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2013 Awardees: Request for Proposals for Pilot Collaborations with Low- and Mid-Income Countries (LMICs) in Global Cancer Research or Global Health Research at NCI-Designated Cancer Centers

, by Ted Trimble

The National Cancer Institute (NCI), Center for Global Health (CGH) in collaboration with the Office of Cancer Centers, is pleased to announce the 2013 awardees of the Request for Proposals for Pilot Collaborations with Low- and Mid-Income Countries (LMICs) in Global Cancer Research or Global Health Research at NCI-Designated Cancer Centers.

In 2013, CGH and the Office of Cancer Centers developed a funding opportunity to promote research collaborations between NCI-Designated Cancer Centers with institutions in LMICs to stimulate cancer research pilot programs  and expand the reach of Cancer Centers in international settings. The scope of these pilot proposals was broad, and included a range of research projects, trainings, advanced technologies, development of clinical research networks, and other focus areas that support the development of cancer research capacity in LMICs.

CGH and the Office of Cancer Centers selected 15 NCI-Designated Cancer Centers for award, based on the merit of proposals.  The pilot projects, outlined below, are supported through subcontracts with the respective NCI-Designated Cancer Center and are executed and managed by Leidos Biomedical Research, Inc. (NCI Contract No. HHSN26120080001E).

CGH looks forward to continuing our support of NCI-Designated Cancer Centers through the development of new opportunities that will enhance collaborations, further cancer research, and improve cancer control prevention and treatment strategies in the US and abroad.

I would like to share my congratulations with everyone, and I wish you great success with your projects.

Ted Trimble

Pilot Projects

  • A Low-Cost Optical Imaging Tool for Cervical Cancer Prevention

The University of Texas MD Anderson Cancer Center; Barretos Cancer Hospital (Brazil)

The proposal is for a collaborative project between MD Anderson Cancer Center (PI: Dr. Kathleen Schmeler), Barretos Cancer Hospital in Brazil (PI: Dr. José Humberto Feregnani) and Rice University (PI: Dr. Rebecca Richards-Kortum). The proposal addresses the significant unmet need for simpler, more cost-effective cervical cancer prevention methods for Brazil and other LMICs. It includes a prospective clinical study testing an innovative, low-cost optical imaging tool developed by our collaborators at Rice University. This tool allows for point-of-care diagnosis and treatment of cervical dysplasia using a single visit, See & Treat approach. To complement this clinical study, the proposal includes a two-day symposium and other educational activities focused on increasing research capacity and collaboration between MD Anderson and our current and future collaborators in Latin America and other LMICs.

  • Cloud-Based Collaboration for Radiotherapy Clinical Trials, Research and Training

Virginia Commonwealth University Massey Cancer Center; Tata Memorial Center (India)

This proposal is for the development of an electronic software platform to collate medical information that includes personal health records, diagnostic images, and radiotherapy data and share via Cloud.  It will facilitate inter-institutional access to a wider range of services such as on demand computing, training and knowledge sharing in new RT modalities, research application development, and advanced analyses of aggregated data.  The cloud-based electronic platform will make it easier to implement standard operating procedures for quality assurance and quality control (QA/QC) of aggregated data

  • Tobacco-Free Teachers: Pilot Study to Assess Program Adoption in Schools in India

Dana-Farber Cancer Institute; Healis Sekhseria School of Public Health (India)

This study provides the foundation for dissemination of an evidence-based tobacco use cessation intervention for schoolteachers, who are key opinion leaders in their communities. The objective of this one-year pilot study is to determine the facilitators and barriers associated with the schools’ willingness to adopt a comprehensive tobacco control intervention. We will survey randomly selected school principals in two Indian states, and will conduct focus group interviews with a subsample of principals and potential lead teachers to determine needed changes in existing program materials. Type of project proposed: this pilot study focuses on development of community-based cancer prevention dissemination trial using survey and formative research methods.

  • Vincristine Optimization in Kenyan Children with Cancer

Melvin and Bren Simon Cancer Center, Indiana University; Moi Teaching Hospital (Kenya)

The project described in this proposal is aimed at optimizing dosing of vincristine in pediatric cancer patients in Kenya, which we believe will also allow us to develop revised dosing strategies for cancer patients around the world. Our pilot project data, which forms the basis of this proposal, showed that Kenyan children metabolize vincristine much more efficiently than American (primarily Caucasian) children due to genetic polymorphisms in CYP3A5. The faster metabolism of vincristine in Kenyan children results in less toxicity in this population, but it likely also negatively impacts overall cancer-related survival. It is our hope that the information gained from the research funded by this proposal will ultimately allow us to determine the best dose for each individual patient, enabling oncologists around the world to maximize survival while simultaneously limiting toxic side-effects associated with this life-saving chemotherapy.

