Strengthening the Cancer Research Enterprise

NCI leads the national effort against cancer in many ways. NCI sustains the cancer research workforce through training and research grant support. The institute also supports infrastructure to care for patients and conduct clinical trials, prevent cancer and develop better treatments by understanding the biological and molecular mechanisms that promote cancer growth, and promote data sharing to hasten progress in cancer research for all Americans and the rest of the world. Resources developed by NCI help investigators maximize their research efforts. Research at NCI focuses on high-risk studies and areas of unmet need. Together, these efforts are aimed at improving cancer prevention, detection, and treatment, with the goal of producing better outcomes for patients and those at risk for cancer.

Supporting Scientists at Every Career Stage

A strong workforce of researchers who are passionate about cancer research and are well-supported can make discoveries faster and translate them more efficiently into new ways to prevent, detect, and treat cancer. To address this need, NCI supports a diverse scientific workforce over the course of their careers—as high school, college, and graduate students; research and clinical fellows; early career researchers; and established investigators. NCI supports individual investigators as well as collaborative research teams.

Training the Next Generation of Cancer Researchers

NCI supports the next generation of cancer scientists, who will make the paradigm-shifting discoveries of the future.

  • The middle and high school years are important in shaping students’ perceptions about possible future careers, and two programs showcase how NCI is providing training opportunities to students at this impressionable stage.
    • The Continuing Umbrella of Research Experiences (CURE) program promotes diversity in the cancer and cancer health disparities research workforce by providing training and career development support for underrepresented minorities. CURE emphasizes mentorship, provides protected time to gain research experience, and creates training opportunities to develop career skills. CURE provides support to high school students and to undergraduate and graduate students, and in 2014, the program began engaging students at the middle school level. Over the past two decades, the program has supported more than 3,000 scholars from almost every state across the country. (Read about former CURE trainee Chanita Hughes-Halbert, Ph.D., of the Medical University of South Carolina.)
    • The Werner H. Kirsten Student Intern Program has brought more than 1,000 high school students to NCI’s campus in Frederick, Maryland, for a summer internship that continues part-time throughout their senior year. The interns gain hands-on laboratory research training or experience in scientific support areas, including communications and information technology. More than half of the students in the program have gone on to careers in health, medicine, science, or education. The program recently celebrated its 25th anniversary and received an Award of Excellence from the Maryland State Department of Education in 2017.
  • The NCI Predoctoral to Postdoctoral Fellow Transition Award (F99/K00) helps graduate students who are near the end of their graduate education and wish to pursue a research career move into postdoctoral studies. The program helps students to develop a well-defined career path more quickly by preparing them for other awards that will lead to independent, tenure-track, or equivalent faculty positions.

Investing in Early-Career and Established Investigators

Everything NCI does focuses on supporting the best science to improve the outlook for patients and their families. To do this, NCI seeks to recruit outstanding investigators and provide them with support throughout their careers in cancer research. A few ways in which NCI does this include:

  • Focusing on investigator-initiated research: More than 40% of the total NCI budget supports research project grants, an important mechanism for advancing the ideas of an individual or small group of investigators at all stages of their career. Supporting investigator-initiated research is a high priority for NCI because the unique insights and expertise of investigators allow research to expand into previously unforeseen but potentially productive areas. Between 2013 and 2015, NCI increased support for new awards from $400 million to $500 million per year and continues to sustain the increase. In addition, 2015 and 2016 were the first years since 2004 and 2005 that NCI provided full support for noncompeting grants (funding for the next budget period within an approved project period) for 2 years in a row. This support is greatly valued for assuring continued advancement in all areas of cancer research.
  • Supporting new and early-stage investigators: Scientists starting independent research positions are at a critical stage in their careers. NCI supports these innovators of the future through grants, such as mentored career development awards, and other activities designed to enhance their ability to succeed in cancer research. One new activity, the principal investigator workshops conducted by NCI’s division leadership and program staff, connects new R01 grant recipients with NCI staff responsible for administering their grant. Approximately 20%–24% of all R01 awards are provided to new and early-stage investigators, and 40% of R21 grant awards are made to new investigators.
  • Finding new approaches to fund researchers: The NCI Outstanding Investigator Award (R35), which is given to principal investigators who have a history of significant research accomplishments and outstanding productivity, is an example of a new approach to fund researchers. The R35 award provides stable funding for a longer period than that afforded by a traditional R01 award. The funding stability provided by this award encourages accomplished investigators to take on higher-risk and potentially higher-reward research projects. The R35 program began in fiscal year (FY) 2015 with awards made to 43 prominent investigators, followed by 35 new awards in FY 2016 and 43 in FY 2017.
NCI invests in scientists throughout their career from high school onward.

