Strengthening the Cancer Research Enterprise
Scientific opportunities for researchers abound thanks to the great progress and strong foundations of basic science enabled by NCI’s support of the national cancer research system. NCI remains strongly committed to training investigators and taking advantage of the opportunities to establish or reinforce infrastructures that advance science. These remain pivotal components in our work to reduce the burden of cancer and improve the health of Americans.
NCI’s research enterprise helps train the next generation of cancer researchers, provides investigators with mechanisms that promote innovative thinking, coordinates the research and clinical trials infrastructure, and makes diverse resources available to the cancer research community. The basic and applied research conducted by NCI-supported scientists and organizations underpins advances in cancer prevention, detection, and treatment that produce better outcomes for patients, those at risk of cancer, and survivors.
Supporting the Cancer Research Workforce
To strengthen the cancer research enterprise, NCI develops and supports a cadre of exceptional scientists from a variety of disciplines across the career continuum—from students just starting to explore a career path to well-established cancer investigators. Having a community of researchers from diverse backgrounds and at all levels of expertise strengthens cancer research and its translation to patient care.
NCI offers a number of training and funding mechanisms to support individuals and research teams as they pursue new discoveries and technologies to overcome cancer. Scientists can apply for training, career development, and mentored research awards.
In 2018, NCI supported the training of more than 3,400 students and early-career scientists, ranging from the high school level through the postdoctoral years and beyond. In addition, fellowships are available in cancer prevention; the behavioral, epidemiologic, and genetic sciences; and in immunotherapy and technology transfer.
NCI promotes diversity in the cancer research workforce through several programs, including the Continuing Umbrella of Research Experiences program and the Partnerships to Advance Cancer Health Equity program.
By ensuring that scientists are equipped to make discoveries and test novel ideas that advance cancer research and clinical care, NCI puts patients at the forefront of its efforts.
Early-stage investigators (ESI), such as cancer disparities researcher Tomi Akinyemiju, benefit from the Method to Extend Research in Time (MERIT) Award. The ESI MERIT Award provides up to 7 years of support to certain investigators who have their first R01 grant compared with 5 years of support for the traditional R01 grant.
Providing Infrastructure and Resources for Cancer Research and Patient Care
The rapid pace of scientific and technological discovery has created enormous opportunities along with challenges. Progress in cancer research is more dependent than ever on the synergy of interdisciplinary research teams and on government, academia, and industry collaborations. NCI supports the cancer research community by investing in infrastructure that connects investigators in academic research centers, community settings, and private sector companies. By ensuring that scientists are equipped to make discoveries and test novel ideas that advance cancer research and clinical care, NCI puts patients at the forefront of its efforts.
NCI-Designated Cancer Centers
NCI supports 71 NCI-Designated Cancer Centers across the nation. These cancer centers are key partners in NCI’s efforts to speed the process of discovery and bring the benefits of cancer research to the public. The cancer centers develop and translate scientific knowledge from promising laboratory discoveries into new treatments for patients with cancer.
Many of the cancer centers are located in communities with special needs and serve specific populations. Each year, approximately 250,000 patients receive their cancer diagnoses at an NCI-Designated Cancer Center, and thousands of patients are enrolled in clinical trials at these cancer centers. An even larger number of patients are treated at a cancer center each year, such as pediatric patient Rihanna.
NCI Community Oncology Research Program (NCORP)
To bring the latest scientific advances to community settings where the majority of patients with cancer are treated, NCI supports NCORP, a national network that conducts cancer prevention and treatment clinical trials as well as cancer care delivery research (CCDR).
In 2018, nearly 3,300 participants were accrued to CCDR studies at some of the 1,000 community sites, local hospitals, physician practices, and other organizations that participate in NCORP. In addition, NCORP is contributing significantly to enrolling patients in the NCI-MATCH trial. In partnership with the National Institute of Diabetes and Digestive and Kidney Diseases, NCORP is helping to enroll 4,000 patients in the New-Onset Diabetes Cohort study, to study the link between new-onset diabetes and pancreatic cancer.
To address and reduce cancer disparities, NCORP has designated 12 Minority/Underserved Community Sites in areas with patient populations comprised of at least 30% racial/ethnic minorities or rural residents. Jerome’s experience highlights the value that NCORP brings to more diverse patient populations where they live and work.
