ARPA‑H’s ‘1 Cure’ program bets smarter design can expand cancer care to more people, faster

Terry Gerton ARPA-H announced a program last month called One Comprehensive Universal Radiotherapy for Everyone (1-Cure), and it’s a really ambitious idea, using a single, widely accessible treatment approach across many kinds of cancer. When you think about this, what problem is the 1-Cure program trying to solve that existing cancer research hasn’t been able to crack?

Wilfred Ngwa Yeah, no, that’s a great question. So, in the United States, there are about 2 million new cancer cases every year. There are about 600,000 deaths. There are hundreds of different cancers. Patients have to deal with high cost, months of grueling treatment. You know, sometimes you can go into years of treatment. And so, ARPA-H, obviously focusing on bold, high-risk, high impact approaches. So we thought, why not change this? Why not change it for American patients, populations so that you don’t have to, you know, go through all these months of grueling treatment, pay this high cost, you know, so that’s why we came up with the one comprehensive universal radiotherapy approach for everyone. And the really great thing here also is that this approach can work for multiple cancers. So not just one cancer, because cancer has hundreds of different types of cancers. And so each one of these different cancers has a different treatment approach. So what if you could just have one radiotherapy approach that’s low cost and you can use that for treating all kinds of cancers?

Terry Gerton At a high level, how would this approach work? You’ve just described hundreds of cancers. They all manifest differently in the body. How could you have one solution?

Wilfred Ngwa Yep, so this is really the important question to ask. The way our bodies are designed to fight disease is through our immune system. And so remember that cancer is just part of your body that goes rogue. And it starts to divide and grow. But your body never really knows that it’s a bad thing. And so if you can show your immune system that the cancer cell is bad then your immune system can take care of the cancer. And so the approach here is essentially use this one radiotherapy to damage the cancer and force the cancer to take off the camouflage. Normally, it hides itself from your immune system, and so you force it to take off that camouflage, and then your system can say, aha, so you are not really a healthy cell. And the immune system can take over the process of eliminating this cancer and because you are just showing the cancer to your immune system, it doesn’t matter what type of cancer it is, all you just need to do is show your immune system that this cancer cell is bad and so we use this approach using radiotherapy to do that.

Terry Gerton And the radiotherapy is one part of the solution set, right? What is the other part?

Wilfred Ngwa Yes, you’re absolutely right. So radiotherapy starts, it’s just one part of the solution. You use that mainly to damage the cancer, force it to take that camouflage off itself, but cancer itself is very adept, adept at — it is very smart — trying to find ways to evade the immune system. And so the second part of it, and this is a really critical part of the program, is number one, we use what we call smart radiotherapy biomaterials. These smart radiotherapy biomaterials … target the cancer and they force the cancer to be shown, to be expressed, to be showed to your immune system so that your immune can now take over the process. So you can think about these smart biomaterials as the ways that empower your immune systems. You are SEAL Team 6. If you think about SEAL Team six, you know, that attacks the cancer, it empowers, it gives it ammunition to be able to then attack the cancer. So that’s one critical component of the program. The second one is with the advent of artificial intelligence, we don’t want this to work only for some patients. And so with AI now today, we can actually develop what you call a treatment planning system that can allow you, if you’re coming into the clinic and you are a patient with pancreatic cancer or lung cancer or breast cancer. If you put the type of cancer into that treatment planning system, tell what the size of the cancer is, where it has spread, it can literally, you can use that system with the help of artificial intelligence to make a treatment plan and say, use this amount of radiotherapy and this dose of the smart biomaterial to be able to empower your immune system to cause a regression of the cancer that you treated. So that’s the second component of that.

Terry Gerton I’m speaking with Dr. Wilfred Ngwa. He’s the program manager for the a-Cure program at ARPA-H. Will, one of the things that stands out about this program is it’s focused on low cost, widely available treatment. Why was affordability and global access built into the design from the start?

Wilfred Ngwa Yes, affordability is really at the core of this program because we know that patients deal with a lot with financial toxicity. So we say not only the treatments that we have for cancer today are toxic, patients always have to deal with financial aspects of that. And so we wanted to make sure that this is accessible to everybody. So that’s why we say one comprehensive universal radiotherapy approach for everyone. And so the critical component here is by using that smart biomaterial, we can use a very small amount of drug. So if you think about today, you are taking your chemotherapy or immunotherapy treatment, literally you get infused with these drugs, you take these drugs over and over for weeks and months and years. But if you are using this smart biomaterials, you can target a very small amount of that immunoglobulinal drug so that it goes only to the cancer. And then it’s released gradually over time to then empower your immune system to take over. So you don’t have to keep injecting drugs over time, week after week into years. And so that really goes to saving the cost for patients. And you can go back to your work and to your family. And that’s really critical because nowadays in the United States cancer treatments can cost hundreds of thousands of dollars and many people cannot afford those.

Terry Gerton That is an exciting prospect. If you’re a cancer patient today, what should you be thinking about in terms of the timeline that this program might deliver results?

Wilfred Ngwa Yes, upper age is, the director usually says upper age is like a time machine, right? So some things that take decades, we can shrink that down to a few years. So the program is planned over five years. The goal is that we can put together really the best team, the best minds across the US, including across the world, who can really be part of this? Think about an Avenger team against cancer. And they will really work within these five years, where we can move that from engineering these biomaterials and the treatment planning system. And then by the time we reach year four, we can actually start clinical trials, which is really gonna be important for that clinical translation, so that cancer patients today can be able to access that. Now, and I would say upper edge is really unique here because typically these things can take decades, but, you know, with our flexible funding. And the ability to, you know, build these kind of teams, that makes it really accelerate the process.

Terry Gerton And as you go through the research, ARPA-H sits at the center of that, what is your role in orchestrating research at a variety of different sites and labs and technologies?

Wilfred Ngwa Yeah, so as a program manager, that’s a really great position to be, is that right now we’re just, you know, we launched the program, but let everybody be able to provide the ideas. And then this can be across different institutions, across geographies. And then I build a team. So the team can be from Florida, can be from California, can be from Washington, D.C., and so I bring all these people together to start working on this project. And so my job is to go across meeting these teams, you know, monthly sometimes, making sure that the work is going forward. And so it brings people literally across geographies and my work as a program manager is to work with these people, you facilitate that.