Special Issue of the NCI Cancer Bulletin on Survivorship
Three NIH-funded Researchers Win 2009 Nobel Prize
Drs. Elizabeth H. Blackburn of the University of California, San Francisco; Carol W. Greider of Johns Hopkins University School of Medicine; and Jack W. Szostak of Harvard Medical School have won the Nobel Prize in Physiology or Medicine for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase. Telomeres limit the number of times a cell can divide and therefore play an important role in aging and cancer.
During a visit to the NIH campus last week, President Barack Obama announced that NIH will spend $275 million over the next 2 years to catalogue the genetic changes driving more than 20 types of cancer. Read more > >
At NCI, we clearly recognize cancer as a global health crisis, and one for which the worldwide impact—both personal and economic—is rapidly expanding. A recent study reported that in the past 30 years the global burden of cancer, based on the incidence of new cancer cases and annual deaths, has doubled. Read more > >
- Cancer.gov Highlights Breast Cancer Awareness Month
- Searchable Database for Cancer Control Publications Now Available
- New Statistical Software Aids Health Disparities Research
- NCI Recognizes Clinical Investigators with New Team Leadership Award
- Recovery Act Funds Made Available to Expand NCCCP
- UC Berkeley Cancer Researcher Wins 2009 MacArthur Fellowship
- Dr. Thomas Waldmann Awarded Service to America Medal
- NIH FARE 2010 Awards Announced
- President's Cancer Panel Explores Effects of Demographic Change on Cancer
- NCI to Host Forum Connecting SBIR Companies and Potential Investors
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.
For more information about cancer, call 1-800-4-CANCER or visit http://www.cancer.gov.
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The Cancer Genome Atlas Project to Map 20 Tumor Types
During a visit to the NIH campus last week, President Barack Obama announced that NIH will spend $275 million over the next 2 years to catalogue the genetic changes driving more than 20 types of cancer.
The grant, which includes $175 million in Recovery Act funds, will support the second phase of The Cancer Genome Atlas (TCGA) project. This collaborative effort led by NCI and the National Human Genome Research Institute (NHGRI) aims to discover the molecular alterations that occur in major types and subtypes of cancer.
Leaders of the project said that the TCGA pilot study, launched in 2006, has demonstrated the feasibility of using integrated genomic strategies to characterize the molecular alterations in cancer. The first three cancers profiled were brain, lung, and ovarian.
“The pilot project showed not only that we could build the infrastructure for a large-scale genome mapping project, but also that a very large team of scientists could come together and do work that benefits the entire community,” said NCI Deputy Director Dr. Anna Barker, who co-leads the research program.
More than 150 researchers at some 18 centers around the country will use various genomic technologies, including next-generation DNA sequencing machines, to produce the data. As has happened during the pilot project, the information will be deposited in public databases, where the scientific community can use the results for many purposes, including searching for vulnerabilities in tumors that could be exploited by therapies.
The project aims to complete in-depth genomic analyses of 10 cancer types using approximately 500 samples of both tumor and matched normal tissue of each type, while also sequencing and characterizing at least 100 tumors for each of the additional cancers in the next 2 years, officials said.
The TCGA research network will broaden its mapping efforts and generate more in-depth analyses of all of the cancers in the following 3 years. Dr. Barker noted that the development of new bioinformatic tools to analyze large amounts of genomic data will be critical to the project’s success.
NCI and NHGRI will each commit $50 million in non-Recovery Act funds to TCGA over the initial 2-year period. The two institutes have also committed to funding the remaining 3 years of the project, and the details will be finalized shortly, officials said.
The 20 cancer types have not been announced, but the criteria include relatively high incidence, substantial lethality, and the availability of high-quality biological samples for analysis. A type of kidney cancer called clear cell renal cell carcinoma and a type of breast cancer called invasive ductal carcinoma are examples of cancers likely to be priorities.
“This ambitious effort promises to open new windows into the biology of all cancers, transform approaches to cancer research, and raise the curtain on a more personalized era of cancer care,” NIH Director Dr. Francis Collins said in a news release.
For example, TCGA data could accelerate the discovery of biological markers associated with specific subtypes of cancer. Even before new drugs or diagnostic tools are developed for patients with these subtypes, physicians could use biomarkers to assign patients to the most appropriate clinical trials, Dr. Barker noted.
The project also collects detailed information about each participant’s clinical course and outcomes, so researchers can identify associations between genomic changes and treatment responses. For example, TCGA investigators reported recently that certain genetic alterations in patients with glioblastoma (a form of brain cancer) are associated with the development of resistance to a drug that is commonly used to treat the disease.
In his speech at the NIH Clinical Center on September 30, President Obama announced that $5 billion in 2009 Recovery Act funding for NIH would support more than 12,000 grants. Calling the Recovery Act grants the “single largest boost to biomedical research in history,” he said that the investment would drive cutting-edge research across America, unlocking treatments to diseases such as cancer “that have long plagued humanity.”
After attending a scientific meeting on brain cancer last week, Dr. Barker said that TCGA was already making a difference in the field. Many presentations included TCGA data, and clinicians were discussing the issue of drug resistance uncovered by project investigators. Some researchers at the meeting had begun to work on glioblastoma largely because reliable genomic data on the tumor type were available, she noted.
“This project has transformed our view of glioblastoma, first and foremost, by providing new therapeutic points of attack,” Dr. Ronald DePinho of the Dana-Farber Cancer Institute, who was also at the meeting, said in an email message. “It is an extraordinary resource for all of cancer science, not just glioblastoma.”
“What is particularly helpful for the field,” he continued, “is that investigators can now conduct a comprehensive analysis of pathways and their interactions across all dimensions of the genome space—RNA, splicing, microRNA, copy number, mutations, and epigenetics.”
As the project’s next phase gets under way, Dr. Barker predicted that the scientific community would continue to use the data to develop new insights into the biology of cancer.
“I think the TCGA approach has enormous promise to change the face of cancer research as we roll out the genomic profiles on these various tumors in the next 5 years,” she said.
—Edward R. Winstead
Cancer Research Highlights
Hormone Therapy for Prostate Cancer May Pose Heart Risks
The largest study of its kind indicates that hormone treatments used to block the effects of testosterone on prostate tumors can increase the risk of cardiac events and cardiac death. The retrospective study reviewed the health records of more than 30,000 Swedish men and found that the risk was highest in those men taking gonadotropin-releasing hormone (GnRH) agonists, the most commonly used hormone treatment in the United States. The results were reported at the ECCO 15-ESMO 34 conference in Germany.
