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March 9, 2010 • Volume 7 / Number 5

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Miscellaneous chemotherapy bottlesExperimental Drug Benefits Patients with Advanced Prostate Cancer

The experimental drug cabazitaxel has improved the survival of some patients with advanced prostate cancer compared with those who received standard chemotherapy, according to results from a randomized phase III clinical trial presented last week at the Genitourinary Cancers Symposium in San Francisco. Although the benefit was modest (several months), there currently are no effective treatments for patients with this form of the disease, called metastatic castration-resistant, or hormone-refractory, prostate cancer. Read more > >


Director's Update: Mapping a Strategic Scientific Vision for the National Cancer Program

When we at NCI cite the National Cancer Act of 1971, it is not simply as a recitation of history, but rather a recognition of the tremendous responsibility assigned to the Institute. That legislation, which launched what is often referred to as the “War on Cancer,” imparted a series of distinctions and special authorities to NCI as the leader of the National Cancer Program. Because of the 1971 law, the position of NCI director became a presidential appointment; the outstanding and much envied NCI-designated Cancer Centers Program came into existence; and the Institute gained the authority to prepare and submit directly to the President an annual budget for review and transmittal to Congress.

The act also established a new, powerful advisory board to both the President and the NCI director: the National Cancer Advisory Board. The NCAB, the act stated, would be a presidentially appointed panel of “leading scientific or medical authorities outstanding in the study, diagnosis, or treatment of cancer or in fields related thereto.” Read more > >




  • Legislative Update

    • Congressional Hearing Focuses on the Prevention of Medical Radiation Overdoses
    • House Committee Convenes Hearing on Prostate Cancer
  • FDA Update

    • NIH-FDA Initiative Aims to Speed Development of New Medicines
    • First Meeting of FDA Tobacco Products Advisory Committee Announced
  • Update

    • NCI Recovery Act Web Site Features Comparative Effectiveness Research and ACTNOW Trial Details
    • Interactive Translational Cancer Research Web Site Launched


    • BSA Meeting Held
    • 2010 Survivorship Research Conference Accepting Applications
    • NCI and German Cancer Research Center Launch Exchange Program
    • NIH Offers New Online Health Resource for Seniors: Life after Cancer
    • NHGRI Launches Online Tool for Educators on Genetics and Genomics

Selected articles from past issues of the NCI Cancer Bulletin are available in Spanish.

The NCI Cancer Bulletin is produced by the National Cancer Institute (NCI), which was established in 1937. Through basic, clinical, and population-based biomedical research and training, NCI conducts and supports research that will lead to a future in which we can identify the environmental and genetic causes of cancer, prevent cancer before it starts, identify cancers that do develop at the earliest stage, eliminate cancers through innovative treatment interventions, and biologically control those cancers that we cannot eliminate so they become manageable, chronic diseases.

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Featured Article

Experimental Drug Benefits Patients with Advanced Prostate Cancer

Miscellaneous chemotherapy bottles

The experimental drug cabazitaxel has improved the survival of some patients with advanced prostate cancer compared with those who received standard chemotherapy, according to results from a randomized phase III clinical trial presented last week at the Genitourinary Cancers Symposium in San Francisco. Although the benefit was modest (several months), there currently are no effective treatments for patients with this form of the disease, called metastatic castration-resistant, or hormone-refractory, prostate cancer.

“This is the first positive study of its kind,” said Dr. Nicholas Vogelzang, chair and medical director of the Developmental Therapeutics Committee of the company US Oncology, who moderated a press briefing on March 3 ahead of the symposium. Cabazitaxel should clearly be considered now as an alternative for men in whom standard chemotherapy has failed, he added.

The international TROPIC (Treatment of Hormone-Refractory Metastatic Prostate Cancer Previously Treated with a Taxotere-Containing Regimen) study included 755 men whose prostate cancers had progressed despite treatment with hormone therapy and subsequent chemotherapy with docetaxel, which is the standard drug used to treat men with advanced disease. The participants were randomly assigned to receive cabazitaxel plus prednisone or another chemotherapy drug, mitoxantrone, also in combination with prednisone.

With a median follow-up of 12.8 months, median overall survival for men in the cabazitaxel group was 15.1 months compared with 12.7 months for patients in the mitoxantrone group. This translates into about a 30 percent reduction in the risk of death, said lead investigator Dr. Oliver Sartor of the Tulane Cancer Center.

Cabazitaxel—which, like docetaxel, is part of a class of drugs known as taxanes—was designed to be active in cells that develop resistance to docetaxel, which happens in many patients with this disease. The drug appears to elude a mechanism in prostate cancer cells that pumps anticancer drugs out of the cells before they have a chance to be effective, the researchers said.

The improvement in overall survival was consistent across different patient subgroups, such as those stratified by age, race, and certain co-morbidities, Dr. Sartor said. And men treated with cabazitaxel also had improvements in important measures such as length of survival without tumor growth (progression-free survival) and significant tumor shrinkage following treatment (response rate).

In terms of side effects, patients who received cabazitaxel were more likely to experience febrile neutropenia, a high fever associated with significant reductions in white blood cells called neutrophils. So, Dr. Sartor advised, patients treated with cabazitaxel need to be “carefully watched” for this toxicity.

Because there is no well-accepted standard treatment for men whose tumors no longer respond to docetaxel, choosing the treatment with which cabazitaxel would be compared was difficult, Dr. Sartor noted. Mitoxantrone was chosen instead of a placebo because it has some activity in these types of patients, he explained.

“It’s a promising feature that you can treat patients with a taxane-based chemotherapy in a second-line setting and still have a response and reasonable tolerance,” said Dr. Daniel George, an assistant professor of medicine and urologic surgery at the Duke University Comprehensive Cancer Center. And patients who respond well to first-line treatment with docetaxel tend to fare better with second- and third-line therapies, Dr. George added. “So, for those patients this may be even more of an advance.”

The results also further confirm that in patients with advanced prostate cancer, chemotherapy isn’t strictly a last ditch treatment, Dr. George said, but that it “can really extend survival even further than we originally recognized.”

Noting that advances in treating cancer have always been incremental, Dr. Vogelzang said that the results were similar to those from the 2004 study that demonstrated the benefit of docetaxel as treatment for advanced prostate cancer.

Sanofi-Aventis, which manufactures cabazitaxel, is expected to seek FDA approval of the experimental drug as a second-line treatment. It would be the first FDA-approved agent for this indication.

The third annual symposium was co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Urologic Oncology.