  • Cancer Bioinformatics Network in the Central America LMICS: Gastric Cancer Focus

Vanderbilt-Ingram Cancer Center; Ministry of Health, El Salvador; Ministry of Health Honduras

The primary aim of this proposed program is to establish a cancer informatics infrastructure in Central America, building upon the established Vanderbilt cancer research infrastructure and professional relationships within the respective Ministries of Health (MOH). The central scientific focus is gastric cancer, with the establishment of a permanent regional clinicopathology registry (Aim 1). The core infrastructure component herein is the creation of a standard regional cancer registry, based upon the International Agency for Cancer Research (IARC) standards (Aim 2). The initial geographic focus in this proposal is the contiguous area of western Honduras and El Salvador, the central region of the CA-4. The cancer informatics partnership with Vanderbilt would provide the foundation for a series of future initiatives: geographic extension (e.g., Nicaragua, Guatemala), bioinformatics extension (e.g., biorepository and pathology capacity building), and research and cancer control (e.g., gastric cancer epidemiology and prevention). Importantly, this cancer information collaboration is expected to provide invaluable inputs for cancer control among U.S. Hispanics from Mesoamerica, particularly with respect to the gastric cancer risk of immigrants from the region.

  • HIV Infection, Viral Hepatitis and Hepatocellular Carcinoma in Uganda

Johns Hopkins Sidney Kimmel Comprehensive Cancer Center; Makerere University (Uganda)

Hepatocellular carcinoma (HCC) is one of the few cancers with increasing incidence in the U.S. attributed largely to prior hepatitis B or C virus (HBV, HCV) infection, but also related to alcohol, tobacco, and obesity. With improved survival following effective antiretroviral therapy (ART), liver disease, including HCC, has become a leading cause of death among HIV-infected persons in Western cohorts, mostly affecting those co-infected with HBV or HCV. The recent scale-up of ART among HIV-infected populations in Africa has translated into dramatic survival benefit. Paradoxically, as HIV-infected persons survive longer, the burden of HCC is expected to increase substantially in aging African populations with endemic HBV, sporadic HCV, and generalized HIV. In prior collaborations, Drs. Kirk and Ocama have documented increasing HCC incidence rates in Uganda and a high prevalence of liver fibrosis associated with HIV, and documented the feasibility of conducting high-level research on HCC and HIV. Building on existing collaboration between Johns Hopkins/SKCCC and the Makerere University, Uganda Cancer Institute (UCI), Infectious Disease Institute (IDI), and NIAID’s International Center for Excellence in Research (ICER) in Uganda, the aims of this proposal include:

1. To solidify the clinical and translational research infrastructure for investigation of HCC in Uganda.
2. To define HCC risk factors and contrast the etiology of HIV-associated HCC compared to non-HIV HCC.
3. To characterize pathways of HIV-accelerated hepatocarcinogenesis in contrast to HIV-accelerated liver fibrosis. 


  • Expanding a Team of Clinical Investigators in Nigeria with a Prospective Colorectal Cancer Biobank and Database

Memorial Sloan-Kettering Cancer Center; Obafemi University (Nigeria)

This proposal expands on an existing cancer research and training collaboration between Memorial Sloan Kettering Cancer Center (MSKCC) and Obafemi Awolowo University (OAU) in Nigeria. This 1-year protocol has two goals. The first is to expand our collaboration with two cancer symposia at OAU titled “Colorectal cancer: Partnerships for research and clinical care.” These symposia will utilize faculty from MSKCC and OAU. In addition, there will be a 3-month fellowship (funded by an existing fellowship at MSKCC) for a junior surgeon at OAU to learn additional research and clinical skills to use in treating cancer patients in Nigeria. The second goal is to create a regional network of Nigerian cancer investigators to prospectively acquire demographic, radiologic, and pathologic presentations of patients with colorectal cancer in Nigeria. Patients from four hospitals will be accrued for this protocol. We anticipate obtaining detailed prospective demographic, environmental, dietary, radiographic, pathologic, therapeutic, and outcomes data on approximately 150 patients with colorectal cancer. These data will be analyzed with the MSKCC team and presented at the second symposium. They will be a platform for future prospective studies that will engage the clinical investigators at all four Nigerian hospitals and take advantage of our faculty and research resources as MSKCC.

