Disrupting Cancer
The following is a script from "Disrupting Cancer" which aired on Dec. 7, 2014. Dr. Sanjay Gupta is the correspondent. Draggan Mihailovich, producer.
Cancer has outwitted scientists and doctors for decades. More than 1,500 people still die of the disease every day in this country. But scientists will tell you they have learned more about cancer in the last five years than ever before. And no one is more optimistic about what that will mean for patients than Dr. Patrick Soon-Shiong. He's been called a genius, a showman, an innovator and a hypester. He's also the richest man in Los Angeles, a doctor and entrepreneur who is worth an estimated $11 billion.
Soon-Shiong was a respected surgeon before making his name in the cancer world by developing a multibillion dollar drug that few initially thought would work. He now wants to disrupt the conventional way we treat cancer and Soon-Shiong is overflowing with ideas on how to do it.
Give Dr. Patrick Soon-Shiong a white board and a few markers, and like a mad scientist he'll diagram how he thinks cancer can be beaten. He wants to attack on multiple fronts and is confident there is a pathway to the cure. For 45 minutes, he outlined his vision from beginning to end.
Sanjay Gupta: This is a crazy looking board (laughter)...
Patrick Soon-Shiong: This is what goes on in my head you know, this is, it's like bursting. It just has to get this stuff out right?
Sanjay Gupta: Are we looking inside your head?
Patrick Soon-Shiong: Yeah, I think so, a little bit (laughter)...
Sanjay Gupta: How long before we get to here?
Patrick Soon-Shiong: I'm incredibly encouraged to say that we are on the path. And the technology to actually do all these things is not just hypothetical.
Technology is the main weapon Soon-Shiong is deploying against cancer. In October, at his company's headquarters in Los Angeles, final tests were being run on high-speed tumor genome sequencing machines that Soon-Shiong is convinced will unmask the molecular secrets to cancer.
Patrick Soon-Shiong: And for the first time with this technology we can watch it, catch it, outsmart it, and play chess at this multi-dimensional level.
To understand the significance of what Soon-Shiong is touting, it's important to know what cancer is.
Patrick Soon-Shiong: A cancer is not what people think, cells growing. Cancer is actually the inability of the cells to die.
The key is figuring out the genetic mutation or glitch that prevents cells from dying a natural death. Soon-Shiong's hope is to provide patients with the precise genetic mutations that fuel their cancer regardless of where tumors are found in the body.
Patrick Soon-Shiong: The mutation that happens in lung cancer could be the exact same mutation that happens in the breast cancer. So you need to treat that patient based on its mutation not on its physical, anatomical location.
"A cancer is not what people think, cells growing. Cancer is actually the inability of the cells to die."
Sanjay Gupta: That's a big idea. I mean, you know, the idea that the breast cancer specialist, they're looking for breast cancer mutations and they may be missing the ball.
Patrick Soon-Shiong: Absolutely.
A lung cancer drug could work on breast cancer, for instance, if the mutation is the same.
The concept of doing away with labeling the disease by where it's found is not unique to Soon-Shiong, but it is a tectonic shift in the fight against cancer, the notion of classifying a cancer by its mutation.
Patrick Soon-Shiong: Imagine reclassifying cancer. And having people conceive and understand that cancer's a slew of rare diseases. So I am very excited because we are gonna create this revolution.
Sanjay Gupta: And what's it going to mean?
Patrick Soon-Shiong: Well, it's going to mean you have a better shot at having a better outcome and having a quality of life and actually turn the cancer hopefully into a chronic disease.
Sanjay Gupta: That's very optimistic. Realistic as well?
Patrick Soon-Shiong: I think so. Very much so.
Soon-Shiong has appointed himself to lead this revolution. Cancer genome sequencing is not new but what's different about Soon-Shiong's project is the scale. He has spent nearly a billion dollars of his own money to build a massive infrastructure, run by super computers, to find every single genetic mutation that could drive cancer.