National Clinical Trials Network (NCTN)
Cancer clinical trials allow researchers to evaluate new ways to prevent and detect cancer, improve therapies, and enhance the quality of life of patients during and after treatment. During fiscal year 2018, more than 30,000 new patients enrolled in NCI-sponsored or -supported clinical trials at locations across the United States and Canada through NCTN.
This network now includes more than 3,000 study sites that work to implement and complete clinical trials far more rapidly than in the past. NCTN’s structure includes one pediatric and four adult research groups, with 30 centers designated as lead academic research sites. Many investigators at other medical centers participate in NCTN trials, including researchers at NCORP sites and NCI-Designated Cancer Centers.
NCI partners with many federal and private-sector organizations to facilitate complex research programs that spur innovation, ensure the judicious use of public resources, and continue to help reduce the burden of cancer in the United States and beyond. A few of NCI’s many partnerships include:
- Collaboration with the Department of Veterans Affairs (VA) through the NCI and VA Interagency Group to Accelerate Trials Enrollment (NAVIGATE) program, for example, is helping VA medical facilities in 11 states to enroll patients directly in NCI-supported clinical trials, making it easier for veterans to access state-of-the-art cancer treatments.
- The Applied Proteogenomics Organizational Learning and Outcomes (APOLLO) network is a Cancer MoonshotSM effort through which NCI and the VA work with the Department of Defense to provide personalized cancer care based on gene and protein expression in the tumors of individual patients.
- NCI is collaborating with the Department of Energy (DOE) on a Cancer Moonshot initiative called the Joint Design of Advanced Computing Solutions for Cancer, a program that applies cutting-edge computing technologies to: identify promising new treatment options, deepen our understanding of cancer biology, and improve our understanding of the impact of new diagnostics and treatments, as well as patient characteristics, at the national level.
- NCI, the Foundation for NIH, and 11 leading pharmaceutical companies are engaged in a public–private research collaboration called the Partnership for Accelerating Cancer Therapies (PACT) as part of the Cancer Moonshot with the aim of identifying, developing, and validating robust biomarkers (standardized biological markers of disease and treatment response) to advance new cancer immunotherapy treatments.
One of the ways NCI supports the national cancer research enterprise is by providing resources to individual investigators and institutions. NCI’s Resources for Researchers provides a directory of NCI-supported tools and services for cancer researchers. Most resources are free of cost and available to anyone.
In addition, through partnerships with industry, NCI provides rapid access to therapeutic agents for use in preclinical and clinical studies via the NCI Formulary. In 2018, investigators from more than 300 clinical research centers accessed the formulary, which, to date, contains 30 agents provided by 10 companies.
The Surveillance, Epidemiology, and End Results (SEER) Program is another well-used resource that provides essential information for tracking the nation’s progress against cancer and enables researchers to explore and explain trends in cancer incidence, mortality, and survivorship.
Strengthening Small Business Innovation and Commercialization
Through the Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs, NCI supports US-owned small businesses to develop and commercialize technologies to diagnose, treat, and prevent cancer. Successful commercialization of these innovations means that doctors and their patients can access cutting-edge cancer-related technologies to improve outcomes.
NCI’s SBIR/STTR Programs have supported the development of numerous technologies since 1982. In 2018, the portfolio contained 475 projects including drugs, in vitro diagnostics, devices, and other technologies.
For example, SBIR supported the development of CYAD-101, a CAR T-cell therapy made from healthy donor immune cells instead of a patient’s own immune cells. CYAD-101 is being tested as a treatment for metastatic colorectal cancer but has the potential to treat other cancers as well. Following the Food and Drug Administration’s (FDA) approval of an investigational new drug application for CYAD-101 in 2018, three phase 1 trials were designed to evaluate the efficacy and optimal dosage of this CAR T-cell therapy against several other cancers that have been challenging to treat, including bladder, pancreatic, ovarian, and triple-negative breast cancer.
A recent economic impact study showed that the SBIR/STTR Programs can improve the lives of patients by strengthening the role of small businesses that develop innovative cancer technologies. The study found that NCI received a strong return on investment in supporting small businesses, with an estimate as high as $33 returned for every $1 invested.