—Edward R. Winstead and Carmen Phillips

Cancer Research Highlights

Internal Radiation Effectively Reduces Local Recurrence of Some Endometrial Cancers

In a large, randomized clinical trial of women with high-intermediate risk endometrial cancer, vaginal brachytherapy (VBT) was as effective at reducing the rate of cancer recurrence in the vagina as external-beam radiation therapy (EBRT), and VBT had fewer side effects. These results from the PORTEC-2 trial, led by Dr. Remi Nout from Leiden University Medical Center in the Netherlands, were published March 6 in the The Lancet.

A previous trial, PORTEC-1, had shown that EBRT reduced the rate of local or regional cancer recurrence from more than 20 percent to 5 percent for women at high-intermediate risk of recurrence. However, more than a quarter of these women reported side effects in the first 2 years after treatment, mostly in the gastrointestinal tract (such as diarrhea).

To test whether VBT would be as effective as EBRT but less toxic, the researchers enrolled 427 women in the PORTEC-2 trial. After surgery to remove the uterus, ovaries, and fallopian tubes, 214 women received EBRT and 213 received VBT as low-, medium-, or high-dose-rate treatment according to the treating center’s discretion. After a median follow-up of 45 months, four women in the EBRT group and three women in the VBT group had a vaginal recurrence. The estimated 5-year vaginal recurrence rates were 1.6 percent after EBRT and 1.8 percent after VBT. No significant differences in disease-free survival or overall survival were seen between the groups.

More than four times as many women reported gastrointestinal side effects at completion of EBRT (53.8 percent) as those who received VBT (12.6 percent). This difference between groups decreased over time and was no longer statistically significant 2 years after treatment. One woman in the EBRT group and four women in the VBT group reported high-grade atrophy of the vaginal mucosa, a condition in which the skin lining the vagina becomes thin and can cause uncomfortable symptoms. Rates of sexual activity after treatment were not significantly different between the two groups.

“VBT achieves excellent vaginal control and rates of locoregional recurrence, overall survival, and disease-free survival that are similar to EBRT, and quality of life and gastrointestinal toxic effects are significantly better with VBT. VBT should be the adjuvant treatment of choice for patients with endometrial carcinoma of high-intermediate risk,” the authors concluded.

Extensive Lymph Node Removal May Improve Survival in Some Women with Endometrial Cancer

The systematic removal of lymph nodes around the pelvis and along the aorta in the abdomen may improve overall survival in women with endometrial cancer who are at an increased risk of the disease returning after surgery, according to a new study by Japanese researchers. Their findings were published online February 25 in The Lancet.

The retrospective cohort study included 671 women treated at two hospitals in Japan, where the care of women with endometrial cancer—including lymph node removal—is highly standardized. There was a 66 percent improvement in overall survival in women at intermediate or high risk of recurrence who received both a pelvic and para-aortic lymphadenectomy along with a hysterectomy, compared with women who only had the pelvic lymph nodes removed after hysterectomy. There was no improvement in overall survival associated with more extensive lymph node removal in women who were considered to be at low risk of recurrence. Recurrence risk was based on a widely used international risk categorization system for endometrial cancer. The study also showed that, along with para-aortic lymphadenectomy, post-surgical chemotherapy independently improved overall survival in women who had a higher recurrence risk.

The findings run counter to those of two earlier clinical trials (reported in The Lancet and Journal of the National Cancer Institute) that showed no survival improvement after lymph node removal, Dr. Yukiharu Todo and colleagues from the Hokkaido Cancer Center explained. But they noted that both trials included only a small number of patients who had an increased risk of cancer that had spread to the lymph nodes. “Both pelvic and para-aortic lymph nodes must be removed to eradicate microscopic and macroscopic tumor involvement and achieve sufficient therapeutic effect in patients at risk of lymph node metastasis,” the researchers concluded.

Although the study was retrospective, its design limited the bias that can hinder such studies, wrote Drs. Sean Dowdy and Andrea Marini from the Division of Gynecologic Surgery at the Mayo Clinic in an accompanying editorial. They concurred with the Japanese researchers that the findings must be validated in a randomized clinical trial, which is needed to help establish a standard of care “for the surgical treatment of endometrial cancer. Such a standard is long overdue.”

Children and Teens Less Likely Than Young Adults to Die of Non-Hodgkin Lymphoma

Young adults diagnosed with non-Hodgkin lymphoma (NHL) between the ages of 20 and 29 are about twice as likely to die from the disease as adolescents and children, researchers from the CDC reported in the March Archives of Pediatrics and Adolescent Medicine. A number of factors may contribute to this disparity, including the fact that young adults with this disease have much lower participation rates in clinical trials than children and teens, the researchers suggested.

To compare survival rates, Dr. Eric Tai and his colleagues analyzed data on 2,442 patients with NHL from 13 SEER cancer registries. The patients included 1,455 young adults and 987 teens and children diagnosed between 1992 and 2001.

Even after taking into account the subtype of the disease and the stage at diagnosis, young adults were still more likely to die within 5 years compared with children and teens. The study found that 87 percent of children and teens survived 24 months compared with 79 percent of young adults; the 5-year survival rates were 85 percent for children and teens and 75 percent for young adults.

Although survival in NHL has increased over time, the gains have been smaller among young adults than among children and adolescents, the researchers noted. They suggested that “differences in underlying conditions known to increase the incidence of NHL, differences in treatment, lack of participation in clinical trials, potential long-term or late effects on mortality, and lack of optimal follow-up” may all play a role. Future efforts to address survival should include increasing the number of clinical trials for young adults, encouraging them to enroll in the trials, and promoting improved access to care for this population, the investigators concluded.

Older Women Are at Low Risk of New HPV Infections, Infections that Progress to Cervical Cancer


A report published online March 2 in the British Medical Journal by researchers from NCI’s Division of Cancer Epidemiology and Genetics, led by Dr. Sholom Wacholder, examined the risk of miscarriage following HPV vaccination with Cervarix in two multicenter phase III clinical trials, one sponsored by GlaxoSmith-Kline (GSK) and the other by NCI in Costa Rica. Participants in the NCI trial were randomly assigned in a masked fashion to receive either Cervarix or the hepatitis A vaccine Havrix. In both trials, the vaccination schedule for both arms included three doses administered over the course of 6 months.

“Overall, there is no evidence for an association between HPV vaccination and risk of miscarriage,” the authors concluded.