The researchers looked at all men with prostate cancer in Sweden who were treated with hormone therapy between 1997 and 2006 and assessed their incidence of cardiac problems for 3 years after receiving the hormone treatment. The majority of patients received either GnRH agonists (which reduce testosterone production) or GnRH agonists plus anti-androgen drugs (which block testosterone from attaching to prostate cells). The remaining patients received anti-androgen therapy or orchiectomy (removal of the testicles).
According to study author Ms. Mieke Van Hemelrijck, treatment with any hormone therapy was associated with a 24 percent increase in the risk of a nonfatal heart attack and a 28 percent increase in risk of a fatal heart attack. The risks of heart failure, arrhythmia (irregular heart beat), and ischemic heart disease also increased, as did the risk of death from these cardiac problems. The lowest risk was associated with anti-androgen therapy, whereas GnRH agonists were associated with the highest risk.
The findings, stated Ms. Van Hemelrijck in a news release, “may have implications for treatment choice.”
Other studies have pointed to a potential increased risk for cardiac events associated with hormone therapy, explained Dr. Eric Horwitz, a radiation oncologist at Fox Chase Cancer Center. But that finding has not been consistent, he cautioned. “It’s hard to separate out this risk from patients’ other underlying health issues,” he said. For patients with aggressive disease, hormone therapy is very effective in conjunction with other therapies including radiation therapy and surgery. “But it’s a real risk,” he said. “It’s a discussion we’re now having every day with our patients.”
Breast Cancer Trial Suspends Recruitment
An NCI-sponsored phase III clinical trial for women with high-risk breast cancer has temporarily suspended accrual while researchers study the incidence of congestive heart failure among participants. The E5103 trial is comparing bevacizumab (Avastin) combined with standard adjuvant chemotherapy versus adjuvant chemotherapy alone for women with lymph node-positive or high-risk lymph node-negative breast cancer who have undergone lumpectomy or mastectomy. As a preplanned safety measure, the investigators suspended accrual after 6 of the first 200 women enrolled in the trial developed clinical congestive heart failure. In the cases where follow-up data were available, the symptoms of congestive heart failure resolved with treatment. More than 3,300 women are currently participating in the study.
NCI and the Eastern Cooperative Oncology Group suspended recruitment of new patients on September 24. Women currently participating in the trial will be notified of these adverse events and may choose to continue receiving their assigned treatment or withdraw from the study.
High-dose Daunorubicin Benefits Younger Adults with Leukemia
In two studies published in the September 24 New England Journal of Medicine, a high dose of daunorubicin given as part of initial treatment for acute myeloid leukemia (AML) increased the rate of complete remission and, in one study, improved overall survival compared with the standard dose given in the clinic. These beneficial effects of high-dose daunorubicin appeared to be confined to patients aged 65 or younger.
One clinical trial, designed by the Eastern Cooperative Oncology Group, randomly assigned 657 patients aged 17 to 60 to either high-dose or standard-dose daunorubicin; all patients also received the drug cytarabine. If a complete remission was not observed after the first course of the drugs, patients received a second course of cytarabine and standard-dose daunorubicin.
Significantly more patients in the high-dose daunorubicin group had a complete remission compared with those in the standard-dose group (70.6 percent versus 57.3 percent). The median overall survival was 15.7 months for patients in the standard-dose group and 23.7 months for patients in the high-dose group.
The second trial, performed by several European cooperative research groups, enrolled 813 patients between ages 60 and 83. Patients were randomly assigned to receive a first course of either standard-dose or high-dose daunorubicin, along with cytarabine. All patients received a second cycle of treatment with cytarabine alone.
Significantly more patients in the high-dose daunorubicin group had a complete remission (64 percent versus 54 percent in the standard-dose group). However, unlike in the American study, the two groups did not have significant differences in survival. An analysis showed that patients aged 60 to 65 had an increase in survival with high-dose daunorubicin; however, explained the authors, “these differences could be due to chance findings,” since the trial was not designed to analyze the results by age group.
Neither trial saw an increase in serious side effects from the higher dose of daunorubicin. “The lack of an increase in toxic effects and the benefit in overall survival strongly argue for incorporating high-dose daunorubicin into the initial treatment of younger patients with AML,” concluded the authors of an accompanying editorial.
Many Survivors of Childhood Cancers Have Healthy Babies
Most people who are treated for cancer as children or adolescents and go on to have children of their own are just as likely as other parents to have healthy babies, according to two studies in the October Archives of Pediatrics & Adolescent Medicine. After examining birth records of nearly 2,400 childhood cancer survivors and 18,000 comparison subjects, female survivors overall were not more likely to have major complications during pregnancy, to have babies with birth defects, or to experience infant death compared with other women, one study found. The other study found no major differences in birth outcomes between the offspring of male childhood cancer survivors and a matched comparison group.
The results are “very reassuring,” said Dr. Eric Chow of Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, an author of both studies. “People who have childhood cancers who then go on to have children of their own should be reassured that most likely their children will be fine.”
Concerns have been raised about the potential for birth defects and complicated pregnancies as a result of treatments such as radiation and chemotherapy. And some studies suggest that the offspring of childhood cancer survivors may have more health problems than other children. The new studies did find that among female survivors of childhood cancers, there was an increased risk of infants born prematurely or with a low birth weight. While premature birth and low birth weight are not insignificant, they do not necessarily predict health problems later in life, the researchers noted.
Women who survive cancer and intend to become pregnant should alert their health care providers so they can be monitored more closely to minimize the chances and consequences of having a low birth weight or premature baby, Dr. Chow said. He also cautioned that some of the survivors in the study were treated several decades ago and that more research is needed to follow more recent survivors who may have received different treatments.
“The most important take-home message is that for childhood and adolescent cancer survivors who go on to have families, the prospect for having healthy offspring is excellent,” said Dr. Julia Rowland, director of NCI’s Office of Cancer Survivorship.
