PHASED APPLICATION AWARDS IN CANCER PROGNOSIS AND PREDICTION

RELEASE DATE:  May 5, 2004

PA NUMBER:  PA-04-102

Updates:

March 2, 2006 (NOT-OD-06-046) – Effective with the June 1, 2006 submission date, 
all R03, R21, R33 and R34 applications must be submitted through Grants.gov using 
the electronic SF424 (R&R) application. This announcement will stay active for 
only the May 1, 2006 AIDS and AIDS-related application submission date. The 
non-AIDS portion of this funding opportunity expires on the date indicated below. 
Replacement R21/R33 (PA-06-434) and R33 (PA-06-435) funding opportunity announcements
have been issued for the submission date of June 1, 2006 and submission dates 
for AIDS and non-AIDS applications thereafter.

August 12, 2005 - Expiration date extended, see NOT-CA-05-026

This Program Announcement (PA) replaces PAR-03-098, which was published in 
the NIH Guide on April 8, 2003.

EXPIRATION DATE for Non-AIDS Applications: March 2, 2006
EXPIRATION DATE for AIDS and AIDS-Related Applications: May 2, 2006

Department of Health and Human Services (DHHS)

PARTICIPATING ORGANIZATION:  
National Institutes of Health (NIH)
 (http://www.nih.gov)

COMPONENT OF PARTICIPATING ORGANIZATION: 
National Cancer Institute (NCI) 
 (http://www.nci.nih.gov)

CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:  93.394


THIS PA CONTAINS THE FOLLOWING INFORMATION

o Purpose of the PA
o Research Objectives
o Mechanisms of Support 
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements
o Where to Send Inquiries
o Submitting an Application
o Supplementary Instructions
o Peer Review Process
o Review Criteria
o Award Criteria
o Receipt and Review Schedule
o Required Federal Citations

PURPOSE OF THIS PA 

The Cancer Diagnosis Program of the National Cancer Institute invites 
applications for research projects to evaluate the utility and pilot the 
application of new strategies for determining prognosis or predicting 
response to therapy. This will provide tools to improve clinical decision-
making in the care of cancer patients.  This PA provides support for a first 
phase (R21) for technical development and a second phase (R33) for 
application and evaluation of clinical utility.  The first phase should 
produce data to demonstrate the technical feasibility of the study design 
proposed for the second phase, including the analytic performance of the 
assay or test system on samples comparable to those that will be used in the 
second phase.  The second phase should be designed to test whether 
application of the strategy will provide clinical benefit to a defined set of 
cancer patients.

RESEARCH OBJECTIVES 

Background

The number of clinical laboratory assays currently in routine use in oncology 
is very small.  For example, estrogen and progesterone receptor status of 
breast cancers is used to predict response to hormonal therapy.  Blood levels 
of prostate specific antigen and human chorionic gonadotropin in prostate 
cancer and germ cell cancer, respectively, are used to assess the 
effectiveness of treatment and to detect recurrence.  Patients whose tumor 
cells exhibit over-expression or amplification of the Her2/neu gene may be 
offered trastuzumab, forerunner of a new class of therapeutic agents directed 
against specific molecular targets. These markers are the exception, not the 
rule. During the past six years the College of American Pathologists, 
American Society of Clinical Oncology (ASCO) Expert Panels, and the American 
Joint Committee on Cancer have carefully considered many new markers proposed 
for use in managing breast, colon, and prostate cancer, but have found none 
with proven clinical utility sufficient to justify their adoption for routine 
practice.

Recently, the NCI has sought to encourage the rapid appraisal of new 
candidate prognostic and predictive markers through a series of program 
announcements soliciting exploratory (R21) studies.  An increasing number of 
publications have described new molecules, new patterns of gene expression, 
and new aspects of tumor cell growth that appear to be correlated with known 
prognostic factors.  However, very few markers progress beyond the stage of 
an initial promising result.  Studies to move the development of a new 
diagnostic test beyond the exploratory stage require large numbers of patient 
samples with associated clinical data; a robust, efficient assay technique; 
and substantial statistical input. 

