NCI Board of Scientific Advisors November, 2004 Dr. Robert C. Young, BSA Chair, President, Fox Chase Cancer Center Dr. Kirby I. Bland, Fay Fletcher Kerner Professor and Chair, Department of Surgery; Deputy Director, Comprehensive Cancer Center, University of Alabama at Birmingham Dr. Kathleen M. Foley, Director, Pain and Palliative Care Service, Department of Neurology, Memorial Sloan Kettering Cancer Center Dr. Sanjiv S. Gambhir, Professor, Department of Radiology and Bio-X Program; Director, Molecular Imaging Program, Stanford University Dr. Joe W. Gray, Director, Division of Life Sciences; Associate Director, Biosciences, Lawrence Berkeley National Laboratory Dr. Mary J. Hendrix, President and Scientific Director, Children's Memorial Research Center; Professor of Pediatrics, Feinberg School of Medicine, Northwestern University Dr. Leroy E. Hood, President and Founder, Institute for Systems Biology Dr. Stanley J. Korsmeyer, Professor, Department of Pathology, Dana-Farber Cancer Institute Dr. Christopher J. Logothetis, Chair and Professor of Medicine, Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center Dr. Edith A. Perez, Professor of Medicine, Division of Hematology/Oncology, Mayo Medical School; Director, Breast Cancer Program, Mayo Clinic Dr. John D. Potter, Senior Vice President and Division Director, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center Dr. Ellen V. Sigal,* Chair, Friends of Cancer Research Dr. Jane C. Weeks, Assistant Professor, Department of Medical Oncology, Dana-Farber Cancer Institute * Reappointed

At the NCI Board of Scientific Advisors (BSA) meeting on November 8 and 9, the board discussed a proposed initiative to accelerate the identification of cancer biomarkers, as well as ways in which the quality of health care practice can be improved.

Dr. Leland Hartwell, Nobel laureate and director of the Fred Hutchinson Cancer Research Center in Seattle, began his presentation by noting that the case for early detection through biomarkers is founded in both economics and patient outcomes. He said that a more organized and systematic approach for discovering biomarkers for cancer exists than that which is currently available, and stated that even with existing technology, "If we take a divide-and-conquer strategy" beginning with 1,000 biomarker candidates and splitting the work among different laboratories, "we could end up with something in the order of 30 to 40 good things in the end."

The principle obstacles in this process, he noted, are a lack of reagents and a lack of standards within this research field. He called on NCI to lead and oversee a new biomarker initiative, and proposed a structure whereby centers are funded for focused work on reagents, technology, and informatics, with smaller pilot projects led by individual researchers.

BSA members were largely supportive of Dr. Hartwell's proposal, but identified key concerns that should be reviewed, including legal issues surrounding the collection of samples for biomarker testing; the size and nature of the patient population for this research; the ultimate cost during clinical trials of biomarker candidates; and the other programs and initiatives, such as the NIH Roadmap and the Early Detection Research Network, that should dovetail with this new effort.

Dr. Mark Clanton, NCI's deputy director of Cancer Care Delivery Systems, followed with an overview of health care quality assessment as context for future discussion. "The public health impact of cancer can really only change if we can increase and enhance the performance of the health care system," he said. Staff from NCI's Outcomes Research Branch in the Division of Cancer Control and Population Sciences then presented a summary of the research dissemination tools that NCI makes available to the health care community, the challenges in translating research into practice, and two programs to improve palliative health care in specific populations, with following discussion of the appropriate role for NCI in provider training and in evidence synthesis and dissemination.

BSA members had many suggestions for how to address these issues, including a report-card system in which clinicians have incentives to comply with standards of practice, NCI-funded "leverage research" that would be adopted by health care practitioners, and identification of interventions that have been effective in systems similar to that of health care in this country.