Investigational Drug Effective Against Metastatic Melanoma in Early Phase Trial
An investigational agent called PLX4032 that targets a specific genetic mutation effectively shrunk tumors in an ongoing phase I clinical trial involving patients with metastatic melanoma, U.S. researchers reported on September 23 at the ECCO 15-ESMO 34 conference in Germany. Metastatic melanoma has proven particularly resistant to most treatments, and 5-year survival rates are below 20 percent. Based on the trial results, the company that developed the drug has begun enrolling patients in a phase II trial, and a phase III clinical trial is expected to begin enrolling patients by the end of the year.
Presenting the results, Dr. Paul Chapman of Memorial Sloan-Kettering Cancer Center reported that nearly two-thirds of the 22 patients for whom data were available had at least a partial response to the drug—that is, tumor shrinkage of at least 30 percent. Some patients’ tumors have regrown after initially responding to the drug, and several patients have developed nonmelanoma skin cancers, he said.
Most of the patients in the trial had previously had their disease progress after receiving other treatments, including chemotherapy and interleukin 2. All trial participants have a specific mutation in a gene called BRAF, which is mutated in approximately half of advanced melanoma cases. The data presented at the conference came from a 30-patient extension of the original phase I trial, which involved 55 patients and was intended to find the best dose to use in future trials. The patients being treated in the extension trial are all receiving the same dose of PLX4032. Overall, 20 of 22 patients have had some level of tumor shrinkage following treatment.
“Right now we are seeing dramatic responses,” Dr. Chapman said in a news release, although he stressed that it’s too early to draw conclusions about patients’ long-term outcomes. The phase II trial of PLX4032 will enroll 100 patients with metastatic melanoma whose tumors have BRAF mutations that did not respond to previous treatment, whereas the phase III trial will test the drug as a front-line therapy in previously untreated patients with the mutation.
Invasiveness of Breast Cancer Cells Linked to Two Proteins
How breast cancer cells acquire the ability to break off from a tumor and travel to other parts of the body is poorly understood, but researchers have now identified a critical player in the process. In some breast cancer cells, increased levels of a protein called 14-3-3ζ (zeta) appears to trigger a molecular cascade that leads to the loss of molecular “glue” (E-cadherin) that binds cells together, allowing the cells to break free of the main tumor and spread to other tissues.
“We have discovered a key molecular mechanism for the deadly transition of non-invasive breast cancer into invasive disease,” lead investigator Dr. Dihua Yu of the University of Texas M.D. Anderson Cancer Center said in a press release. This transition was observed in cells that produced increased levels of both 14-3-3ζ and another cancer-related protein, ErbB2/HER2, the researchers reported in the September 8 issue of Cancer Cell.
Women with advanced breast cancer commonly have their levels of ErbB2/HER2 tested to determine whether they should be treated with trastuzumab (Herceptin), but little has been known about the role of this protein in early stage disease. It now appears that ErbB2/HER2 and 14-3-3ζ may cooperate in transitioning some abnormal breast cells known as ductal carcinoma in situ (DCIS) into invasive breast cancer and metastasis.
Although it may be impractical to block the activity of 14-3-3ζ because it has many roles in normal cells, it is possible that the protein could be used to identify those women with DCIS who are at high risk of progressing to invasive cancer. It may also be possible to target the pathways and partners of 14-3-3ζ, including the growth factor TGF-β, the researchers said.
“This is a seminal paper,” commented Dr. Suresh Mohla of NCI’s Division of Cancer Biology. He noted that 14-3-3ζ is overexpressed in many human epithelial cancers, and the findings therefore could potentially be relevant to lung, liver, pancreatic, ovarian, and prostate cancers.
Global Cancer Control: An Essential Duty
At NCI, we clearly recognize cancer as a global health crisis, and one for which the worldwide impact—both personal and economic—is rapidly expanding. A recent study reported that in the past 30 years the global burden of cancer, based on the incidence of new cancer cases and annual deaths, has doubled. The burden of cancer, however, is not equally distributed, and this represents a major concern. Today, 63 percent of cancer cases occur in countries less developed than ours. It has been estimated that across the globe there will be 12.9 million new cases diagnosed this year, and the worldwide toll is predicted to rise to 27 million new cancer cases and 17 million deaths by the year 2030, unless we take more pressing action.
In the United States, lung cancer is a major health problem, and in Mexico, cancers of the lung, bronchus, and trachea are also highly lethal, with a recently reported crude mortality rate of 6.5 per 100,000 people. However, cervical and uterine cancers in Mexico have an even higher crude mortality rate (recently reported at 7.6 deaths per 100,000 women), which is probably the result of inadequate screening and thus diagnosis of cancer at advanced, and more likely fatal, stages.
In Chile, the leading cause of cancer death in women is not breast or lung cancer, but cancer of the gallbladder. Both examples above, from Mexico and Chile, suggest differences in genetic susceptibility and environmental risk factors.
In China, smoking rates have skyrocketed, with an estimated 350 million current smokers. Two thirds of men in China smoke. That staggering statistic means that the rates of lung cancer and other tobacco-related cancers, such as pancreatic and bladder cancer, will increase markedly in the coming decades. An August 2009 report commissioned by the Lance Armstrong Foundation and conducted by staff at The Economist stated that, “It takes about 40 years for the increase in smoking rates to be fully reflected in cancer epidemiology statistics. As a result, the number of deaths in the developing world will continue to rise based on past activities as well as the projected increase in new lung cancer cases.”
For the United States, cancer in other countries is clearly a humanitarian and diplomatic challenge, but also a tremendous opportunity to learn through studies of genetic drivers of risk and interactions between genes and the environment. Indeed, NIH Director Dr. Francis Collins has made improving global health one of the five pillars of his directorship. Our country, he said during a recent town hall meeting with NIH employees, has been viewed of late as a “soldier to the world.” Using our scientific and medical expertise to improve global health would be a welcome display of “soft power,” he said, demonstrating that the United States can be a “doctor to the world.”
NCI’s international cancer efforts are a response to these challenges. The global economic cost in 2009 of new cancer cases—factoring medical and nonmedical costs, along with productivity losses and the cost of cancer research—is currently estimated to be at least $286 billion, according to the The Economist report, “Breakaway: The Global Burden of Cancer—Challenges and Opportunities.” A steep rise in cancer cases will only drive this economic burden higher. Such data become tangible, though, when you take a more personal perspective. In the United States, adjuvant use of the breast cancer drug tamoxifen for 5 years often costs $4,000. Meanwhile, the annual per capita income in Bangladesh is just under $600; in sub-Saharan Africa, it is about $1,100. Many of the therapies that Americans with health insurance expect to be available for their care cost at least 10 times the annual per capita income of developing nations. Yet only 5 percent of global resources for cancer are spent in that part of the world, less than $1 to $2 per day, according to the World Health Organization.