Conducting Research at NCI
While working to build scientific knowledge; advance cancer prevention, detection, and treatment; and improve the lives of patients and survivors, researchers in NCI’s intramural research program (IRP) have collaborated with more than 2,000 extramural investigators at more than 800 academic institutions across the United States, and from 68 countries around the world.
The IRP consists of two components: the Center for Cancer Research, which focuses on solving important, challenging, and neglected problems along the cancer continuum from fundamental research to patient care; and the Division of Cancer Epidemiology and Genetics, which works to uncover the causes of cancer and the means for preventing it through studies of risk factors, such as lifestyle choices, genetic predisposition, and environmental exposures.
IRP investigators, fellows, and visiting scientists from around the world conduct basic, clinical, and population-based research and are encouraged to explore the translation of relevant findings from the laboratory to the clinic. High-risk research and clinical trials that would be difficult for the extramural community to conduct or would not be a priority for industry are performed in NCI research laboratories, offices, and at the NIH Clinical Center. NCI investigators’ ability to work with patients from all over the world facilitates clinical research on rare cancers, which may benefit patients with these diseases and produce insights relevant to more common cancers.
The IRP can claim many accomplishments. In 2018, IRP investigators opened 40 new cancer trials and enrolled more than 4,000 patients in more than 250 clinical research studies. During 2017 and 2018, FDA approved three drugs that IRP scientists developed in concert with extramural partners, including avelumab (Bavencio) to treat Merkel cell cancer, axicabtagene ciloleucel (Yescarta) for B-cell lymphoma, and the immunotoxin moxetumomab pasudotox-tdfk (Lumoxiti) for hairy cell leukemia.
IRP scientists and extramural colleagues are also developing the therapy selumetinib to treat pediatric and adult patients who have a genetic syndrome called neurofibromatosis 1 (NF1); selumetinib received FDA’s orphan drug status in 2018. Other IRP researchers continue to study the epidemiology and carcinogenesis of human papillomavirus (HPV) infections and identify populations at risk of HPV-associated cancers.
To find answers to difficult problems currently facing the cancer research community, the IRP recently launched several programs that focus on liver cancer, rare tumors, and “RASopathies” (difficult-to-treat cancers driven by RAS mutations). Researchers are studying large cohorts to better identify populations at risk for cancer, including a major effort to evaluate factors influencing lung cancer risk among never smokers (Sherlock-lung) and common and rare genetic susceptibility for breast cancer (the Confluence Project). The IRP is bolstering the NCI Natural Products Repository, a national resource of natural chemical compounds for researchers developing cancer drugs.
Frederick National Laboratory for Cancer Research (FNLCR)
NCI sponsors FNLCR, a national laboratory dedicated to improving human health through discovery and innovation in biomedical research. FNLCR offers unique partnership opportunities for academia, government, and the private sector for rapidly addressing the most difficult challenges in cancer prevention, treatment, and control. The laboratory provides cancer researchers a bridge between basic research and clinical practice with support that is not readily available elsewhere.
Two examples of the types of projects spearheaded by FNLCR are:
- RAS Initiative: The family of oncogenes called RAS, when mutated, drive 30% of all human cancers, including 95% of pancreatic cancers and 45% of colorectal cancers. Research has shown that association with the cellular membrane is necessary to initiate KRAS protein signaling. RAS Initiative researchers recently reported new information about how KRAS interacts with the cell membrane and identified multiple factors that might be targeted to disrupt this interaction.
- Cancer Distributed Learning Environment (CANDLE): NCI and FNLCR researchers collaborate with DOE and data scientists from four DOE national laboratories to develop new supercomputing capabilities for precision oncology. CANDLE is an open source software platform providing artificial intelligence methodologies to help accelerate cancer research. As part of this collaboration, data scientists and cancer researchers are working closely together to build the capability to use cancer data to develop predictive models for drug responses, provide better molecular understanding of cancer growth, and support decisions on individualized treatments.
FNLCR offers unique partnership opportunities for academia, government, and the private sector for rapidly addressing the most difficult challenges in cancer prevention, treatment, and control.