Recently, I had the opportunity to speak to billionaire surgeon-inventor Dr. Patrick Soon-Shiong about his plans, both private and through the Cancer Moonshot 2020, to cure cancer.
Soon-Shiong, who made his fortune by founding and selling two pharmaceutical companies, has gathered a group of pharmaceutical companies, academic institutions, and insurers to spur cancer research and to attempt to make breakthrough gains by the year 2020. This effort dovetails with the Obama administration’s $1B plan to fund cancer research led by Vice President Joe Biden, whose son, Beau, recently died after a long struggle with brain cancer.
Soon-Shiong’s path to cancer research began while doing research for NASA that involved harnessing stem cells to make insulin. He stumbled upon a paper that reported that the binding of zinc to the blood protein albumin is what transposes it into pancreatic islet cells, enabling the production of insulin. This discovery led to an “aha” moment. “A light bulb went on. In fact you should feed the tumor, not stop the tumor. And if you could take a nanoparticle of albumin and attach Taxol [a common cancer drug] at the core, then it [the tumor] would take up the albumin and kill itself, like rat poison.” This revelation led to his creation of the cancer drug Abraxane, or albumin-bound paclitaxel (Taxol). Abraxane is used currently in a wide variety of cancers, including breast, lung and pancreatic cancer. “To this day, oncologists don’t understand the mechanism of action of Abraxane,” he said, “They think of it as another form of Taxol.” According to Soon-Shiong, Abraxane works so well is because the binding to the blood protein albumin allows it to penetrate cancer tissues better.
Abraxane has had huge clinical and commercial success, but he says the path to getting there wasn’t easy. Initially, after developing Abraxane, he approached large pharmaceutical companies but was unable to gain support despite showing that it had remarkable results in animal models. He was forced to make the painful decision to leave a secure academic career to risk launching his own company. His risk paid off. He ultimately founded both APP Pharma and Abraxis BioScience to support his work. In the end, APP Pharma was sold to Fresenius SE for $4.6B and Abraxis BioScience was sold to Celgene for $4.5B. Then, in 2011, he founded NantWorks, a holding company with a portfolio of firms to pursue his diverse entrepreneurial interests. One of these is NantHealth, a company that has developed a fully integrated digital health platform to collect and analyze genomics and proteomics data on cancer research patients.
Soon-Shiong, a bit of an heretic in the world of oncology, has ideas that veer from the traditional approach to cancer treatment. One example is how he wants to harness patients’ natural immune abilities to treat their cancers. “As we sit here speaking, we are creating 10,000 cancer cells a day. And the natural killer cells in your body are monitoring it and killing it,” he said, “Cancer is a normal evolutionary process. And guess how we’re trained as oncologists? To give you the maximal tolerated dose of drugs to kill those natural killer cells that are protecting you, which makes no sense. This is the dogma in oncology and even in drug development.”
He’d like to see drugs given at lower doses to cause what he calls “cytostress” instead of “cytotoxicity”. The natural killer cells of our bodies look for cells that are under stress (by detecting distinct proteins and enzymes that are released) and then destroy those cells. He suggests that chemotherapy should be administered at what he calls the “lowest effective dose” instead of the much higher “maximal therapeutic dose” typically given in clinical trials for cancer. The lowest effective dose, he argues, won’t completely wipe out patients’ immune systems, and thereby allow patients’ natural killer cells to target “cytostressed” cancer cells. He argues that this approach will revolutionize cancer treatment and lead to more cures and cites numerous personal anecdotes when this approach has worked for his patients.
Unfortunately, for the time being, he’s had a difficult time convincing oncologists and drug companies to move away from what he calls the “schizophrenic dichotomy” of treating with the maximal therapeutic dose that destroys natural immune function.
Another challenge to finding a cure for cancer, according to Soon-Shiong, is developing health IT systems to support cancer research. “Cancer is really a rare disease,” he said, “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer. So you actually need to create a collaborative overarching global connected system.” He continued, “The problem is now you have the other obstacle to the advance of medicine and the cure of cancer…it is going to be bombastic, dogmatic IT.” In order to solve this problem, Soon-Shiong is collaborating with other health IT experts in the Commonwell Alliance to facilitate the development of the digital architecture needed to support the interoperability of electronic medical records.
His critics question the sheer breadth of the projects he’s begun under his NantWorks empire, but Soon-Shiong seems too consumed with making his ideas a reality to worry about critics. At a time when one might expect him to retire, he seems to be only just beginning. “At this point in my career, it’s just: let’s show that there are patients that are alive. Let’s show we’ve created less suffering in cancer patients and then expand it globally.”