As populations move, as governments change, as environmental toxins affect great land areas, what happens to one region of the world is clearly felt in another. I believe NCI’s international duty must be, in part, to study patterns of population movement. We must also understand the impact of poverty on health and cancer rates, and we must continue to study and attempt to drive down global smoking rates. We must contemplate infectious agents as the causes of greater numbers of cancers, and we must never lose vigilance in studying the malignancies that are so often a consequence of HIV/AIDS. In short, we must employ our international research efforts to better understand the biology of cancer around the world.
Consider Bangladesh, one of the world’s poorest countries, where 162 million people live in an area the size of Iowa. With support from NCI and other organizations, Dr. Richard Love of Ohio State University is attempting to break through political and cultural barriers to save women’s lives. Dr. Love has worked with the Bangladeshi government to open free breast cancer clinics that treat hundreds of breast cancer cases, almost all of which present in late stages. In that country, where more than 30 percent of the population lives on less than $1 per day, Dr. Love is not only helping patients, he is studying populations, looking for differences in individual tumors, in the reactions of patients to medicines and treatments, in cultural traditions, and in health care systems. Dr. Love is even conducting a study in a small village to determine whether it is possible to educate women and men about breast health and breast cancer by employing a type of traditional song often performed as street theater.
Last week, I met with top health and diplomatic officials from Argentina, Brazil, Mexico, and Uruguay, who came to the NIH campus to sign letters of intent formally bringing them into the U.S.-Latin America Cancer Research Network, joining Chile, which signed a letter of intent earlier this year. For a pilot project in breast cancer, researchers from the five countries will perform molecular profiling of tumor samples from women to help identify the most common breast cancer subtypes and to improve both diagnosis and treatment. Given the growing Hispanic population in the United States, this work promises significant benefits for all of the partner countries.
In our own country, we have considerable evidence that the incidence of cancer has two principal drivers: a population that is rapidly aging, and one that is increasing in number and ethnic heterogeneity. This presents opportunities to apply what we are learning from global research programs to changing U.S. demographics.
NCI also has a long history of international population-based studies, specifically in Russia and China, to identify environmental and genetic determinants of cancer.
Healthcare, many argue, is a basic human right. The United Nations’ Universal Declaration of Human Rights from 1948 says, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family.” When it comes to NCI and the rest of the world, I would suggest a simpler way of thinking: It is our duty to reduce cancer’s great burden for all people.
Dr. John E. Niederhuber
Director, National Cancer Institute
Experts Tackle the Challenge of Managing Ductal Carcinoma In Situ
One of the controversies in oncology today concerns how to treat ductal carcinoma in situ (DCIS), a common pre-cancer of the breast that accounts for at least 20 percent of all breast cancer diagnoses. Nearly 100 percent of patients with DCIS achieve long-term disease-free survival with current therapies. NCI and NIH’s Office of Medical Applications of Research convened a state-of-the-science conference titled, “Diagnosis and Management of Ductal Carcinoma In Situ” 2 weeks ago, which brought together researchers, clinicians, advocates, and policymakers to discuss some key questions about this condition.
The draft conference statement, produced by a panel of 14 experts and delivered by chair Dr. Carmen Allegra of the University of Florida Shands Cancer Center at Gainesville, was intended “to provide health care providers, patients, and the general public with a responsible assessment of currently available data.” The statement addressed most of the dilemmas and included the panelists’ recommendations about how they should be handled. Questions addressed by the panel were prompted by an evidence-based report compiled by the Agency for Healthcare Research and Quality.
Perhaps the most animated discussions at the meeting were about whether the condition should be called something other than DCIS, since the fear and stigma associated with breast cancer can compromise a health provider’s efforts to explain the diagnosis and guide patients to an informed decision about treatment choices. Despite dramatically higher cure rates than invasive breast cancer (IBC) and excellent prognoses after treatment, women with DCIS experience psychological responses (e.g., anxiety and worry) similar to those experienced by women diagnosed with invasive disease.
The panel concluded that “strong consideration should be given to elimination of the use of the anxiety-producing term ‘carcinoma’ from the description of DCIS,” though Dr. Allegra emphasized it was not their charge to suggest an actual change of nomenclature and felt that pathologists would be an important constituency to consult on this issue.
The heart of the DCIS dilemma stems from the rise of screening mammography; in the 1970s, DCIS accounted for less than 5 percent of cancer diagnoses. With the addition of mammography and magnetic resonance imaging (MRI), much more disease is being detected today, and the incidence of DCIS is growing faster than that of any other breast cancer subtype.
While the natural history of DCIS is poorly understood, low-grade disease can persist for more than 4 decades without progressing, said Dr. D. Craig Allred, director of breast pathology at the Washington University School of Medicine in St. Louis. Left untreated, however, “the few studies that have been done suggest that about 35 percent of DCIS cases will progress to IBC within 30 years, and there’s actually reason to think that the real incidence of DCIS that progresses to IBC is even higher.”
The panel acknowledged that the majority of treated DCIS lesions will not progress to IBC, but Dr. Allred points out that “unless you know which ones those are, all are potentially threatening.” In addition to routine mammorgraphy, MRI is used increasingly to screen for breast cancer, and in terms of DCIS the panel asked, “To what degree does breast MRI in this setting result in overdetection, meaning the detection of biologically insignificant lesions?”
Most women with DCIS elect to have some form of surgery, given the risk of progression and their fear of invasive disease. Approximately one in three patients elect to have a mastectomy and some also have the other breast removed as a preventive measure (prophylactic mastectomy). The alternative is a local excision (lumpectomy), often followed by radiation therapy and, in estrogen receptor-positive DCIS, tamoxifen or aromatase inhibitor therapy to prevent recurrence.
Currently, it is unclear whether all patients “uniformly benefit from these interventions [and] important therapeutic questions remain unanswered,” wrote the panel. “[R]esearch efforts should focus on the identification of patients who are at high risk for developing recurrence.” They added that “the appropriate investigation of biomarkers could be helpful in guiding both systemic and local treatment decisions.”
The panel also called for better decision-making tools, which will help address patient anxiety related to the diagnosis of DCIS, the complex choice of treatment options, and “misperceptions regarding outcomes and risks of therapy.”