Providing Infrastructure and Resources for Cancer Research and Patient Care

NCI supports the cancer research community through an infrastructure that connects investigators working at major academic research centers, in community settings, within NCI and other federal agencies, and at private-sector companies. NCI’s collaborative efforts with partners across the community put patients at the forefront by ensuring that scientists and clinical researchers are equipped to make discoveries and test ideas that advance cancer research and clinical care across the United States.

Sustaining NCI-Designated Cancer Centers

The NCI-Designated Cancer Centers Program constitutes a major component of the national cancer research enterprise. NCI-Designated Cancer Centers meet rigorous standards for research focused on developing new and better approaches to cancer prevention, diagnosis, and treatment. Acquiring the “NCI-designated” status is a major achievement, and cancer centers that receive it are highly valued by their communities because they are recognized as providing state-of-the-art, evidenced-based cancer care. There are currently 69 of these cancer centers in the United States. In recent years, NCI has increased the size of the Cancer Center Support Grants that support the infrastructure needed by researchers at a cancer center—such as centralized shared resources—and that create a focused transdisciplinary research environment. The program was established with a vision of having an NCI-Designated Cancer Center within 200 miles of every person residing in the United States.

Facilitating Cancer Clinical Trials

NCI has a long history of supporting all phases of clinical trials, from small early-phase trials that seek to determine the safety of new interventions to large trials that compare new interventions with the current standard approach.

  • NCI’s National Clinical Trials Network (NCTN) serves as the cornerstone of the institute’s clinical trial enterprise. NCTN provides streamlined mechanisms for conducting cancer clinical trials throughout the United States. The network includes five U.S. clinical trial research groups and several international member sites that contribute to the approximately 2,400 NCTN sites enrolling patients in clinical treatment trials, including precision medicine clinical trials such as the NCI Molecular Analysis for Therapy Choice (NCI-MATCH) and NCI–COG Pediatric MATCH trials.

    Examples of NCTN trials with recently reported results include:

    • A trial demonstrating that, after 10 years of follow-up, progression-free and overall survival were 30% and 20% longer, respectively, for patients with grade 2 glioma who received combination chemotherapy and radiation therapy compared with patients who received radiation therapy alone.
    • A trial, called the Trial Assigning IndividuaLized Options for Treatment (Rx), or TAILORx, showing that women with estrogen receptor–positive early-stage breast cancer who have a low risk of recurrence based on a 21-gene expression assay can forgo chemotherapy and the associated side effects and be safely treated with hormone therapy alone.
  • The NCI Community Oncology Research Program (NCORP) is a network of institutions that conducts research and clinical trials in community-based health care systems. Launched in 2014, NCORP is comprised of 46 community sites. Twelve of these sites focus on minority and underserved communities, including patients who live in rural areas and cannot travel far distances to receive treatment at an NCI-Designated Cancer Center. (Read more about one of these sites in the story about Chanita Hughes-Halbert, Ph.D., of the Medical University of South Carolina.) NCORP participation accelerated the pace of enrollment in the NCI-MATCH trial and helped to reach traditionally under-represented rural populations. NCORP builds on previous NCI programs to bring clinical trials and cancer care delivery research into the community, where most cancer patients—approximately 85%—are treated.
This map shows enrollment in N C I-MATCH has enrolled patients from all 50 states.