They noted that there was a slight but not statistically significant increase in the rate of miscarriage during the first 3 months after any dose of HPV vaccination compared with the hepatitis A vaccine, 14.7 percent versus 9.1 percent. Based in part on these findings, the FDA has requested that GSK conduct further research to assess the risk of miscarriage in women who become pregnant around the time of Cervarix administration.

Data from a large cohort of women in Costa Rica have clarified the natural history of human papillomavirus (HPV) infections among older women. The data indicate that risk of infection declines markedly with age and suggest that frequent HPV DNA screening to find new infections or vaccinating middle age women against newly-transmitted HPV provides very little benefit. The analysis appeared March 3 in the Journal of the National Cancer Institute.

New infections with cancer-causing strains of HPV are mainly transmitted sexually at young ages. At any age, new infections typically don’t lead to cancer; only infections that persist in a detectable state for years are likely to progress.

For 7 years, a team of researchers from NCI’s Division of Cancer Epidemiology and Genetics, Division of Cancer Prevention, and collaborators in Costa Rica and the United States followed a cohort of women age 18 and older who enrolled in a long-term, population-based study of almost 10,000 participants. Approximately one-third of these women were actively followed with cervical screening every 6 to 12 months to determine their HPV infection status, to look for abnormal cell changes using conventional and liquid-based Pap tests, and to examine the visual appearance of the cervix. Women with abnormal tests suggesting precancer (equivocal or definite cervical squamous intraepithelial neoplasia 3) or cancer were diagnosed with colposcopy and biopsy and treated as needed. The remaining two-thirds of the women in the study, who were at low-risk for cervical cancer, received a follow-up screening 5 to 7 years after the initial screening at enrollment (passively followed).

For all women in the study, new infections were unlikely to persist or lead to the development of precancerous lesions. Infections of long duration were associated with the highest risk of further persistence and precancer diagnosis. But newly detected infections among older women (some of which might have been re-appearances from a latent state) were just as benign as those in young women.

Explaining the natural history of HPV infections and the propensity for the body to clear them at any age, the authors stated that “a focus on HPV persistence, and avoidance of overreaction to HPV infections that are likely to resolve spontaneously, is essential for a rational introduction of HPV testing into cervical cancer screening programs.” They cautioned that, “Vaccination and screening programs must specify clearly what kind of infections they are targeting to avoid mistaken conclusions.”

People Continue to Trust Physicians, Despite Increasing Health Information Online

According to a recent NCI survey, the public’s trust in their physicians has continued to rise in spite of the fact that people report turning to the Internet first for their health information needs. In contrast, trust in the Internet and other more traditional sources such as television has been on the decline. The survey also showed a consistent increase in the number of Americans who communicate with their doctors through e-mail. A letter about the findings from staff who oversee NCI’s Health Information National Trends Survey (HINTS) appeared March 4 in the New England Journal of Medicine.

HINTS is the only national survey that examines how people access and use cancer-related information. NCI researchers surveyed approximately 5,000 to 6,000 adults in waves during 2003, 2005, and 2008. The findings build on earlier trends observed in the first two waves of the survey.

“Despite a decade’s worth of exposure to health information on the Internet, the public’s trust in physicians as their preferred source of health information has remained high, and if anything, increased from 2002 to 2008,” wrote Drs. Bradford Hesse and Rick Moser of NCI’s Division of Cancer Control and Population Sciences.

People have experienced data overload, Dr. Hesse suggested, and, because the clarity of online health information is not guaranteed, it can be confusing to them. At the same time, Dr. Hesse said, “we know reputable sites don’t always put information online that’s understandable to the general public.”

The next HINTS will be administered in 2011, and will include items designed to track Healthy People 2020 goals for meaningful use of health information technology.

Director's Update

Mapping a Strategic Scientific Vision for the National Cancer Program

Dr. John E. Niederhuber Dr. John E. Niederhuber

When we at NCI cite the National Cancer Act of 1971, it is not simply as a recitation of history, but rather a recognition of the tremendous responsibility assigned to the Institute. That legislation, which launched what is often referred to as the “War on Cancer,” imparted a series of distinctions and special authorities to NCI as the leader of the National Cancer Program. Because of the 1971 law, the position of NCI director became a presidential appointment; the outstanding and much envied NCI-designated Cancer Centers Program came into existence; and the Institute gained the authority to prepare and submit directly to the President an annual budget for review and transmittal to Congress.

The act also established a new, powerful advisory board to both the President and the NCI director: the National Cancer Advisory Board. The NCAB, the act stated, would be a presidentially appointed panel of “leading scientific or medical authorities outstanding in the study, diagnosis, or treatment of cancer or in fields related thereto.”

It was clearly the intent of Congress in drafting and passing this legislation, that the NCI director and the NCAB would work together to provide leadership for the nation’s efforts against cancer. “With the advice of the National Cancer Advisory Board,” the cancer act said, the NCI director would “plan and develop an expanded, intensified, and coordinated cancer research program encompassing the programs of the National Cancer Institute, related programs of the other research institutes, and other Federal and non-Federal programs.”

The NCAB meets four times a year to hear updates on key NCI initiatives and fulfill a most-important role of reviewing all internally vetted and scored grants before they can be selected by NCI program staff members for awards. NCAB members have also been of tremendous service in forming and managing a number of special working groups, which have greatly helped NCI establish large-scale programs, review existing programs, and create research priorities. Among them are:

  • P30-P50 Working Group (2003), which looked at how NCI-designated cancer centers and SPOREs could facilitate the discovery and translation of future research
  • Working Group on Biomedical Technology (2005), which recommended a human cancer genome project
  • Clinical Trials Working Group (2005) and the Translational Research Working Group (2006), which made recommendations on coordination, prioritization, scientific quality, and operational efficiency of NCI-supported clinical studies and on advancing discoveries more rapidly toward human testing

Continuing its role in helping NCI develop and support programs vital to the national cancer agenda, the NCAB recently voted to convene a new working group to develop a strategic scientific vision for the National Cancer Program. This working group, which is tasked with producing a report by September, will have four co-chairs: current NCAB members William Goodwin, Robert Ingram, and Dr. Bruce Chabner, along with a former NCAB chair and Nobel laureate, Dr. Phillip Sharp. Other members of the panel will be named in the weeks ahead.

We are clearly at a crossroads in cancer research. We can no longer afford to proceed with a sure but steady pace. We have invested far too many resources and far too much time on solving the riddles of cancer to not move ahead more aggressively now to fulfill the promise of the 1971 act.