A Closer Look
This is the third article in a series of stories highlighting cancer technology. Look for the symbol on the left in an upcoming issue for the next article in the series.
Adapting Capsule Endoscopy for Colorectal Cancer Screening
The Agency for Healthcare Research and Quality recommends colorectal cancer screening for average-risk adults between the ages of 50 and 75 with one of the following methods: annual fecal occult blood testing, sigmoidoscopy every 5 years, or colonoscopy every 10 years. However, as of 2005, only 59 percent of people aged 50 or older had been screened according to these recommendations, and only 50 percent had had a colorectal endoscopy procedure (either sigmoidoscopy or colonoscopy, screening techniques that can both visualize cancer in the colon and rectum and remove precancerous polyps) within the past 10 years.
Many factors contribute to this low rate of screening endoscopy, including a shortage of medical professionals trained to perform the techniques, disparities in access, and people’s reluctance to undergo an invasive screening procedure.
“Having a tube placed for a colonoscopy is something that’s uncomfortable for a lot of people to think about,” said Dr. Stephen Taplin, senior scientist in NCI’s Division of Cancer Control and Population Sciences’ Applied Research Program (ARP).
One way to boost colorectal cancer screening rates may be to develop new screening technologies that are simpler, more accessible, and more acceptable to participants. A tiny, futuristic device smaller than the tip of one’s finger called the capsule endoscope is currently being tested and improved for what its developers hope will be a place in the cancer screening armamentarium.
Visualizing the “Black Box” of the Body
Originally developed to explore the small intestines, the small-bowel capsule endoscope (CE) is a tiny device about the size of a large vitamin pill, containing a light, a miniature camera, and a transmitter that sends images to a recording device worn by the patient during the procedure. A patient swallows the CE just like a pill, and the capsule is propelled through the digestive system by the normal movement of the intestines, transmitting pictures of the intestinal walls throughout its passage.
Approved by the FDA for the diagnosis of small bowel diseases in 2001, CE revolutionized small bowel medicine by allowing noninvasive imaging of part of the body that had been previously inaccessible except through surgical exploration.
One of the three companies that manufacture small-bowel CEs has now developed a version for the colon, in the hope of producing a less invasive alternative to traditional endoscopy for colorectal cancer screening. The colon CE has not been approved by the FDA for use in the United States, but it is being tested in clinical trials and explored by researchers interested in its potential applications.
Unmet Hopes in First Large Trial
The new colon CE—which contains two video imagers, one at each end of the capsule, and captures pictures at a rate of four frames per second—was recently tested in an international clinical trial led by researchers from the Université Libre de Bruxelles in Belgium and the manufacturer, Given Imaging, from Yoqneam, Israel. The researchers enrolled 332 patients with known or suspected colon disease into the trial. Each patient underwent both CE and standard colonoscopy on either the same or successive days.
Although the capsule was found to be safe, the preparation regimen that was required to cleanse the gut (including a clear liquid diet and laxatives) was more involved than the regimen for a standard colonoscopy, and the sensitivity of the capsule was not as high as colonoscopy (which is thought to have a maximum sensitivity of just over 90 percent). Advanced adenomas of any size were detected in 52 patients by colonoscopy, but in only 44 patients by CE. Nineteen cancers were detected by colonoscopy, but only 14 of those were visualized by the capsule.
“With the capsule’s relatively low sensitivity for the detection of colorectal lesions, [and] its requirement for more extensive bowel-cleansing regimens as compared with colonoscopy and CT colonography…colon capsule endoscopy cannot be recommended at this time,” concluded Dr. Michael Bretthauer of Oslo University Hospital Rikshospitalet in an editorial that accompanied the trial’s publication in the July 16 New England Journal of Medicine.
Challenges and Promises
A number of challenges lie in the way of colon CE being ready for the clinic, including improving sensitivity, which is related to the amount of data that can be captured by the imaging device, and the human error that can arise in analyzing large amounts of captured video. Reducing the cost per procedure will also be necessary.
Dr. Ram Sriram, a group leader with the National Institute of Standards and Technology Manufacturing Engineering Laboratory, and his colleagues in the Information Technology Laboratory, with input from the Asian Institute of Gastroenterology, are designing software to help automate image analysis for the small-bowel CE to speed analysis time (and thereby decrease cost) and reduce the likelihood of human error. Similar software could potentially help reduce the cost and increase the accuracy of colon CE, as well, but first the capsule must be able to capture enough data for the software engineers to analyze.
The colon is much wider than the small bowel, making it more challenging to develop a sufficiently sensitive colon CE. Even with a slightly larger size, “the capsule tends to move around a lot and doesn’t have a focus area, so you’re not getting all the pictures that you need,” explained Dr. Sriram. “Once they can take enough pictures, engineers can do image processing to make the technology more sensitive.”
The issue of simplifying the complicated bowel preparation currently required for colon CE is also “not trivial—it’s a huge issue, because the preparation is another aspect of colonoscopy that a lot of people don’t like,” said Dr. Taplin.
But the potential advantages of colon CE will likely keep researchers focused on improving the technology. For example, CE holds promise for telemedicine applications, explained Dr. Sriram, such as helping patients in remote areas who cannot travel to see a specialist for screening or diagnosis.
Also, if an improved, lower-cost colon CE could be administered by a primary care physician instead of a specialist, “that could remove the barrier of the scheduling process, and make it easier for patients to get access,” said Dr. Taplin. “Improving any kind of screening process is not just about improving the technology; it’s about streamlining the whole process to make it work.”
Featured Clinical Trial
Targeting HER2 in the Treatment of Ductal Carcinoma In Situ
Name of the Trial
Phase III Randomized Study of Radiotherapy with Versus without Trastuzumab (Herceptin) in Women with HER2-Positive Ductal Carcinoma In Situ Who Underwent Lumpectomy (NSABP-B-43). See the protocol summary.
Dr. Melody Cobleigh, Dr. Douglas Arthur, and Dr. Thomas Julian, National Surgical Adjuvant Breast and Bowel Project
Why This Trial Is Important
Ductal carcinoma in situ (DCIS), a condition in which abnormal cells are confined entirely to the milk duct of the breast, is a risk factor for the development of invasive breast cancer. The standard treatment for DCIS is surgery, which produces excellent long-term disease-free results. Although most patients can be treated with lumpectomy (breast-conserving surgery, in which only part of the breast is removed) and radiation therapy, patients with larger tumors or tumors with high-grade features may undergo mastectomy (removal of as much of the breast as possible).
