Advisers to the US Cancer Moonshot Initiative have produced a wide-ranging laundry list of research targets for the project — even as its funding remains uncertain.

The ten recommendations released on 7 September include the launch of a national clinical-trial network specifically targeted at therapies that harness the immune system, and the creation of a 3D cancer atlas to catalogue a tumour's mutations and its interactions with neighbouring normal cells.

The advisory panel — whose members include leading cancer researchers, physicians and patient advocates — also called for new cancer technologies, including advanced imaging techniques and drug-delivery devices; a focus on proteins that drive many paediatric cancers; and studies of how tumours become resistant to cancer treatments.

The National Cancer Institute (NCI) has not yet determined how much funding will go to each of the initiatives, or how the projects will be structured.

The White House launched the moonshot in January to double the pace of cancer research over the next five years. But the programme is stuck in funding limbo as Congress hashes out next year’s budget. The US National Institutes of Health requested US$680 million for the moonshot for the 2017 fiscal year, which starts on 1 October. Despite vocal support from members of both political parties, lawmakers have said that they need more detail on the programme before they can fully fund it.

If that does not happen before Congress sets the government’s 2017 budget, full funding might have to wait until the 2018 fiscal year, says Matt Hourihan, director of the research and develop­ment budget and policy programme at the American Association for the Advancement of Science in Washington DC.

Waiting game

The recommendations from the moonshot’s advisory panel provide the information that lawmakers want, says Jon Retzlaff, managing director of science policy and government affairs for the American Association for Cancer Research in Washington DC. Retzlaff plans to start lobbying Congress with the recommendations in hand. “The concepts and the grant proposals that will be generated because of these proposals, I think, will inspire Congress to say, ‘Yes, this is a worthy project,’” he says.

For now, uncertainty hangs heavy over moonshot discussions. At a meeting on 7 September, NCI deputy director Dinah Singer said that the agency aims to launch some parts of the moonshot programme in fiscal year 2017 and might seek funding from the private sector. But some NCI advisers are concerned that without substantial new funding, implementing the advisory panel's recommendations could hamper the NCI's current projects.

The initiative already received $195 million in 2016, and lawmakers have expressed interest in committing at least that much again in the next year, says Hourihan. NCI director Douglas Lowy said he is hoping for a substantial funding boost. “If we didn't get one, it’s not that we wouldn’t be able to start anything,” he said. “It’s just that the size, scope and speed would be dramatically different.”

In spite of the uncertainty, the report generated excitement among some cancer researchers. A call to expand the use of proven cancer-prevention and early-detection strategies, for example, was a pleasant surprise, says cancer geneticist Bert Vogelstein of Johns Hopkins University in Baltimore, Maryland. Although many experts think that the approach could slash cancer deaths, it has not typically been high on the funding list, says Vogelstein. “I was very impressed,” he says. “They picked out some underexplored opportunities.”

Mixed reactions

But the recommendations also faced criticism at the 7 September meeting. Several attendees argued that the report needs to contain a stronger emphasis on disparities in cancer deaths that have been linked to race and economic status. “Disparities should be sitting at the top of this whole thing,” said Mack Roach, a radiation oncologist at the University of California, San Francisco. “People are dying who shouldn’t be dying.”

That issue was left largely to the Moonshot Task Force, a separate advisory panel that is focused on improving access to cancer care and removing barriers to cancer research, said the task force’s leader, Greg Simon, who is chief executive of Poliwogg, a health-care investment company in New York City. The task force plans to release its report later this year.

The latest recommendations could not cover the full gamut of cancer research, advisory-panel members stressed during the meeting. “We really need to show we can produce something,” said cancer researcher Elizabeth Jaffee of Johns Hopkins. “We went after the shovel-ready or low-hanging fruit as the priority right now.”

Even so, the breadth of the recommendations was impressive, and could serve to draw new researchers to the field, says Stephen Elledge, a geneticist at Harvard Medical School in Boston, Massachusetts. “They did a pretty good job,” he says. “I was glad they didn’t just say, ‘Oh we just need to sequence more tumours.’”

Credit: Sandy Huffaker/Redux /eyevine