To that end, the working group will look back at how NCI has evolved in its use of special authorities and its structure over the almost 40 years since the passage of the act. Even more important, the group will project what NCI needs to do, in terms of authorities and leadership, to aggressively move forward in this new era of science during the next decade. The working group is charged with assessing the scientific strategic vision and the required structure to enhance the organizational effectiveness of NCI to further advance our progress in understanding, diagnosing, treating, and preventing cancer.

It is abundantly clear that cancer research is moving toward an era when we will characterize tumors at the molecular level and employ electronic cancer health records and massive databases to follow patients through the evolution of their disease. These patients, millions strong, will be the research cohort for a virtually on-demand system of clinical trials, which will change the very nature of drug development. NCI’s capacity to lead this biologic, data-driven revolution of cancer research—and our cancer health care system, for that matter—will be greatly improved by the guidance of this NCAB working group.

Members of the NCAB devote considerable hours and great helpings of their expertise to help make sure NCI conducts only the best, most rigorous science. Their wisdom is without parallel. I thank them all for their service.

Dr. John E. Niederhuber
Director, National Cancer Institute

Special Report

Searching for Commonalities between Two Deadly Lung Diseases

A computed tomography (CT) image of airways in the lung of a patient with COPD. Inflammation around the airways appears white in the image (sample areas of inflammation indicated by red arrows). A computed tomography (CT) image of airways in the lung of a patient with COPD. Inflammation around the airways appears white in the image (sample areas of inflammation indicated by red arrows). Airway inflammation caused by COPD has been suggested as a potential mechanism leading to lung cancer development. (Image courtesy of the COPDGene Project.) Click to Enlarge.

Despite enormous strides in tobacco education during the last few decades, more than 20 percent of adult Americans still smoke, and tobacco use causes more than 400,000 deaths each year in the United States alone. The majority of these tobacco-related deaths are caused by two diseases: lung cancer and chronic obstructive pulmonary disease (COPD). These diseases often occur together in patients.

“With a background of tobacco exposure, you have several disease pathways that are studied separately even if they co-exist,” explained Dr. Eva Szabo, chief of NCI’s Lung and Upper Aerodigestive Cancer Research Group in the Division of Cancer Prevention.

“Having COPD is a risk factor for lung cancer,” said Dr. Antonello Punturieri, program director in the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI). “Many patients have moderate and often severe COPD in addition to lung cancer. But we don’t understand how tobacco exposure may lead to only COPD, or only lung cancer but not COPD, or COPD and lung cancer.”

Until recently, scientists have tended to study either lung cancer or COPD. But that is beginning to change. More laboratories are now looking at the complicated interplay between the two diseases and their risk factors, including smoking.

Roles for Both Exposure and Genetics

Among smokers, only 15 to 20 percent get either lung cancer or COPD, leading researchers to propose a genetic component of risk. Dr. Laura Bierut, professor of psychiatry at Washington University School of Medicine, and her colleagues recently identified a single-nucleotide polymorphism (SNP)—a variation in a single unit of DNA—on chromosome 15 that is associated with smoking behavior. This same variant increases the risk of lung cancer and COPD.

As more of these genetic risk factors are discovered, “the million-dollar question will be, Is the link between these genetic variants to lung cancer and COPD driven only through their influence on smoking behavior—such as increasing the number of cigarettes smoked per day—thus increasing the risk of disease? Or is there a direct pathogenic effect of these genetic variants on lung cancer and COPD?” said Dr. Bierut.

The SNP on chromosome 15 does appear to have an independent effect on disease risk. “If you incorporate the pack-years someone has smoked or how many cigarettes someone smokes per day into the statistical analyses, the genetic variant continues to contribute to lung cancer risk, above and beyond the behavior.”

She added that translational animal studies will likely be needed to tease apart the relationships between behavior, exposure, and disease, which are incredibly complex to study in humans.

A Cancer-friendly Microenvironment

Dr. James Crapo, professor of medicine at National Jewish Health, is interested in the role that chronic inflammation plays in both COPD and lung cancer.

“Clearly there are some shared factors that create risk for people who develop COPD and lung cancer. My hypothesis is that some individuals develop chronic inflammation that’s progressive even if they stop smoking,” he said.

“As we move into studying lung cancer and COPD associations, it’s very important that we start thinking of COPD as a syndrome with different subtypes,” he continued. “People tend to think of COPD as destruction of the lung tissue, but that only describes a subset of COPD. In fact, a large proportion of our COPD patients predominantly have airway inflammation and not tissue destruction, and inflammation is an environment in which cancer can develop.”

Dr. Crapo believes that there is a subtype of COPD that has a much stronger cancer association than others COPD subtypes. “And I’d bet that it’s the COPD patients who predominantly have airway disease who are at greater risk of cancer,” he said.

As part of the 12,000-person COPDGene cohort study, Dr. Crapo and his colleagues are performing genome-wide association studies to look for genetic links to airway inflammation and other possible risk factors for COPD. Although the cohort is designed to primarily examine COPD, the researchers hope to also collect data on lung cancer incidence.

“Once we find out what’s driving both of these diseases to occur in the same subjects, if it’s something like inflammation that we can treat at an early stage, we could potentially prevent the lung cancer and COPD from developing. That’s the long-term hope for us,” he explained.

Encouraging an Emerging Field of Research

On March 2, NCI and NHLBI released a joint request for applications (RFA) to encourage cross-disciplinary, translational research into common disease-causing mechanisms of lung cancer and COPD. The RFA will fund 8 to 12 new research projects and will favor applications with two principal investigators—one from the pulmonary community and one from the cancer community—to foster collaborative activities.

The two main objectives of the research effort will be to identify the genotypic and phenotypic characteristics that determine individual susceptibility to lung cancer and COPD, and to better understand the shared biochemical, molecular, and immunological pathways involved in the origin and progression of the two diseases.

“These patients are complex. Though they may die from one disease, they often have other tobacco-related diseases at the same time,” said Dr. Szabo. “A better understanding of one disease may lead to clues for the other; not only clues about pathogenesis, but clues to possible therapeutic targets.”

—Sharon Reynolds


The Heart: An Unintended Victim of Some Targeted Cancer Therapies

An afternoon session on the last day of a large scientific conference is typically a recipe for poor attendance. That’s what Dr. Edward T.H. Yeh expected last March at the American College of Cardiology (ACC) annual meeting in Orlando, where he moderated a session on cancer treatment-induced heart failure.