  • A Study of Etiology of Esophageal Cancer in Tanzania (SEEC-TANZANIA)

UCSF Helen Diller Family Comprehensive Cancer Center; Muhimbili University (Tanzania)

This project focuses the expertise of UCSF and HDFCCC in the area of global health on the problem of esophageal cancer (EC) and its suspected high incidence in Eastern Africa. In collaboration with colleagues in Tanzania, we will focus on the cancer burden from EC by carrying out the following aims: (1) to determine the age-standardized incidence and age-adjusted survival rates for EC diagnosed between 2004 and 2008 in four urban area in Eastern Africa represented by population-based cancer registries; (2) to perform a retrospective chart review of all cases of EC identified by the Tanzania Cancer Registry (TCR) in Dar es Salaam in 2012 and 2013 to determine distribution of disease stage at diagnosis; and (3) to perform a case-control study to determine the potential etiologic effect of dietary, other lifestyle, and environmental factors in the development of EC in Dar es Salaam.


  • Tanzanian Research Training Program in HIV-Related Malignancies

Dartmouth-Hitchcock Norris Cotton Cancer Center; Ocean Road Cancer Institute and Muhimbili University

The goal of this training program is to develop a critical mass of trained investigators in Tanzania with expertise in conducting research on the prevention and treatment of cancer, particularly HIV-associated malignancies. This collaborative program between the Norris Cotton Cancer Center (U.S.) and Ocean Road Cancer Institute (Tanzania) will provide a structured format to train future leaders in cancer epidemiology and clinical research. The trans-institutional training program will focus in the areas of epidemiology, biostatistics, bioinformatics, nutrition, genetics, biomarkers, and molecular pathology, and will also emphasize substantive training in the epidemiology of HIV-related cancers. The program will produce skilled clinical investigators in Tanzania with the tools and infrastructure to conduct high quality research on the prevention and treatment of HIV-associated malignancies.

  • African Pain Policy Fellowship; A Pilot Regional Collaboration to Improve Opioid Availability for the Treatment of Cancer Pain

Carbone Cancer Center, University of Wisconsin; African Palliative Care Association (Uganda)

This pilot project will launch and collaboratively implement a regional cohort of the International Pain Policy Fellowship (IPPF), the aim of which is to empower healthcare practitioners from low- and middle-income countries (LMICs) with knowledge and skills to improve patient access to opioid analgesics for cancer pain management in their countries. The Pain & Policy Studies Group (PPSG), based at the University of Wisconsin Carbone Cancer Center (UWCCC), will collaborate with the African Palliative Care Association (APCA) to administer the fellowship for five practitioners, or in country “champions,” who will act as change agents. The project builds on a Fellowship program offered from the U.S., aimed at training champions from a variety of LMICs; its success will facilitate the broader global dissemination of the IPPF through the use of regional collaborations throughout the world and will serve to increase the capacity of the APCA and its member countries to improve palliative care in Africa.

This new approach for conducting the IPPF program has several key advantages over the current U.S. based, PPSG-led, largely email-focused model. First, involving a local partner organization (i.e., APCA) will contribute vital knowledge and experience about local traditions, beliefs, cultures, and political situations and how these might affect opioid availability and palliative care. Coupling this information with PPSG’s policy and technical expertise will result in identifying solutions that are most feasible and effective given each country’s unique characteristics. Second, Fellows from the same region often share common experiences related to opioid availability and face similar challenges. Bringing PPSG staff, together with Fellows, staff, and International Expert Collaborators (IEC) from Africa will facilitate finding solutions to the common challenges and will increase the likelihood of sustainable partnerships and a sense of ownership of the accomplishments. Finally, geographic proximity will make communication and in-country visits more practicable and affordable. Being surrounded by others with a shared mission will serve to elevate the enthusiasm and commitment as they approach their defined goals. Their efforts in the future will benefit from knowing more colleagues who are addressing the same opioid availability issues, thereby expanding their networking abilities, leading to further progress to address barriers, and leading to increased and positive future communications and assistance with other countries.


