view necessary to take on a project this ambitious, as well as the resources to marshal the world-class computing and genome-sequencing facilities that it requires.
When I sat down with him after the MoonShot announcement, I found him enthralled by the power and aesthetics of newly emerging cancer science, and deeply optimistic about near-term outcomes. This, it seems, is an exciting time to tackle cancer anew. Yes, I think that’s why we’ve been losing the war. As physicians we’re trained to be reductionist. We rigidly follow protocol. But life is not that way. Cancer is not linear—it is completely non-linear. It lives in the science of chaos. There’s no single point of control. You need to attack it in a non-linear fashion across time and space, monitoring it and truly dancing with it. I know this sounds philosophical and silly and esoteric but it’s not. If you biopsy a patient with breast cancer twice in the same day, once in the breast and once in the lymph node, you can get cancer cells with different sequences. Even if you biopsy two different points in the breast, the sequence can be different. This heterogeneity has really only come to light recently. Which breaks all these reductionist assumptions, because which target are you hitting and what made you choose it? Is it just because you biopsied here instead of there? You’re whacking a mole, but you have no idea which one you’re whacking. You whack this one, this other one wakens. The only chance we have, in my opinion, is to do what I call micro killing and macro killing at the same time. Micro killing meaning you go after these little targets, maybe even using a little chemotherapy. And macro killing meaning either surgery, radiation, or immunotherapy.