Tension between Washington and Beijing is on the rise over China’s close ties with Russia, differences over Taiwan, and a suspected Chinese spy balloon flying over the United States. Yet the two countries have a continuing common interest in working together to fight cancer, a leading physician at elite American cancer hospital Memorial Sloan Kettering Cancer Center said at a forum on Friday.
Collaboration makes sense given the magnitude of the problem in each nation and the huge potential benefits, said Dr. Bob Li, a medical oncologist and physician ambassador to China and Asia-Pacific at New York-headquartered Memorial Sloan Kettering Cancer Center. China and the U.S. account for almost 40% of the world’s 10 million cancer deaths annually and “really are the greatest victims of cancer,” said Li, speaking via a video interview at a gathering in the Chinese city of Yixing, near Shanghai, under the theme “China Healthcare Breakthroughs: Transformative Leadership Summit.” The event was organized by Forbes China, the licensed Chinese-language edition of Forbes, and attracted approximately 200 industry leaders.
“It makes sense for the two greatest victims to work together against this seemingly relentless, invincible enemy,” Li said.
Memorial Sloan Kettering –- or MSK — knows the fight well. It was among the world’s first hospitals dedicated to treating cancer when founded as the New York Cancer Hospital in 1884. MSK has for more than a century pioneered innovative treatments such as immunotherapy, which was first conceptualized by MSK cancer surgeon William Coley, Li noted.
Coley observed more than a century ago that the human immune system may play a role in fighting cancer. Today, up to one third of patients may benefit from life-saving immunotherapy that were later developed from Coley’s insights. More recently, the 2018 Nobel Prize in Medicine was awarded to Jim Allison, whose early work in immunotherapy was done at MSK. His life has been celebrated in a documentary “Jim Allison: Breakthrough.” MSK has also been a leader in precision medicine.
International collaboration among experts in clinical trials of new treatments, however, is a “crucial step” in translating scientific discoveries into saving lives, said Li, who is also a senior fellow for global public health at the Asia Society Policy Institute’s Center for China Analysis in New York. “We’re in an era of technological transformation and explosion of biological knowledge of cancers,” he said. International cooperation that tests new treatments via “clinical trials are absolutely a critical step. And we need to do better.”
Organizations aren’t working together fast enough to seize the potential benefits, Li said. As a result, “the whole ecosystem of oncology research development and clinical trials are in the process of being reformed. This is certainly a major focus for MSK — to play a key role in accelerating the breakthroughs of innovative cancer treatments and prevention,” he noted.
Trials involve drugs that are scientifically promising but are not yet on the market and, to be sure, their phases of development take time: phase I assesses safety, phase II looks at whether tumors shrink, and phase III sizes up the extent improvement is being made against current standard of care.
Yet without global collaboration, clinical trials can take about 10 to 15 years to complete,” Li noted. “And that 10 to 15 year process is painful. It’s slow, expensive, and most drugs actually fail this process. So this is an incredibly expensive exercise. It’s unsustainable if we just keep going with this status quo. International collaboration is now the key to advancing this clinical trial testing,” Li noted.
Besides shortening the time it takes to get drugs to market, international collaboration can get new treatments to more patients earlier. Today, for instance, only about 5% of all cancer patients participate in trials for new cancer treatments. “There’s something fundamentally wrong with this system,” Li said.
That’s all the important because new medicines to attack cancer tumors are now very much tailored to the individual through a field known as precision medicine. “We’re now matching specific medicines to specific patients,” he said. “It gets very difficult to even find the right patient that would benefit from the right drug.”
“Through getting the world together, we rev up the scale of the patient population and accelerate that timeline,” Li said.
One successful collaboration between the U.S. and China cited by Li as an example is in treating EFGR (epidermal growth factor receptor) mutations that are present in about 20% of lung cancers yet disproportionately strike Asian women who don’t even smoke.
U.S.-China and international collaboration in just two-and-a-half years as led by Professor Wu Yi-Long of Chinese Thoracic Oncology Group in Guangzhou resulted in the first FDA approval of the EGFR inhibitor Tagrisso that blocks this type of lung cancer. “This is a world record in terms of cancer drug development. We really need to leverage international collaboration to make this a norm, not the exception. The norm should be two to three years, not 10 to 15 years,” Li said.
Looking ahead, Li said, “the next decade is going to be so critical in terms of the way we reimagine the ecosystem of oncology research and development. Certainly the status quo of what we do right now is not good enough. It’s not going to be fit for the purpose in terms of curing cancers – it’s way too expensive. Pharmaceutical companies just can’t keep raising cancer drug pricing to pay for the R&D — that is also unsustainable. And they know that as well. So we really need to reinvent the ecosystem and make it a lot more patient centric.”
Rather than the 5% of cancer patients that get access to trials today, “we need access to every single patient with cancer. They all have a right, and they all should have an opportunity to access clinical trials. We need to bring the medicines to the patient, not have them jump through hoops, just to get into an academic center to have the opportunity to participate,” he said.
“This should be an option for every patient with cancer,” Li said.
“That is a fundamental rethink” that can be helped through international collaboration, he said. “We are now in the process of reinventing all of those rules and changing the ecosystem together with regulatory agencies,” as well as industry, academic centers and community centers where the vast majority of patients are cared for, he said.
“But to translate progress in laboratories to humans, we really need to do the clinical trials to get it right. And by accelerating that clinical trial process and reimagine the ecosystem, we can translate all of that explosion in science into saving lives,” Li said.
China with its large population of cancer patients “does have the scale that is unmatched,” Li said. “It can really accelerate clinical trials and cancer cures at a pace that is unimaginable in the United States. We’re struggling with clinical trial accrual in the U.S. at the moment.” And yet at the same time, a lot of the clinical demand is coming from increasingly prosperous Asia and in particular from China. Diversifying the patient population among different ethnic groups can also broaden knowledge of cancer and accelerate cures, he noted.
Other event participants included Forbes Senior Editor Alex Knapp; Forbes Midas List member; Nisa Leung, managing partner at Qiming Venture Partners; Innocare CEO Jasmine Cui; Profex Chairman Pavlos Kontomichalos; AstraZeneca China President Leon Wang; MSD China President Anna Van Acker; Gilead Sciences China General Manager Jim Jin; and Bristol Myers Squibb China President Siyuan Chen.
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— Russell Flannery
“What we need is numbers. And what we need is scale. What we need is speed. And that’s where U.S.-China can really synergize by working together,” Li said.
Other event participants included Forbes Senior Editor Alex Knapp; Forbes Midas List member; Nisa Leung, managing partner at Qiming Venture Partners; University of Michigan Business Professor Dave Ulrich; Innocare CEO Jasmine Cui; Profex Chairman Pavlos Kontomichalos; AstraZeneca China President Leon Wang; MSD China President Anna Van Acker; Gilead Sciences China General Manager Jim Jin; and Bristol Myers Squibb China President Siyuan Chen.