One high-grade feature seen in some DCIS tumors is overexpression of the HER2 protein. When there is too much of this human epidermal growth factor receptor, tumors tend to grow faster and are also more likely to recur after initial treatment. Trastuzumab (Herceptin) is a monoclonal antibody that binds to the HER2 receptor and interferes with the growth of HER2-expressing tumors. It is approved by the FDA to be used with chemotherapy to treat HER2-positive invasive breast cancer. In addition, laboratory and animal studies have suggested that trastuzumab can increase the effectiveness of radiation therapy.
In this clinical trial, women with HER2-positive DCIS will be treated with lumpectomy followed by whole-breast radiation therapy; half of the women will also receive two doses of trastuzumab during their radiation treatment. The researchers will then monitor the women in both groups to see whether trastuzumab prevents or delays the development of invasive breast cancer or the recurrence of DCIS in the breast, among other outcomes, such as breast cancer in the opposite breast. Trastuzumab is administered for a short period of time with radiation and without chemotherapy, so the side effects from trastuzumab are expected to be minimal.
“We are looking for ways to extend the option of breast-conserving surgery to women whose more aggressive or advanced DCIS would normally indicate a mastectomy,” said Dr. Cobleigh. “We have seen that radiation therapy can significantly improve protection after lumpectomy.
“Trastuzumab has been proven safe and effective in the treatment of both early and metastatic breast cancer, and we want to see if it can make HER2-expressing tumor cells more sensitive to radiation. These women are more likely to have aggressive DCIS, and they should have an alternative to mastectomy,” she said. “This is a targeted approach that could make a real difference for women in that group.”
This is the second article in a series of stories related to cancer survivorship. Look for the next article in our survivorship series in an upcoming issue.
Spokes of Hope: Surviving Cancer and Riding On
A headwind slowed the riders all the way from Indianapolis to Pittsburgh, and then the hills began. For Cindi Hart, a “flatlander” from Indiana and two-time cancer survivor, the gentle hills started to feel more like mountains.
“We were climbing 15 percent grades that seemed to go on forever,” recalled Hart, who organized the ride to raise awareness of cancer and advocate for research. “But this was not a race, and when people dropped back, we would stop and wait for them. Just as in the journey through cancer, no one should have to do it alone.”
The riders were from Cyclists Combating Cancer, an international support group of people touched by cancer who share a passion for cycling. This online community had been Hart’s primary support group during her illness, and last month more than 100 members rode in a series of regional rides around the United States that included visits to several NCI-designated cancer centers. About a dozen riders met in Washington, DC, on September 16, including some who had started in Indiana or joined along the way.
“I’ve never seen so much compassion and support and love and hope as on this ride,” said Christopher States of San Francisco, a two-time cancer survivor who flew in to join the ride from Pittsburgh to DC. At the cancer centers, he and others shared their stories of coming back from multiple cancers and drew inspiration from patients who are still battling the disease.
These patients and their caregivers joined the tour by signing banners that traveled with the cyclists to Capitol Hill, where the group met with Senator Richard Lugar (R-IN) and other lawmakers, including Rep. Steven Rothman (D-NJ), who sponsored their visit. In what the cyclists described as fruitful discussions, they talked about the challenges facing cancer survivors and their caregivers.
Turning Negatives into Positives
The cyclists were frequently overcome with emotion by the stories of the remarkable patients they met. In Pittsburgh, the riders met Michelle, a 22-year-old mother who had undergone a bone marrow transplant for leukemia. Because her immune system had been suppressed, she had not been able to see her 3-year-old son for 3 months. But at the urging of her nurses, she spent about an hour talking with the cyclists.
“We told her our stories and that we’d been in the chemo chair, that we’d been hairless,” Hart said. “We’d been where she was, and now we were on the bike ride trying to make a difference in this cancer fight. We encouraged her to stay active and said that every step she took down that hallway would put her one step closer to her son.”
The cyclists did lots of listening, as well. As they got up to leave, the young mother embraced one of the riders, Jeffrey Rowe of Knoxville, TN. “She just wept and thanked us all for giving her the courage and the hope to go forward in her treatment. Attitude is everything—it’s one of the Lance Armstrong Foundation manifests,” Hart recalled.
Rowe is a professional speaker who survived brain cancer at age 17. When he signed on to the tour last spring, he was excited to mark his upcoming 20th anniversary as a cancer survivor on the ride. But in July doctors found two new tumors. For Rowe, the meaning of the ride changed, and he focused more than ever on turning negatives into positives. He was hopeful that by sharing his own experiences with cancer he could help patients like Michelle avoid some of the struggles he had endured.
Focusing on Survivors
Hart was in the midst of chemotherapy when she came up with the idea for the Spokes of Hope tour. A former nurse who had raced bikes for nearly 3 decades and also coached, she was looking ahead to the day when she’d be back riding. She approached members of Cyclists Combating Cancer at a gathering for cancer survivors and advocates sponsored by the Lance Armstrong Foundation in July 2008.
More than a year later, as a final stop before reaching the Capitol, the cyclists visited the NIH campus in Bethesda, MD, where they toured the Clinical Center and gave a presentation to NCI officials. They also heard about the latest research on the complex health and psychosocial issues facing some 11.4 million cancer survivors in the United States.
“Being cancer-free does not mean being free of cancer,” Dr. Julia Rowland, director of NCI’s Office of Cancer Survivorship, told the cyclists. “It’s not over when it’s over.” Cancer treatments can have long-term and late-occurring side effects, and survivors need to have their health monitored over time. The goal, she added, is not just to live longer but to ensure that a person has a high quality of life after a cancer diagnosis. She praised the cyclists as shining examples of the remarkable resilience of cancer survivors.
Researchers have not quantified the benefits of cycling after a cancer diagnosis, but the riders in the room did not need a study to validate their experiences.
“I have no doubt that I’m alive today because of cycling,” said Dr. Kenneth Youner, a retired gastroenterologist from New Jersey who was diagnosed with kidney cancer in 2003. He was taking sunitinib (Sutent) for a recurrence during the tour. A former marathon runner and longtime cyclist, he said that regular exercise had helped him come back from aggressive treatments that left him unable to get out of bed. He was riding in honor of his wife, Cecile, who died of cancer last year.