I hope that more cardiologists will be trained or versed in the [cardiotoxicity] literature, and the same [goes] for oncologists. It requires a mutual understanding of the scope of the problem. —Dr. Edward T.H. Yeh

“I was hoping to see 20 or 30 people,” said Dr. Yeh, who directs the cardiology department at the University of Texas M. D. Anderson Cancer Center, one of the few cancer centers with a dedicated cardiology unit. “But there were about 300 people. The room was filled!”

Heart failure—when the heart is unable to pump enough blood to meet the body’s needs—is among the most common “cardiotoxicities” associated with certain cancer treatments, in particular the class of chemotherapy drugs known as anthracyclines. But as the use of targeted therapies becomes more widespread, there is mounting scrutiny of their cardiac effects, which can include heart failure, fatal rhythm disturbances, blood clots, and hypertension. Late last year, for example, a phase III breast cancer trial involving the targeted therapy bevacizumab (Avastin) had to halt enrollment temporarily because of an excess number of congestive heart failure cases. (Enrollment was reopened several months later.)

The potential impact of cardiotoxicities on cancer care is so significant, an Italian research group recently wrote, that it should spur the formation “of a novel discipline, which could be termed cardio-oncology or onco-cardiology,” Dr. Adriana Albini and colleagues proposed in the January 6 Journal of the National Cancer Institute.

Discussions with both oncologists and cardiologists indicate there is no consensus on that point, but they do suggest that the concern about cardiotoxicities is very real and is beginning to be tackled in a more direct and collaborative manner.

How Much of a Concern?

Mechanisms of Cardiotoxicity

What cancer therapies do on a molecular level to cause toxic effects in the heart is becoming clearer. With trastuzumab, for instance, by inhibiting the HER2 protein, the drug “can block different growth factor signaling pathways in cells that express HER2,” Dr. Yeh explained. “And it turns out that a lot of those signaling pathways are shared by cells in the heart and cancer cells.” Cancer cells rely on those pathways to proliferate, he continued, “but the heart cells rely on them to survive.” So killing cancer cells by blocking these signaling pathways could also be damaging heart cells.

The TKIs, meanwhile, hit numerous cellular targets, including those that relate to cell metabolism, added Dr. Lenihan. “The heart muscle is very metabolically active,” he said. “Any drug that has a transient effect on metabolism in your body has a high potential to affect the heart muscle.”

Among the targeted agents, the monoclonal antibody trastuzumab (Herceptin), which is used in women with both metastatic and early-stage breast cancer, has probably received the most attention for its cardiotoxicities. But it’s far from unique. Other established agents, including those in the class known as tyrosine kinase inhibitors (TKIs), such as sorafenib (Nexavar) and sunitinib (Sutent), can also have potentially serious effects on the heart.

In patients with more advanced cancer who are candidates for treatment with agents that have been linked with cardiac side effects, the anticancer benefit tends to outweigh the potential risks, explained Dr. Dawn Hershman, who co-directs the breast cancer program at Columbia University’s Herbert Irving Comprehensive Cancer Center. “But now we’re treating more patients with earlier stage disease, with a low recurrence risk and high survival probability, so long-term effects become a much bigger deal,” she said.

In the clinical trials that established trastuzumab as an effective adjuvant therapy in women with early-stage breast cancer, the incidence of cardiac side effects was around 4 percent. But the patients in these trials, said Lisa Stegall Moss, a nurse practitioner who works in oncology outreach clinics operated by Duke University Medical Center, aren’t necessarily “representative of the patients we typically see, who are often overweight and have underlying heart disease or diabetes.”

For many cancer patients, added Dr. Daniel Lenihan, director of clinical research at the Vanderbilt University Medical Center’s Heart and Vascular Institute, heart disease and cancer go hand in hand. “The fact is, most people who get cancer, in general, are exactly the same demographic we see for cardiovascular disease,” he said. In some cases, patients being treated for cancer have undiagnosed heart disease, and their cancer treatment “might unmask that underlying tendency toward heart problems.”

There is some evidence to support that view. For example, in one recent study of 61 women with breast cancer being treated with trastuzumab, 19, or nearly one-third, of the women experienced a cardiac side effect, and 7 had to halt treatment altogether.

Unlike trastuzumab, some targeted therapies associated with cardiac side effects are almost strictly used to treat patients with advanced cancer. Sunitinib, which inhibits blood vessel formation, or angiogenesis, and is most commonly used to treat advanced kidney cancer, can significantly decrease the heart’s ability to pump effectively, leading to heart failure.

Hypertension is also a well-documented side effect of sunitinib and another anti-angiogenesis drug, sorafenib, said Dr. Percy Ivy of the Cancer Therapy Evaluation Program in NCI’s Division of Cancer Treatment and Diagnosis. “Any therapy intended to influence the vasculature is likely to have an impact on vascular pressure and blood pressure,” Dr. Ivy explained.

Consequently, cardiac effects will need to be closely watched in the trials testing these agents as adjuvant therapy in patients with earlier-stage kidney cancer, said Dr. Arthur Sagalowsky, who specializes in the treatment of urologic cancers at the UT Southwestern Medical Center. Some community oncologists already “have made the leap” of using sunitinib and sorafenib as adjuvant therapy in patients with earlier-stage disease who are at high risk for their disease returning, Dr. Sagalowsky warned, without understanding the potential cardiac implications, not to mention the lack of efficacy data.

Cardiotoxicities are definitely on the minds of both the private sector and the research community. “We’re seeing the industry starting to pay more attention to the side effect profile of their cancer drugs,” Dr .Yeh said, “because eventually they’re going to be competing against each other based on both efficacy and side effects.”

Meanwhile, the NCI-sponsored ASSURE trial, led by the Eastern Cooperative Oncology Group, is testing sorafenib and sunitinib as adjuvant therapy in patients with earlier-stage kidney cancer who are at higher risk of their cancer recurring. Built into the trial is a sub-study that will entail extensive cardiac monitoring of study participants to determine the extent of cardiac risk associated with either drug.

A New Field?

Dr. Yeh, the founding chair of the cardiology department at M. D. Anderson, isn’t convinced that a formal cardio-oncology field is needed. His department has 12 full-time cardiologists, all of who work with the oncology staff to assess and manage cardiac side effects in patients undergoing or about to receive cancer treatment. “Both communities need to appreciate the problem and talk to each other more often,” he said. “I hope that more cardiologists will be trained or versed in the [cardiotoxicity] literature, and the same [goes] for oncologists. It requires a mutual understanding of the scope of the problem.”