Providing Resources to Advance Research

NCI develops and maintains resources to help researchers prevent, diagnose, and treat cancer, including databases and specimen repositories, cancer-related tools, and other materials that are available to scientists and the public via NCI's website. The following represent just two of these kinds of resources.

  • The Surveillance, Epidemiology, and End Results (SEER) Program facilitates the collection and analysis of cancer statistics at the population level. SEER serves as the authoritative source of information on cancer incidence and survival in the United States. The program oversees the only population-based cancer registries in the country that include a broad set of clinical elements, with the registries located at or associated with NCI-Designated Cancer Centers. NCI manages the program and collaborates with other organizations, including the American Cancer Society and the Centers for Disease Control and Prevention, to make SEER a success. Furthermore, SEER data are used extensively to support research beyond NCI, with 4,000 downloads of its public-use files annually. For example, researchers use SEER to track trends in cancer at the national, state, and local levels; understand factors that influence these trends; and describe cancer disparities among different populations.
  • The NCI Natural Products Repository holds more than 80,000 natural products obtained from all over the world and makes the products and their extracts available to academic and industry researchers. The products and extracts are screened for anticancer activity and used in the development of cancer drugs and for other medical uses. NCI’s leadership role in natural products has increased as industry has begun to focus on screening synthetic (laboratory-made) chemicals, which are easier to analyze than the complex mixtures of chemicals present in natural products, which need to be fractionated further for study. To promote the use of natural products in this modern era of drug development, NCI is generating 1 million extracts for high-throughput cancer drug screening. As seen in the story on the development of eribulin mesylate, this unique resource harnesses the power of nature to identify and develop new drugs to treat and prevent cancer, which is fundamental to ensuring the health of many Americans.

Strengthening Small Business Innovation and Commercialization

NCI provides funding and support to drive the development and commercialization of novel technologies and products to prevent, detect, and treat cancer.

  • NCI’s Small Business Innovation Research (SBIR) and Small Business Technology Transfer Research (STTR) Programs are two of the largest sources of financing for early-stage technology in the United States. Small businesses are a national resource for technological innovation and a mainstay of the economy. These programs strengthen their role in federally supported research and development by providing funding, mentoring, and networking assistance to small businesses and researchers, like Avrum Spira, M.D., M.Sc., of Boston University. (Read about the lung cancer screening test Avrum developed.) NCI also helps connect researchers with government scientists who can help them develop promising cancer drugs, diagnostics, and devices. In addition, SBIR fosters participation by minority and socially disadvantaged companies in technology innovation.
  • The I-CorpsTM at NIH program, which is led by NCI in collaboration with the Centers for Disease Control and Prevention (CDC), supports training that will help project teams at NIH- and CDC-funded small businesses overcome key obstacles along the path of innovation and commercialization.

Conducting Research at NCI

Although the overwhelming majority of NCI’s budget funds extramural research—that is, research conducted in laboratories and clinics throughout the United States—the national cancer research enterprise also includes work done by scientists at laboratories and offices located primarily on the National Institutes of Health (NIH) campus and surrounding locations in suburban Maryland.

Intramural Research Program

NCI’s intramural research program (IRP) conducts long-term, high-risk research and clinical trials that would be more difficult for the extramural community or industry to complete. The IRP allows NCI to focus on emerging public health concerns and contributes to the training of the next generation of researchers in basic, clinical, translational, and epidemiologic research. IRP basic and clinical researchers at NIH’s Mark O. Hatfield Clinical Research Center and Warren Grant Magnuson Clinical Center collaborate to provide compassionate patient care and unparalleled opportunities for advancing cancer research.