Online Tool for Creating Survivorship Care Plans Evaluated
A new survey has found that cancer survivors and health care providers were willing to use an online decision-making tool called OncoLife to create survivorship care plans and were satisfied with the information provided, according to a report in the Journal of Medical Internet Research. The Institute of Medicine recommends survivorship care plans for all cancer survivors.
“You Are My Sunshine”
With bright yellow jerseys and Livestrong wristbands, the cyclists were often stopped on the street. Upon learning about the ride, a woman in Pennsylvania asked the cyclists to visit a friend who had just come home after a bone marrow transplant and was despondent.
When the cyclists arrived at the woman’s house, she came to the door wearing an isolation mask. As she looked out at the people and bikes assembled on her lawn, the friend said, “I have brought you a gift.” With that, the cyclists started to sing, “You Are My Sunshine.” Everyone then held up three fingers and shouted “three,” because that was the friend’s symbol for I Love You.
“The woman smiled and cried, and we could tell by her eyes that she had been touched,” said Hart. After the woman went inside, her friend turned toward the cyclists and went from being almost giddy to breaking down and sobbing. Hart embraced her and realized that the song was also a gift for the friend.
“Friends and family feel so helpless when a loved one is faced with cancer, and they often don’t know what they can do,” Hart said. “Sometimes even the smallest gift—even just to see a loved one smile—is the most precious gift anyone could give.”
A Final Ride
The song and “3” became themes of the trip. When the group reached the Capitol, they carried armloads of signed banners into the building along with several bikes.
After clearing the security checkpoint, Dr. Youner hopped on his bike and rode down the hallway. He may not have been the first citizen to ride a bike in the Capitol, but he certainly was the first to do so in socks with the words “Cancer Stinks” written across the bottom.
Afterward, he said with a smile, “I couldn’t resist.”
—Edward R. Winstead
Cancer.gov Highlights Breast Cancer Awareness Month
The White House has issued a presidential proclamation designating October National Breast Cancer Awareness Month. As the federal government’s leading funding institution for cancer research, NCI supports a wide range of research to improve breast cancer prevention, detection, and treatment. NCI also funds research on follow-up care for the growing number of breast cancer survivors. Learn more about recent advances and selected resources on NCI’s Web site.
Searchable Database for Cancer Control Publications Now Available
NCI’s Division of Cancer Control and Population Sciences (DCCPS) has launched CC Publications, a searchable database that includes information on publications authored by the division’s staff, grantees, and contract-funded investigators. The database, which currently includes publications from 2005 to 2007, demonstrates the depth and breadth of recent research funded by DCCPS. CC Publications was developed to facilitate literature reviews, share information on the state of the science, communicate the return on investment to NCI stakeholders and constituents, and help researchers identify gaps in knowledge in order to write novel grant applications.
New Statistical Software Aids Health Disparities Research
The Health Disparities Calculator (HD*Calc) is a new statistical software program designed to generate data summaries to evaluate and monitor health disparities (HD). HD*Calc can be used as an extension of SEER*Stat, which allows users to easily import Surveillance, Epidemiology, and End Results (SEER) incidence data and National Center for Health Statistics mortality data. Alternatively, on its own, it can be used with other population-based health data. HD*Calc allows researchers to use a range of HD measures and tests them in different situations.
Cross-sectional and trend data (e.g., cancer rates, survival, stage at diagnosis) categorized by disparity group (including socioeconomic status, race, ethnicity, and geographic area) can be used with HD*Calc to generate 11 summary measures of disparity. Several of these measures are not commonly used to evaluate cancer-related health disparities. The output is presented in both tabular and graphic formats allowing users to specify different conditions and formats, and the tables and graphs can be exported from the program. In addition to summary measures, HD*Calc also allows users to explore underlying trends in the data. Tutorials available on the Web site allow users to gain experience with the software.
The application extends the work published in the NCI Cancer Surveillance Monograph Series entitled Methods for Measuring Cancer Disparities, which evaluates measures of health disparities included in HD*Calc.
NCI Recognizes Clinical Investigators with New Team Leadership Award
NCI has announced the recipients of its new Cancer Clinical Investigator Team Leadership Award:
Dr. Jordan Berlin, Vanderbilt-Ingram Cancer Center
Dr. Jeffrey Clark, Dana-Farber/Harvard Cancer Center
Dr. Steven Devine, Ohio State University Comprehensive Cancer Center
Dr. Jeffrey Lancet, H. Lee Moffitt Cancer Center & Research Institute
Dr. Robert Maki, Memorial Sloan-Kettering Cancer Center
Dr. Wells Messersmith, University of Colorado Cancer Center
Dr. Julian Molina, Mayo Clinic
Dr. Melanie Royce, University of New Mexico Cancer Center
Dr. Christopher Ryan, Oregon Health & Science University
Dr. Melanie Thomas, Hollings Cancer Center
Dr. Antonio Wolff, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Designed for midlevel clinical investigators, the awards provide recognition and funding for those who lead cancer research programs at academic cancer centers. Eleven clinical investigators are being recognized for their exceptional contributions to the advancement of effective new therapies through their collaborative team science approach within NCI-funded clinical trials. The 2-year award provides investigators with partial salary support for their leadership roles in clinical trials at NCI-designated cancer centers.
The awards are the result of one of the recommendations of NCI’s Clinical Trials Working Group (CTWG), which was established to advise the institute on methods to improve and enhance the publicly funded clinical trials enterprise. The goals of the awards are to offer support and provide academic recognition to investigators who promote collaborative team science. The broad clinical trials community, including the Clinical Trials and Translational Research Advisory Committee and the American Society of Clinical Oncology, provided input into the development of this award.
“We are truly excited to be able to recognize these key clinical investigators without whom we couldn’t conduct clinical trials,” said Dr. Sheila Prindiville, director of NCI’s Coordinating Center for Clinical Trials, the office that oversees implementation of the CTWG’s recommendations. “These recipients have exceptional leadership skills in cancer clinical trial activities and have demonstrated a commitment to conducting cancer clinical trials that promise to advance care for patients.”
The initial phase of the program funds 11 awards of $50,000 in each of the next 2 years. The funding is provided to the recipient’s institution and can be applied toward the investigator’s salary, fringe benefits, and associated facilities and administrative costs. Recipients are expected to devote 10 to 15 percent of their time to the activities associated with the award.