The transition from an exploratory marker study to initial confirmatory 
testing in a clinical setting may involve additional developmental work.  For 
example, the study design may change from a retrospective to a prospective 
analysis or from a single institution to a multi-institutional setting.  
Frequently, an assay format must be modified, which may require the 
generation and characterization of additional reagents. Procedures for 
standardization between collaborating laboratories may be needed.  These 
tasks will usually fall outside the scope of an initial R21 grant, but 
without this preliminary work it may be difficult for the investigator to 
establish the feasibility of a larger project.

The phased innovation award, introduced by the NCI initially to support 
technology development, provides an appropriate mechanism to support the 
development of new prognostic and predictive markers.  The R21/R33 phased 
innovation award permits an investigator to perform initial developmental 
work in the R21 phase, to demonstrate feasibility by meeting a set of 
quantitative, peer-reviewed milestones, and then to move directly into the 
clinical study in the R33 phase.  Investigators with sufficient preliminary 
data to demonstrate feasibility can apply directly for an R33 award.  

Research Goals and Scope

This program is intended to accelerate the translation of new discoveries 
into clinical practice by enabling investigators to apply new diagnostic 
strategies to clinical problems.  The desired outcome will be studies with 
sufficient statistical power using efficient assay techniques that are 
conclusive enough to support the initiation of larger clinical trials 
designed to influence practice recommendations or to pursue FDA approval of a 
new device or analytic reagent.

Applicants should justify their proposals on the strength of the study 
proposed in the R33 component.  Applicants who can provide sufficient 
preliminary data are encouraged to apply for R33 grants.

The R21 component of an R21/R33 application will be considered exploratory, 
so that extensive preliminary data from the applicant’s own laboratory are 
not required.  However, the project must be based on a strong rationale, and 
the applicant should provide evidence that the initial clinical evaluation of 
the proposed diagnostic strategy is promising.  The R21 phase provides time 
for necessary preliminary work such as, for example, the substantial 
modification of an assay format. An application that includes an R21 
component may use results obtained during a previous R21 award to support a 
proposal in response to this PA.

Applicants for R21/R33 projects need to provide information in the 
application or to propose milestones that will demonstrate the feasibility of 
the R33 phase.  Milestones must be designed to permit a straightforward 
decision as to whether or not the applicant is ready to initiate the R33 
phase of the project.  Milestones should also be provided to show that the 
assay format to be used in the R33 phase meets necessary performance 
standards for sensitivity, specificity, and reproducibility. 

For example, milestones could be used to demonstrate the feasibility of the 
R33 project in the following ways:

o  Establish assay conditions: types of specimens, fixation processes, 
antigen retrieval methods, reagents and other components of the assay system, 
detection system, positive and negative controls, etc;

o  Define procedures for scoring and for reporting data;

o  Demonstrate that the assay or test system proposed for use in the R33 
phase has the required sensitivity, specificity and reproducibility;

o  Establish procedures for standardization and demonstrate that comparable 
results can be obtained from assays performed at multiple sites;

o  Estimate the prevalence of the marker on a pilot set of  specimens of the 
same type (fixed, frozen, etc.) and the same patient characteristics as the 
set proposed for the R33 study; and

o  Provide evidence that the number of participants or specimens required by 
the study design in the R33 phase can be accrued. 

This list is intended for illustration, and is not meant to prescribe or to 
limit the milestones an application may include.  See below (SPECIFIC 
INSTRUCTIONS FOR PREPARING THE COMBINED R21/R33 PHASED INNOVATION AWARD 
APPLICATION) for examples.

The R33 phase of the study must be described in sufficient detail to permit 
reviewers to assess the significance and innovation of the proposed work and 
the strength of the experimental design.  Applicants are expected to provide 
promising evidence of clinical utility for their proposed diagnostic strategy 
and to show how their new test or procedure will aid the process of clinical 
decision-making for a specific group of patients.  Applicants should plan to 
report correlations between the new diagnostic test and other measures used 
in the same clinical setting.