As the session at the ACC meeting suggests, some of that is starting to happen. A similar session may be held at the upcoming American Society of Clinical Oncology (ASCO) annual meeting. There have been limited efforts to develop general clinical guidelines on cardiotoxicities, but nothing that has borne fruit as of yet, said Dr. Lenihan. No formal clinical guidelines on cancer treatment-related cardiotoxicities are under development by the ACC, ASCO, or the National Comprehensive Cancer Network, according to representatives from those organizations.

However, a forthcoming paper from NCI researchers will lay out strategies that have proven effective for managing hypertension in patients being treated with antiangiogenic therapies, Dr. Ivy noted. The guidance was developed based on experiences in NCI-sponsored clinical trials, often done in consultation with cardiology colleagues. “We’ve been able to show that we can control blood pressure appropriately in these patients, and we can sustain it through the course of treatment,” she said.

Developing ways to identify patients at increased risk for cardiac side effects, as well as early markers of cardiac effects and best practices for managing cardiotoxicities, will be critical in moving forward, Dr. Hershman stressed. In the meantime, oncologists have to take a delicate approach toward discussing the issue with patients.

“It’s a difficult balance, because you want to inform patients of the risks, especially patients for whom the benefits [of treatment] may be borderline,” she said. “But at the same time, the treatments really work and if you’re talking about somebody at high risk, you don’t want them to be afraid to take what could be a life-saving therapy.”

—Carmen Phillips

Medical Societies Highlight Concerns on Androgen Deprivation Therapy

As is the case with chemotherapy and some targeted therapies, there are emerging data that indicate there may be cardiac risks associated with a prostate cancer treatment known as androgen deprivation therapy (ADT), which is increasingly being used in men with high-risk, localized prostate cancer, as well as men whose PSA level has begun to rise sharply after primary therapy or those who have overt metastatic disease.

Just last month, a panel convened by the American Heart Association, the American Cancer Society, and the American Urological Association issued a science advisory on several studies that have shown an association between ADT and an increased risk of cardiovascular events in certain patient groups, in particular, men with a prior history of a heart attack or heart failure.

The available data aren’t sufficient to make specific recommendations with regard to patient treatment with ADT, Dr. Sagalowsky explained, but “overall cardiac risk factors need to be monitored” and taken into consideration in patients who are candidates for ADT, he said.

Featured Clinical Trial

Extending Targeted Immune Depletion to Unrelated Cord Blood Transplantation

Name of the Trial
Pilot Trial of Targeted Immune-Depleting Chemotherapy and Reduced-Intensity Matched Unrelated Double Cord Blood Transplant for the Treatment of Leukemias, Lymphomas, and Pre-Malignant Blood Disorders (NCI-09-C-0210). See the protocol summary.

Dr. Michael Bishop Dr. Michael Bishop

Principal Investigator
Dr. Michael Bishop, NCI Center for Cancer Research

Why This Trial Is Important
Using umbilical cord blood from unrelated donors for allogeneic stem cell transplantation may help save the lives of people with blood or immune system cancers. Umbilical cord blood is rich in blood-forming stem cells that can be used to reconstitute the immune systems of patients whose immunity has been reduced by disease or pre-transplantation conditioning therapy.

In allogeneic stem cell transplantation, patients undergo a pre-transplantation conditioning regimen of chemotherapy or radiation therapy to kill cancer cells and suppress the immune system. Then, healthy donor stem cells are infused into the patient to rebuild the immune system. If stem cells from a human leukocyte antigen (HLA)-matched related donor are not available, stem cells from an HLA-matched unrelated donor are used. As many as 40 percent of patients eligible for allogeneic stem cell transplantation have no HLA-matched related donor available.

However, rejection of the donor cells by the body and delayed reconstitution of the immune system are major problems with cord blood transplants. If the immune system does not reconstitute itself, or if it takes too long to do so, the recipient can experience severe or even life-threatening infections.

Researchers at NCI have developed a strategy called targeted immune depletion to help improve stem cell engraftment (incorporation into the body) and immune reconstitution in allogeneic transplantation by tailoring the extent of immune depletion to individual patients. For example, patients with strong immune systems may need more chemotherapy than patients with weak immune systems to deplete their immune cells.

In this pilot study, patients with leukemia, lymphoma, multiple myeloma, or certain premalignant blood disorders (such as myelodysplastic syndromes) will undergo targeted immune-depleting chemotherapy followed by transplantation of umbilical cord blood from two unrelated donors (double transplant). Doctors hope that using targeted immune depletion will limit the risks of chemotherapy-associated toxicity and transplant rejection while still allowing for a sufficient anticancer effect and rapid reconstitution of the immune system.

“Our aim is to extend the strategy of targeted immune depletion to umbilical cord blood transplants, with the goal of more rapid engraftment, leading to decreased treatment-related mortality and increased overall survival,” said Dr. Bishop. “If the strategy is successful, it could provide a more personalized approach to transplantation and enhance the possible donor pool, especially for subsets of patients for whom transplantation is often not available.”

For More Information
See the lists of eligibility criteria and trial contact information or call the NCI Clinical Trials Referral Office at 1-888-NCI-1937. The call is toll free and confidential.

An archive of "Featured Clinical Trial" columns is available at

Legislative Update

Congressional Hearing Focuses on the Prevention of Medical Radiation Overdoses

In Case You Missed It

In the last issue of the NCI Cancer Bulletin, experts from NCI’s Radiation Research Program authored an article on maximizing the benefits and minimizing the harms of radiation oncology. You’ll find that Guest Director’s Update by Drs. Bhadrasain Vikram, James Deye, and C. Norman Coleman in the February 23 issue. You may also be interested in reading two other NCI Cancer Bulletin articles on radiation exposure—one on CT angiography and the other on diagnostic imaging.

Prompted by recent news reports describing medical radiation overdoses, in some cases resulting in tragic consequences, the House Energy and Commerce Committee, Subcommittee on Health, held a hearing on February 26 to learn more about the risks and benefits of both diagnostic and therapeutic radiation. Chairman Frank Pallone, Jr. (D-NJ), opened the hearing with an acknowledgement of the lives saved due to advances in radiation-based imaging and treatment, an opinion that resonated with the members who were present. But the subcommittee was concerned about the potential harms associated with these technologies.

The subcommittee heard testimony from James Parks, whose son died after receiving a massive radiation overdose during treatment for tongue cancer. Another witness, Suzanne Lindley, credited diagnostic imaging and radiation therapy for her cancer survival. A group of expert witnesses representing academic medical institutions and professional organizations described how radiation is used in clinical practice.