This is Soon-Shiong's plan: A patient, anywhere in the world, has his tumor biopsied. The tumor cell's complete genetic map is then created all the way down to the proteins that are produced. What only recently took months can now be done in a day.
Ultimately, personalized information for each cancer patient would show up in the palm of his hand.
Patrick Soon-Shiong: This is the baby...
Sanjay Gupta: That's it, huh?
Patrick Soon-Shiong: It'll be the world's first browser of the cancer genome, so think about that. You'll be able to fly through to get to the single letter that's mutated.
He's teamed with Blackberry to produce a device that will identify for patients and doctors what they need to make more informed decisions.
Sanjay Gupta: At the end of the day, someone has a tumor and they could find out the complete analysis of that tumor and what the perfect drug is to treat it?
Patrick Soon-Shiong: Correct. That's what's exciting. It's not the end of the day. This is what we think we can bring to the world now.
But some in the cancer world fear Soon-Shiong is getting ahead of himself, that he's declaring victory before any of this has been proven to work consistently.
Derek Raghavan: It's show me the money, show me the data. Show me that it's true.
Dr. Derek Raghavan, a renowned oncologist and researcher, is president of the Levine Cancer Institute in Charlotte, North Carolina.
Sanjay Gupta: Dr. Soon-Shiong says, 'Look, if we can figure out which mutation's driving cancer, we're gonna be able to find the drugs that treat cancer.' Is that a fair theory?
Dr. Derek Raghavan: Yes. That's a fair theory. But to say I can throw a tumor into a gizmo, and that gizmo will tell me the answer in a few minutes, and everything will flow from that, I don't think we're there now. I don't think we'll be there next year. I think there's just too much hard, complex science that has to be done before this is state of the art. But it's a very cool idea for the future.
The vast majority of mutations are actually not a threat. So to figure out which mutations are dangerous, Soon-Shiong is going back in time.
Patrick Soon-Shiong: This national treasure...
Sanjay Gupta: Wow...
In the basement of the John Wayne Cancer Institute in Santa Monica, California, decades of cancer tissues were stored by scientists in deep freeze vats. Now Soon-Shiong wants to use technology that didn't exist back then to map the genomes of these thousands of tissues in order to look for critical patterns.
Sanjay Gupta: So even after a patient died, their samples were stored here. They can go back, say, "Oh, they had this mutation." And now we can explain that this mutation actually leads to death. And other mutations may not.
Patrick Soon-Shiong: That's exactly right. And ask the question, "Why did this patient live and why did this patient die? Why did this treatment work, why did that not work?"
To make any of this work, Soon-Shiong believes you need to upend the way cancer drugs are developed. He's started a biotech company to try to dramatically ramp up production.
Patrick Soon-Shiong: I know it sounds an audacious goal but you need to actually develop 20 to 30 drugs a year to actually get ahead of this game.
Sanjay Gupta: Right now it takes a few years to create a single drug and you're talking about 30 drugs in, in one year. Is that really feasible?
Patrick Soon-Shiong: I think that's where we have the challenge in pharmaceutical industry. We actually need to change the way we develop drugs now.
Soon-Shiong is impatient with the pace of drug approvals. In the early 90s, he invented a drug called Abraxane that treats pancreatic, lung and breast cancer patients. But more than a decade passed before the FDA approved it.
Patrick Soon-Shiong: The problem is for cancer, however, we don't have that time. You know, if you have pancreatic cancer, you have two months, if you have metastases throughout your body. The war against cancer is a war against time.
Soon-Shiong is also frustrated with what he calls the trial and error cycle of cancer care.
Patrick Soon-Shiong: The truth of the matter, we treat cancer today, we guess. We take what we call the average results, put it in you, see if it works. If it doesn't work, oops, we'll try another drug. If it does work, we stop the drug. When you look back 10 years from now, it's almost barbaric.
The 62-year-old native of South Africa can afford to be outspoken because of his immense wealth. He doesn't need to rely on the government or Big Pharma for funding. Soon-Shiong is certain what he terms the Dark Age of cancer treatment is nearly over, and the Enlightened Age is about to begin.
