A ring-fenced metastasis programme with metastasis-specific endpoints
Metastasis causes about nine in ten cancer deaths but gets a small slice of research money. This would ring-fence a tenth of national cancer research budgets for the biology and trials of spread itself.
A dedicated, multi-year programme funds metastasis biology (dissemination, dormancy, organ-specific colonisation), metastasis-directed therapies and, crucially, trials whose primary endpoint is the prevention or delay of new metastases rather than shrinkage of existing ones. It would include model-building (autochthonous and humanised metastasis models), a metastatic tissue banking network with rapid autopsy, and a trial arm for 'anti-metastatic' agents tested in the adjuvant and molecular residual disease setting where they can plausibly work.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Metastasis is understood least and studied last · Metastasis causes about nine in ten cancer deaths but gets a small fraction of research money and almost no trials of its own.