The witnesses reported that, although accidents are rare and the vast majority of imaging studies and radiation treatments are performed safely and as prescribed, the current patchwork approach to regulation, oversight, and data management does little to reduce the potential for harm. There is extreme variability from state to state in education and certification requirements for the technical personnel who administer and supervise medical radiation procedures, and some states have no requirements, they reported. There was general consensus that action must be taken to minimize the cumulative doses of diagnostic radiation received by individual patients, establish minimum competence and training standards for radiology professionals at all levels, urge accreditation of facilities using medical radiation, mandate error reporting, and consider applying these measures nationally.

Several witnesses and subcommittee members expressed their support for legislation introduced by Rep. John Barrow (D-GA). The bill, the Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act (CARE Act, HR 3652), if enacted, would require the Secretary of Health and Human Services to establish certification and licensing standards and procedures for medical radiation technology practitioners, and restrict Medicare payment for imaging and radiation therapy services to those performed in accordance with the CARE Act’s requirements.

Adjourning the hearing, Chairman Pallone commented that the discussion had uncovered troubling issues requiring further scrutiny. He intends to hold additional hearings on the subject.

More information about the hearing, including a full list of expert witnesses, is available on the subcommittee’s Web site.

House Committee Convenes Hearing on Prostate Cancer

The House of Representatives Committee on Oversight and Government Reform held a hearing on March 4 to examine questions surrounding prostate cancer screening, diagnosis, and treatment. The panel of witnesses included researchers, clinicians, and advocates, as well as actor and prostate cancer patient Louis Gossett, Jr.

Members of the committee and panelists recognized the health disparity surrounding prostate cancer incidence and mortality, as African American men currently have a 60 percent higher incidence of prostate cancer than white men and are twice as likely to die from their disease. Panel member Dr. William Dahut of NCI’s Center for Cancer Research emphasized improvements in areas such as imaging, nanotechnology, and the identification of biomarkers as critical to developing more accurate screening methods. He also stressed that being able to differentiate between lethal and non-lethal prostate cancer is the single largest challenge in effectively treating the disease and avoiding unnecessary treatment. A number of panelists echoed these points, and many called for increased federal funding dedicated to research in these areas.

Committee member Rep. Elijah Cummings (D-MD) has introduced the Prostate Research, Imaging, and Men's Education Act of 2010 (PRIME Act, HR 4756), which has been referred to the House Committee on Energy and Commerce. The legislation calls for increased funding for research on prostate cancer imaging and screening methods, among other initiatives. Although the legislation was not the subject of the hearing, panelists referenced the bill and called for many of its provisions.

Prior to the hearing, on March 3 the American Cancer Society (ACS) released updated guidelines on prostate cancer screening. The guidelines focus on the limitations of current screening tools, including the prostate-specific antigen (PSA) test, and encourage men “to have meaningful discussions with their doctors to allow for informed, shared decision making.” Dr. Otis Brawley, chief medical officer of the ACS, was also a panelist at the hearing.

More information on the hearing, including a full list of witnesses and their statements, can be found on the committee Web site.

For more information about this and other NCI congressional activity, visit the NCI Office of Government and Congressional Relations Web site.

FDA Update

NIH-FDA Initiative Aims to Speed Development of New Medicines

NIH and the FDA have announced a partnership to speed the development of new medicines and make them available to patients as quickly as possible. By increasing communication between the two and funding new research on the science behind product evaluations, officials from both agencies believe the initiative can shorten the time between discoveries in the laboratory and their translation into safe and effective therapies for patients.

“We want to accelerate and illuminate the pathway from microscope to market,” said Health and Human Services (HHS) Secretary Kathleen Sebelius at a briefing on February 24. She noted that many promising new treatments for cancer and other diseases are based on emerging technologies, and in some cases the FDA has little experience evaluating these treatments.

The initiative aims to address this issue in part by enhancing communication between scientists at the FDA and NIH. A Joint Leadership Council could, among other responsibilities, ensure that regulatory considerations are a component of planning for biomedical research and that the regulatory review process includes the latest science.

As Secretary Sebelius noted, NIH researchers who have expertise on a particular technology could help FDA scientists develop standards for evaluating therapies based on that technology. Similarly, FDA scientists could alert researchers about which safety issues would be important to win approval for therapies involving certain technologies.

In addition, $6.75 million will be spent over 3 years to support research on regulatory science. The grants will fund projects on new methods, models, or technologies that will inform the scientific and regulatory community about better approaches to evaluating safety and efficacy in medical products.

“This is an unprecedented effort to put together the leadership of NIH and FDA in a way that will catalyze the development of new therapeutics in ways that will benefit the public as quickly as possible,” said NIH Director Dr. Francis Collins.

In recent decades, biomedical research and discovery have evolved greatly, and regulatory science must also evolve, noted FDA Commissioner Dr. Margaret Hamburg. “This has created an imbalance that cannot persist,” she added.

Leaders of the initiative will seek comments from the public, the advocacy community, and scientists on the best ways to advance the goals of the initiative. A meeting could take place this spring.

First Meeting of FDA Tobacco Products Advisory Committee Announced

The first meeting of the FDA’s Tobacco Products Scientific Advisory Committee (TPSAC) will be held on March 30–31 in Washington, DC, the agency announced last week. The committee’s formation was mandated under the Family Smoking Prevention and Tobacco Control Act, which President Obama signed into law last June.

Also announced were the nine voting members of the advisory committee. The committee will include three nonvoting members who represent different components of the tobacco industry, but those members have yet to be selected, the FDA noted in a statement. Dr. Jonathan Samet of the University of Southern California’s Norris Comprehensive Cancer Center will chair the committee.

“FDA will be faced with many challenging tobacco-related public health, science, and regulatory issues as we move forward with implementation of the Tobacco Control Act,” said Dr. Lawrence R. Deyton, director of the FDA’s Center for Tobacco Products, in a statement. “The breadth of knowledge amassed by this highly-qualified group will supplement and enhance the agency’s understanding of tobacco control, prevention, and health promotion issues.”

The advisory committee’s first meeting will focus on menthol, a common additive in cigarettes. Although the Family Smoking Prevention and Tobacco Control Act banned the addition of candy-like flavorings and certain other additives to cigarettes, menthol was not part of that prohibition. The law did, however, direct the TPSAC to deliver a report to the HHS secretary on the public health impact of menthol cigarettes, and, based on the report’s findings, the FDA has the authority to take further regulatory action with regard to menthol.