Sanjay Gupta: What will the average person note about the Enlightened Age versus the Dark Age?
Patrick Soon-Shiong: The treatment doesn't need to be painful. Metastasis doesn't need to be a death sentence. Cancer could be a chronic disease...and treated towards the cure.
While the oncology world may cringe when he boasts, as he's prone to do, patients see him differently.
David Roy: The established community doesn't like false hope. But if you have a terminal disease like I do, you want some hope.
David Roy was diagnosed two years ago with stage four, metastatic pancreatic cancer. He was given four and a half months to live and told to settle his affairs. He called Dr. Soon-Shiong, whom he had met on a plane years before. Soon-Shiong recommended a UCLA oncologist who devised an unusual therapy that combined Abraxane with other cancer drugs. Then Soon-Shiong had Roy's tumor genome sequenced. Based on those results, Roy is now taking part in a clinical trial involving another front in cancer treatment.
Patrick Soon-Shiong: That's the T-cell and that's the cancer cell.
It's called immunotherapy. Soon-Shiong is not the only one working on it, but he was anxious to show us why oncologists believe it's a promising field: a time-lapse demonstration of how T-cells, which our immune systems naturally produce, can attack cancer cells...
Patrick Soon-Shiong: This is a cell that's actually gobbling up the cancer cell. This cell will grow in size and this cell will decrease in size so watch (laughs). So, here's the T-cell gobbling it up. There's the cancer cell. And...
Sanjay Gupta: That's amazing. So you're literally watching cancer cells die here?
Patrick Soon-Shiong: Correct.
Sanjay Gupta: If you find these T-cells and you're able to isolate them, is the idea then, you know they could do the job, you could come out and grow them, proliferate them, and put 'em back in the body.
Patrick Soon-Shiong: Exactly.
Even though it's been two years now since David Roy's original diagnosis, he's realistic about his chances of survival. But he's convinced Soon-Shiong and other scientists are on track to dramatically decrease cancer death rates in the not too distant future.
David Roy: I'm not sure that it'll happen fast enough for me, but I have every confidence that my children and grandchildren won't be concerned about the things that I'm concerned about. We are on the edge here, of going from the oil lamp to electricity. And it is going to happen.
Soon-Shiong's most provocative idea, though, centers on how cancers may become metastatic.
He believes chemotherapy works best when administered in frequent, low doses and that in some cancers the traditional method of blasting a tumor with heavy doses of chemotherapy may be actually be counterproductive - because it could induce cancer cells to escape the hostile environment, enter the bloodstream and find a new home.
Sanjay Gupta: It's on the move.
Patrick Soon-Shiong: It's on the move. And it's looking for another place to land.
Patrick Soon-Shiong: Circulating tumor cells in the blood is the new frontier. Those are the circulating tumor cells.
Sanjay Gupta: That's incredible.
If cancer spreads the likelihood of survival decreases dramatically. So before individual rogue cancer cells fan out and form new tumors, Soon-Shiong wants to detect them with what are known as liquid biopsies. A person's blood sample is put through this bio-chip that separates normal blood cells from heavier, circulating tumor cells. This is a view inside the bio-chip as the tumor cells are being funneled to the top.
Patrick Soon-Shiong: And if we can now monitor the cancer cell in the blood we then have a path to getting this and winning this war. We never had those paths before.
After pulling out the circulating tumor cells, scientists can take them back to the genome sequencer to look for new mutations that made them resistant to the initial treatment...and hopefully find a new drug to treat it. It's yet another angle Soon-Shiong is taking to disrupt cancer.
Sanjay Gupta: You got genomics. You have circulating tumor cell liquid biopsies. Death by T-cell. Why are you the one taking all this on, I mean these are lots of different types of things...
Patrick Soon-Shiong: You know, somebody once said to me, "You know, Patrick, you're all over the place." And I said, "You have to be all over the place" because I'm trying to fight this war from all over the place. Because you can't, there's no one single magic bullet.