  • St. Jude Comprehensive Cancer Center – Pequeno Principe Research Institute Twinning Program

St Jude Children’s Research Hospital Comprehensive Cancer Center; Pele Pequeno Principe Research Institute

The project is designed to assist investigators at the Pelé Pequeno Príncipe Research Institute in Curitiba, Brazil in establishing a state-of-the-art biobank and cancer registry. The proposal is in keeping with the goal of the NCI to improve cancer research capacity and capabilities in low and middle-income countries (LMIC). More specifically, the proposed study addresses the NCI objective to establish a biorepository with supportive database management to adapt best practices to facilities in a LMIC. The importance of building this research capacity in Curitiba is founded in the recent study by St. Jude and Pelé Pequeno Príncipe Research Institute investigators that identified a germline TP53 mutation in one in every 375 individuals in Southern Brazil within a total population of 70 million individuals (~200,000 carriers). This unusual TP53 mutation predisposes carriers to pediatric adrenocortical carcinoma and other childhood tumors, as well as breast, brain, and gastric cancer in adults. 

The quality of biospecimens from throughout this region has been generally poor. Establishing a high functioning tissue bank will facilitate cancer research into this significant public health issue in Southern Brazil to improve early diagnosis and outcome. The research proposal is to establish the biobank and database registry at the Pelé Pequeno Príncipe Research Institute by training investigators at the St. Jude Comprehensive Cancer Center and providing funds for the required laboratory infrastructure (e.g., liquid nitrogen freezer capacity and software programs).

  • Building Cooperation and Capacity for Cervical Cancer Research Between LCCC, Zambia, and Malawi

University of North Carolina Lineberger Comprehensive Cancer Center; Center for Infectious Disease Research (CIDRZ-Zambia); Kamuzu Central Hospital (Malawi)

It is expected the number of cancer deaths in Africa will double within the next 20 years, simply because of the aging and growth of the population. Cervical cancer is the second most frequently diagnosed cancer and the leading cause of cancer-related death in African women.

1. Women in sub-Saharan Africa bear a disproportionate burden of cervical cancer (25% of all gynecologic deaths), with some of the highest incidence and mortality rates reported in East Africa, including the countries of Zambia and Malawi. The most likely causes of these circumstances are inaccessibility and unavailability of cervical cancer screening and treatment. A similar situation existed in the U.S. prior to the wide dissemination of cytology-based cervical cancer screening in the 1960s when cervical cancer incidence in 10 select metropolitan areas in 1947-1948 (40.1 in whites and 73.1 in nonwhites) were the same order of magnitude as the highest rates found in Eastern Africa today.

2. The costly and complex nature of Pap smear screening, coupled with very porous health delivery systems, present insurmountable barriers to the successful implementation of this mode of cervical cancer prevention in resource-poor settings.

3. In response to the challenge of cervical cancer screening in sub-Saharan Africa the University of North Carolina at Chapel Hill, working through the Center for Infectious Disease Research in Zambia (CIDRZ) is extending their established cervical cancer prevention service platform in Zambia using visual screening techniques i.e. visual inspection with acetic acid (VIA) and digital cervicography (DC).

Aim 1: To build cervical cancer screening and treatment capacity in Malawi, with clinical platforms in both countries serving as recruitment and training centers for future research activities.
Aim 2: To establish bio-repositories at both sites, which will store high-value (frozen biopsies) specimens for genomic, transcriptomic, and eventual proteomic analyses. 


  • Expanding Capacity for Infection – Related Cancer Research by Examining the Contribution of Viral Genomic Diversity to the Clinical Manifestations of Cancer in Uganda

Fred Hutchinson University of Washington Cancer Consortium; Uganda Cancer Institute

This project will concurrently address an issue of public health importance in low/middle income countries (LMIC), the contribution of viral oncogene genomic diversity to the clinical manifestations of infection-related cancers, and also build capacity in physical infrastructure and cancer research at our LMIC partner, the UCI. The project will have three specific aims, as outlined below.

Specific Aim 1: Determine the contribution of HHV-8 genomic diversity to the different clinical manifestations of HHV-8 infection, including Kaposi sarcoma and multi-centric Castleman disease.
Specific Aim 2: Build capacity for genomic cancer research at a leading LMIC site for infection-related malignancy research.
Specific Aim 3: Maintain an outstanding cancer biorepository at the UCI. The availability of well-annotated biospecimens from our clinical repository in Kampala allows for an enormous breadth of translational research studies.