A few examples of IRP accomplishments include:

  • Developing treatments for rare tumors, including the 2017 approval of avelumab (Bavencio®), the first drug approved by the Food and Drug Administration (FDA) for Merkel cell carcinoma, a rare but deadly skin cancer.
  • Pioneering adoptive cell transfer immunotherapy, in which a patient’s own cancer-fighting immune cells are extracted from their tumor, grown in large numbers in the laboratory, and then infused into the patient. This research has been applied in several clinical trials and is expected to be used more widely in the clinic in the next several years.
  • Conducting basic scientific research on the human papillomavirus (HPV), which led to FDA-approved HPV vaccines and major advances in the prevention of cervical cancer and other cancers caused by HPV.
  • Identifying risks associated with tobacco use, including the finding in 2016 that low-intensity smokers (those who smoked an average of less than one cigarette per day over their lifetimes) had an increased risk of early death, including death from lung cancer, compared with people who never smoked.
  • Detecting risk-factor status for multiple types of cancer, including Helicobacter pylori infection and gastric cancer, discoveries that have led to the development of risk stratification models and clinical interventions to prevent or treat cancer.

Frederick National Laboratory for Cancer Research

The Frederick National Laboratory for Cancer Research is a government-owned, contractor-operated national laboratory that is dedicated exclusively to biomedical research. It is the Department of Health and Human Service's only federally funded research and development center. The Frederick National Lab offers unique partnering opportunities for academia, government, and the private sector to address the most difficult challenges in cancer prevention and treatment.

Major initiatives and partnerships of the Frederick National Lab include:

A cryo-electron microscopy map of a protein created at the National Cryo-EM Facility hosted by the Frederick National Laboratory for Cancer Research
A cryo-electron microscopy (cryo-EM) map of a protein created at the National Cryo-EM Facility hosted by the Frederick National Laboratory for Cancer Research
Credit: National Cancer Institute
  • The RAS Initiative, launched in 2013, which is exploring innovative approaches to attack the proteins produced by mutant forms of members of the RAS gene family. The goal of the initiative is to develop effective therapies for RAS-related cancers. Because more than 30% of all human cancers—including 95% of pancreatic cancers and 45% of colorectal cancers—are driven by mutations in RAS genes, understanding the biology of RAS proteins is critical to finding better treatments for patients.
  • The Accelerating Therapeutics for Opportunities in Medicine (ATOM) Collaboration, which is a partnership formed in 2017 by NCI, the Department of Energy, GlaxoSmithKline, and the University of California, San Francisco, to leverage their strengths in computational biology to dramatically accelerate the discovery and development of new cancer drugs.
  • The National Cryo-Electron Microscopy (cryo-EM) Facility, which was opened at the Frederick National Lab in 2017, to capitalize on revolutionary changes in the cryo-EM field that allow researchers to capture exceptional imaging resolution at the near-atomic level. The facility is designed to meet the needs of cancer researchers who are engaged in structural biology cryo-EM research but do not have access to the latest technologies at their own institutions.

Stories of Impact

NCI supports cancer research through infrastructure, such as research grants to aid drug discovery and development and clinical trial networks to enhance patient access to trials.

Fighting Cancers with a Sea Sponge

In 2016, the Food and Drug Administration (FDA) approved the first drug that improved the survival of patients with liposarcoma—a drug made possible by a sea sponge. This drug, eribulin mesylate (commonly called eribulin or Halaven®), was also approved in 2010 for certain patients with breast cancer. The story of how a sea sponge led to a cancer drug spans three decades of NCI-supported research and collaboration among governments, a pharmaceutical company, and universities.

Bringing Research to the Community to Reduce Disparities

Approximately 85% of cancer patients in the United States receive care in community settings, not at academic medical centers where most clinical trials take place. This is certainly true in South Carolina, where Hollings Cancer Center at the Medical University of South Carolina (MUSC) serves as the state’s only NCI-Designated Cancer Center.

Key Takeaways

  • NCI leads programs to build, sustain, and diversify the cancer research workforce. This includes supporting the next generation of investigators, established researchers, and collaborative team science.
  • NCI provides critical infrastructure that brings state-of-the-art cancer care and the benefits of clinical trials to more people.
  • NCI conducts research and provides research resources that cannot or will not be provided by others.
  • NCI advances the commercialization potential of scientific discoveries through support to small businesses.
  • NCI supports unmet needs in cancer research through its intramural program and national laboratory.