Presentations at the March meeting will cover a broad array of research on menthol cigarettes, such as the demographics of menthol cigarette users, the influence of these demographics on smoking initiation, and menthol’s effect on how cigarettes are smoked. Update

NCI Recovery Act Web Site Features Comparative Effectiveness Research and ACTNOW Trial Details

NCI has added to its Recovery Act Web site a new article that explores comparative effectiveness research (CER), including patient-centered outcomes research. The article describes how NCI-funded initiatives help make cancer care more personalized, efficient, cost-effective, and improve patient outcomes. To date, the Recovery Act has enabled NCI to support approximately $70 million in CER, including $50 million in “Grand Opportunities” and $13 million in Challenge Grants, which study the impact of different diagnostic and treatment options in real-world settings among diverse patients.

The article showcases several ARRA-funded studies currently under way at the University of Virginia (UVA) and the Group Health Research Institute in Seattle. A Grand Opportunity study at UVA is helping to develop a genome-enabled electronic medical record, examining the use of patients’ genomic information in cancer diagnostics and personalized care. The infrastructure developed will serve as the basis for future CER projects exploring the impact of genomic information on patient outcomes. The article details multiple initiatives at Group Health looking to improve cancer screening in the community care setting.

NCI’s Recovery Act Web site also features a list of the clinical trials supported by NCI’s Accelerating Clinical Trials of Novel Oncologic PathWays (ACTNOW) initiative. The ACTNOW trials are high-priority, early-phase clinical trials of new cancer treatments being studied on an accelerated timeline in a variety of cancer types. The accelerated timeline is intended to shorten the time between drug discovery and approval and safe use of these treatments by cancer patients. The trials include a significant number of correlative studies, including studies of biologic and imaging tests.

The Web page lists the ACTNOW trials by cancer type and contains links to descriptions of the trials, including the objectives, patient enrollment criteria, and current trial locations.


Interactive Translational Cancer Research Web Site Launched

NCI has launched an interactive Web site that provides a single access point to many of the Institute’s translational research resources and initiatives. NCI has a number of initiatives that help to speed the development of new diagnostic tests, cancer treatments, and other interventions that Screenshot of NCI’s Translational Cancer Research Continuum Web site benefit people with cancer and those who are at risk. Users of the Translational Cancer Research Continuum Web site will find resources for the full spectrum of treatment discovery and learn how NCI’s programs and initiatives are expediting translational cancer research through:

  • advanced technologies
  • drug development
  • clinical trials
  • public/private partnerships
  • bioinformatics
  • the study of causes, prevention, and control


BSA Meeting Held

NCI's Board of Scientific Advisors (BSA) met March 8 on the NIH campus in Bethesda, MD. In addition to a report from NCI Director Dr. John E. Niederhuber, the meeting featured status updates on NCI’s Patient Navigation Research Program (PNRP) and the NCI Alliance for Nanotechnology in Cancer. The full agenda and a videocast of the public portions of the meeting are now available.

2010 Survivorship Research Conference Accepting Applications

2010 Cancer Survivorship Research conference bannerApplications are now being accepted for the Survivor Advocate Program for the 2010 Cancer Survivorship Research Conference, scheduled for June 17–19 in Washington, DC. This biennial conference brings together investigators, clinicians, and survivors to share and learn about the most up-to-date cancer survivorship research. This year’s conference is co-sponsored by NCI, the American Cancer Society, LIVESTRONG, and the CDC.

The Survivor Advocate Program provides travel scholarships for 20 advocates to attend the conference. Participants will learn firsthand about emerging advances and opportunities in cancer survivorship science and will have the opportunity to interact with other advocate leaders and survivorship researchers. Applications must be submitted by April 9. Learn more about the program and view eligibility requirements on the Survivor Advocate Program's Web site.

NCI and German Cancer Research Center Launch Exchange Program

NCI’s Dr. Joe Harford and Deutsches Krebsforschungszentrum Director Dr. Otmar Wiestler sign an agreement on a new exchange program for young scientists. NCI’s Dr. Joe Harford (seated at left) and Deutsches Krebsforschungszentrum Director Dr. Otmar Wiestler (seated at right) sign an agreement on a new exchange program for young scientists.

The German Cancer Research Center, Deutsches Krebsforschungszentrum (DKFZ), and NCI have announced a new exchange program for young scientists, the DKFZ-NCI Fellowship Program in Cancer Research. The exchanges will enable young researchers to work at the partnering institute for up to 4 years and possibly create their own junior research groups upon return to their home country.

The agreement on the exchange program was signed February 18 at the State Department by the director of DKFZ, Dr. Otmar D. Wiestler, and Dr. Joe Harford, director of NCI’s Office of International Affairs (OIA).

The first call for proposals for the fellowship program can be found on the OIA Web site. A major focus within this research program will be cancer stem cells. NCI and DKFZ will co-sponsor a conference in Heidelberg, Germany, on this topic in October, when the first fellowship recipients are expected to be announced. Further details regarding this conference will soon be available on the OIA Web site.

NIH Offers New Online Health Resource for Seniors: Life after Cancer

Life after Cancer is a new online resource for older adult cancer survivors that can help them anticipate the follow-up care they will need after treatment, learn about lifestyle changes that can improve their quality of life and survival, and understand the physical and emotional changes they may encounter, including their relationships with friends and families.

The resource was developed by NCI for, a health and wellness Web site developed especially for older adults by the National Institute on Aging and the National Library of Medicine. NIHSeniorHealth features more than 40 other health topics covering issues of interest to older adults, including memory and mental health, healthy aging, several types of cancer, and more. To make the Web site easy for older adults to use, information is presented in short, easy-to-read segments that can be accessed in various large-print type sizes. The site also offers open-captioned videos, simple navigation, and a speech function that lets you hear the text read aloud.

NHGRI Launches Online Tool for Educators on Genetics and Genomics

In an effort to address the growing need among health care professionals for knowledge in genetics and genomics, the National Human Genome Research Institute (NHGRI) has launched the Genetics/Genomics Competency Center (G2C2), a free online tool for educators who train nurses and physician assistants. Educators can use G2C2 to find and download materials for use in their classrooms and to share their genomic and genetic teaching resources and materials with other educators by uploading material, which is regularly reviewed by the center’s editorial board to ensure quality control.

NHGRI’s Genomic Healthcare Branch will host a Webinar this spring to provide educators with a tutorial on using the tool and to answer questions about the resource.