The awards are a new source of funding to support clinical research for those leading NCI-sponsored clinical trials who are not principal investigators, a group that tends to be overlooked by funding opportunities and recognition.
The awards, available to investigators at all NCI-designated cancer centers participating in NCI-funded collaborative clinical trials, ultimately support a shared culture in which investigators collaborate freely across disciplines, institutions, and programs to most expeditiously advance the design and conduct of cancer clinical trials.
Learn more about how NCI is restructuring the national cancer clinical trials enterprise online.
Recovery Act Funds Made Available to Expand NCCCP
Last week, NCI Director Dr. John E. Niederhuber announced plans to use funds from the American Recovery and Reinvestment Act to support the NCI Community Cancer Centers Program (NCCCP). A Request for Proposals (RFP) has been posted online to add approximately 14 new sites and another RFP will be posted on FedBizOpps later this week to enhance work at existing NCCCP sites.
The NCCCP is a pilot program that has formed a national network of community cancer centers to expand cancer research and deliver the most advanced cancer care to people in the communities where they live. Started in 2007, the NCCCP involves 16 community hospitals located primarily in rural, small-town, and underserved urban areas in 14 states.
To explore how NCI-designated cancer centers can implement partnerships with hospital-based community cancer centers using the NCCCP model, approximately half of the awards will be made to NCI-designated cancer centers in partnership with freestanding community hospital cancer centers; the remaining awards will be made to freestanding facilities. NCI will also allocate funds to current NCCCP hospitals for 2 years for 18 specific projects encompassing clinical trials, disparities, community outreach, biospecimen collection, electronic health records, quality of care, partnerships with state cancer plans, communications, survivorship, and palliative care.
Questions about the RFPs should be addressed to Roger Lewis.
UC Berkeley Cancer Researcher Wins 2009 MacArthur Fellowship
Dr. Lin He, a cancer researcher at the University of California, Berkeley, received a 2009 MacArthur Fellowship for her work studying how microRNAs are involved in converting normal cells into cancer cells by interrupting the p53 tumor suppressor mechanism, which normally stops replication or induces suicide in cancer cells.
Dr. He earned her Ph.D. at Stanford University in 2003, completed her postdoctoral fellowship at Cold Spring Harbor Laboratory in 2007, and joined the faculty at UC Berkeley in 2008.
MacArthur Fellowships are awarded each year to approximately 20 or 30 people “who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction,” according to the fellowship program Web site.
MacArthur Fellows receive unrestricted quarterly research subsidies totaling $500,000 over the course of 5 years—money that is viewed as “an investment in [the recipient’s] originality, insight, and potential,” rather than a reward for past accomplishments. Fellows are nominated by peers in their respective research fields and selected by a committee comprising leaders in the arts, sciences, humanities, and for-profit and non-profit sectors.
Dr. Thomas Waldmann Awarded Service to America Medal
Dr. Thomas Waldmann, chief of the Metabolism Branch in NCI’s Center for Cancer Research, was one of nine public servants who received a Service to America Medal on September 23. Dr. Waldmann received the Career Achievement Medal for cutting-edge discoveries made during his 52-year career. He joined NCI in 1956 and has been chief of the Metabolism Branch since 1973. Dr. Waldmann studies the IL-2/IL-2 receptor system in the growth of normal and neoplastic cells. His work has led to effective treatments for previously fatal forms of T-cell leukemia, Hodgkin lymphoma, and multiple sclerosis.
The Service to America Medals program honors the best in the federal workforce and works to inspire a new generation to consider public service careers by sharing recipients’ stories with the general public. Winners were nominated by colleagues familiar with their work and selected by a committee that included members of Congress, journalists, a university president, and leaders of several prominent philanthropic organizations. Nearly 400 nominations were submitted for medal consideration this year.
NIH FARE 2010 Awards Announced
The Fellows Award for Research Excellence (FARE) awards ceremony was held this afternoon to recognize outstanding scientific research by intramural fellows at NIH. Seventy-one of this year’s 236 winners are fellows from NCI’s Center for Cancer Research, Division of Cancer Control and Population Sciences, and Division of Cancer Epidemiology and Genetics.
Each winner received a $1,000 travel award to present their research at a scientific meeting during FY 2010 and was asked to serve as a judge for the following year’s competition. FARE winners will present posters on their research during the NIH Research Festival, being held October 6–9 on the NIH main campus.
A complete list of the 2010 FARE award recipients can be found online.
President's Cancer Panel Explores Effects of Demographic Change on Cancer
The President’s Cancer Panel held the first meeting of its 2009–2010 series, “America’s Demographic and Cultural Transformation: Implications for the Cancer Enterprise,” on September 22 in Seattle, WA. The panel heard testimony from a variety of experts in health demography, biostatistics, and social justice, including public health professionals, research scientists, physicians, and community advocates.
The panel explored the effects of a rapidly changing population on cancer care in the United States. Growing minority populations, particularly in Hispanic groups, and the disappearance of a majority group were widely predicted by experts. The speakers focused particularly on health disparities that exist across race, socioeconomic status, and education level, and noted that underserved populations are disproportionately minority, impoverished, and undereducated. They also acknowledged that health disparities will persist as long as underlying social injustices of poverty and racism continue. The panel will consider speaker recommendations in writing their 2009–2010 report to the President. The panel will continue to hear testimony on the effects of the changing U.S. population on cancer care and research at three future meetings:
October 27, 2009 - Los Angeles, CA
December 9, 2009 - Wilmington, DE
February 2, 2010 - Miami, FL
NCI to Host Forum Connecting SBIR Companies and Potential Investors
NCI’s Small Business Innovation Research (SBIR) Development Center will sponsor the first NCI SBIR Investor Forum on November 5 at Boston University. The event is designed to connect investors and strategic partners with the most promising SBIR companies developing breakthrough discoveries that are primed for commercialization. These innovative developments will be the next generation of cancer therapeutic, imaging, diagnostic, and other important technologies in the fight against cancer.
This full-day conference will feature the top 10 to 15 NCI SBIR companies focused on innovative research in cancer-related technologies, private breakout sessions to explore prospective partnerships, opportunities to discuss upcoming funding and opportunities with NCI SBIR Development Center staff, and a networking reception with leaders in the life sciences and medical technology arena to foster new collaborations.