A contract from NCI’s Office of Cancer Genomics has recently been awarded to characterize the tumor genomes from Ugandan patients with lung cancer, non-Hodgkin lymphoma, and cervical cancer. The analysis of tumor genomes in this project will happen at NCI, and so, despite the involvement of several Ugandan physician-scientists in this project, no in-depth local capacity will be built in the analysis of genomic data. We propose to select one Ugandan physician-scientist with interest in the conduct and analysis of genomic experiments (Dr. Fred Okuku) to come to Seattle for a period of 6 months to conduct an internship in the analysis of viral genomic data. First, we propose that Dr. Okuku will enroll in didactic coursework at the University of Washington’s (UW) outstanding Genome Sciences program (GENOME 552 Technologies for Genome Analysis and GENOME 540 Introductions to Computational Molecular Biology: Genome and Protein Sequence Analysis). This educational work is covered under an established Memorandum of Understanding between the UCI/Hutchinson Center Alliance and the UW. Second, Dr. Okuku will work with Dr. Delrow of the FHCRC Sequencing Shared Resource to conduct the NextGen assays required for the generation of sequence data for Specific Aim 1. Finally, Dr. Okuku will work with the newly-hired Staff Scientist with expertise in genomics and the Computational Biology Core Director at FHCRC, Dr. Martin McIntosh, to analyze the genomic data he helped to generate. Taken together, we believe this internship will allow for the capacity to conduct and analyze a number of genomic studies of infection-related cancers at the UCI in the coming years.


  • Initiative to Improve Cancer Care in Ghana and Nigeria

Roswell Park Cancer Institute; Noguchi Memorial Institute (Ghana); Lagos State University (Nigeria)

The long-term goal is to build a collaborative group of well-trained clinicians in Ghana and Nigeria who will be the backbone of cancer clinical care and research between RPCI and these West African countries. These relationships will:

1. Enhance basic and population research collaborations in cervical, prostate and breast cancer. In particular, we note that breast and prostate cancers share similar epidemiologic characteristics between West Africans and African Americans in the US.
2. Create clinical research opportunities in areas that can enhance drug development and novel therapeutics.

For example, neo-adjuvant therapy in breast cancer is easily performed in these countries because of the frequency of locally advanced breast cancer, allowing for the opportunity to understand mechanisms of action of novel agents. The high incidence of triple-negative breast cancer provides opportunities for rapidly investigating this refractory subset of breast cancers. This partnership will improve cancer care in these two West African countries and serve as a paradigm for other developing countries.


  • Training Chilean Bioinformatics Researchers in the Cancer Genomics Field

University of California, San Diego Moores Cancer Center; Centro de Investigacion y Tratamiento del Cancer, Universidad de Chile

The following activities will be performed in one year:

• Activity 1. International Workshop in cancer genomics and bioinformatics (2 weeks), to be performed at the beginning of the project. It will consist of a 1-week theoretical course (lectures & seminars) and “hands on” course (exercises and wet lab activities) to be taught in Chile by MCC faculty (Dr. Harismendy) and U. de Chile faculty (Dr. Verdugo, Dr. Marcelain, and Dr. Armisen). The theoretical section will be free for all students interested in the scope of the workshop and the practical section will include a selected cohort of five applicants. Target audiences will be mainly graduate and/or undergraduate students with a background in biotechnology, computer sciences, and informatics from Chile. Dr. Verdugo, Dr. Marcelain, and Dr. Armisen have been trained at UCSD by Dr. Frazer and Dr. Ren and will be responsible for the selection of the 15-20 students that will participate in the theoretical lectures and, in collaboration with Dr. Harismendy, will perform the practical course during the second week. The grant funding will help cover course structure, MCC faculty travel costs, and administration costs involved.

Activity 2. MCC visiting fellows. Three students attending the workshop will be invited to visit to MCC for 3-4 months to receive hands-on training in bioinformatics analysis, informatics development, data managing, and data sharing under the supervision of Prof. Kelly Frazer.

Activity 3. Building an informatics genomic research pipeline in the CITC at Chile.

The students will return to Chile with the task to help integrate and implement the informatics facility based on their new knowledge acquired at MCC. MCC faculty will advise on this activity. It is expected that at the end of the project students will continue their academic development in cancer genomics and bioinformatics at graduate schools programs or engage in professional activities at CITC to support our current research efforts.

Dr. Sadarangani will be the project manager responsible for the USA-CHILE coordination. He has 4 years of experience as a project manager and is currently in charge of a $20M CIRM grant at UCSD to develop therapeutics agents for leukemia, where he has managed functional teams, tracking project progress against milestones, monitoring and reporting to the funding agency, as well as project cost analyses. Dr. Sadarangani obtained his Ph.D. in Chile, speaks the language (Spanish), and has proven to be a key connection for obtaining and managing current grants between both Institutions.

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