Fifty years ago, Eagle, the Lunar Module from Apollo 11, landed safely in the Moon's Sea of Tranquility. It was July 20, 1969, at 3:17:04 pm Houston time (CST). The adventure began as a competition between the two most powerful nations after World War II. In 1961, a recently elected President Kennedy asked for Congressional support for space exploration, challenging his compatriots to “land a man on the moon and return him safely to the Earth.” When he did, no one in America knew how to make it happen. However, human space flight accelerated through the 1960s thanks to bright young minds who heard that calling, believed that it could be done, and joined PhD programs in the field of physics. The moonshot made America cleverer, and the developments under the Apollo program changed the world forever.
The period between the early achievements of the Russian Sputnik 1 (the first artificial satellite launched to space in 1957) and by Neil Armstrong and Buzz Aldrin's landing on the moon on July 20, 1969, is known as the “space race.” More than just obtaining a strategic military advantage, it was a challenge in technological development for dominance in spaceflight capability. The challenge was massive, but, if solved, would positively impact the lives of millions, even billions. Indeed, it ended up changing how we see the Earth and space. In addition to significant amounts of funding, it required enormous efforts from researchers and technicians and a gigantic management exercise for meeting difficult engineering, technological, and organizational integration requirements. However, on top of all, it demanded radical solutions that depended on breakthrough technology to solve problems such as the impact of radiation to the human body, the need for recycling water and oxygen, an adequate fuel and spacecraft to complete the mission, navigation, and communications systems. All these and many more were needed to travel through space, make a soft landing on a moving target a quarter-million miles from the Earth, and come back. And still, they did it.
In 1971, another huge challenge was initiated. With the National Cancer Act of 1971, Richard Nixon spearheaded the war on a more international thread, cancer. Dedicated cancer centers and projects such as the Human Genome Project and the Cancer Genome Atlas enabled a better understanding of the genetic factors underlying cancer. New diagnostics and new drugs such as chemotherapies, targeted therapies, and immunotherapies followed. Preventive measures and early detection programs were launched. Despite all this, the number of people diagnosed with cancer every year continues to increase, some tumors remain fatal if detected in advanced stage, and we have not seen a decline in the number of people dying from cancer. A different approach is required.
The advancements in cancer biology achieved in the last two decades reveal that each tumor is a unique and highly complex disorder with distinct causes and mechanisms. This heterogeneity of the disease calls for the development of new methods and strategies for matching drugs with the characteristics of individual patients, i.e., the personalized medicine approach. It may sound like a big, bold aspiration, as challenging as the first “moonshot.” Today, as in 1961, no one knows how to make this happen.
Personalized medicine, like the moon, will not be conquered in 1 day. Space exploration required technological developments, some of which enabled objects that we now take for granted: the development of robotics needed to remotely control space vehicles enabled functionally dynamic artificial limbs and unmanned satellites used to beam data from test flights back to Earth enabled satellite TV. Other examples include water purifiers, computed tomography scanners, computer microchips, and home insulation materials… the same is needed for enabling personalized medicine. A robust mechanism for selecting the right treatment for the right patient at the right time will require developments in molecular biology, platforms for molecular analysis of individual cases, and bioinformatic systems to process the information and integrate it in a coherent way. We also need to develop natural language processing for literature mining and other methods for big data analysis to identify vulnerabilities, functional assays for in vitro or in vivo testing of potential drug combinations, and novel clinical trial designs.
Before aiming to the moon, satellites for global communications were put in orbit; scientific probes were sent to survey the moon; and many orbital flights tested the spacecraft and boosters, the guidance systems, the landing strategy, and the suits for spacewalk. Likewise, personalized medicine needs to test different technological advancements through pilot initiatives.[6,7] There will be no “giant leap for mankind,” but a million of small steps.
At the Journal of Immunotherapy and Precision Oncology, we believe that a personalized medicine approach using targeted drugs and immunotherapies can be achieved, and in our journal, we would like to describe the incremental improvements that can enable this major challenge. For example, we have included two review articles on immunotherapy resistance and drug development in this issue.[8,9] We want to hear about the latest advancements in immunotherapy and precision oncology and share them with our readers. Fifty years after the first moonshot, technology developments put precision medicine within reach, we just need the same boldness!
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