Investigators who propose prospective studies must clearly describe the 
arrangements for collection and analysis of patient outcome data, especially 
if follow-up will be required beyond the end of the award period.  Proposals 
will be evaluated on the strength of the scientific rationale, the 
significance of the problem to be addressed, the adequacy of the proposed 
statistical design, the feasibility of accrual of study participants or human 
tissue specimens and the choice of assay format and analytic performance 
criteria.

Investigators may apply for either an R21/R33 or an R33 award, but not for an 
R21 alone under this PA. Applicants who are interested in R21 projects 
without an R33 phase should consider NCI Program Announcements such as PA-03-
003 (Exploratory Studies in Cancer Detection, Diagnosis and Prognosis) or PA-
03-064 (Correlative Studies Using Specimens from Multi-Institutional 
Prevention and Treatment Trials).  Exploratory studies focused on cancer 
imaging, including new imaging modalities, agents and analysis methods, are 
more appropriate for PA-04-045 (In Vivo Cancer Imaging 
Exploratory/Developmental Grants) or PAR-03-124 (Novel Technologies for In 
Vivo Imaging [R21/R33], both sponsored by the NCI Cancer Imaging Program.

Summary 

Applicants should clearly describe the clinical question that their new test 
or procedure is intended to address: for example, diagnosis, prognosis, 
prediction of response to therapy, disease monitoring, etc., in a specific 
group of patients. Applicants should describe what additional information 
beyond standard clinical parameters that the new test is expected to provide. 
They should also demonstrate that the proposed assay has the sensitivity or 
accuracy adequate to answer the clinical question and that the proposed R33 
study has the necessary statistical power. The R21 phase is available, if 
necessary, to accomplish the development or refinement of an assay.  

MECHANISMS OF SUPPORT 

This PA will use the Exploratory/Developmental Research Grant Phase 2 (R33) 
and the combined R21/R33 Phased-Innovation Award mechanisms.  The R33 is a 
NIH grant mechanism to provide a second phase for the support of innovative 
exploratory and development research initiated under the R21 mechanism.  
Transition of the R21 to the R33 phase will be expedited and is dependent on 
completion of negotiated milestones.  Applicants will be solely responsible 
for planning, directing, and executing the proposed project.  

Under this PA, applicants can submit either a combined R21/R33 application 
(Phased Innovation Award application) or the R33 application alone, if 
feasibility can be documented, as described in the SPECIFIC INSTRUCTIONS 
section of this program announcement.  Applications for R21 support alone 
will not be accepted.  The total project period for an application submitted 
in response to this PA may not exceed the following duration: R33, 4 years; 
combined R21/R33 application, 5 years.  In the combined application the R21 
phase cannot extend beyond 2 years.

For combined R21/R33 applications, the R21 phase may not exceed $275,000 
direct costs (excluding sub-contractual party Facilities and Administrative 
costs) for the two-year period.  For example, the applicant may request 
$100,000 direct costs in the first year and $175,000 direct costs in the 
second year.  The request should be tailored to the needs of the project.  
Normally, no more than $200,000 direct costs may be requested in any single 
year.  Although the R33 application has no official budgetary limit, 
applications requesting $500,000 or more dollars direct costs in any single 
year of the grant period require prior approval before submission.  It is 
strongly recommended that applicants contact NCI staff at an early stage of 
application development to convey critical information, such as potentially 
large budget requests or to discuss programmatic adherence to the guidelines 
of the proposed project.  Early contact with NCI staff is particularly 
critical relative to this PA because it uses the R33 grant mechanism as well 
as an expedited review procedure.  Refer to the INQUIRIES sections of this 
program announcement for NCI staff contacts.

The combined R21/R33 application offers the following advantages over the 
regular application process:

1.  Single submission and evaluation of both the R21 and the R33 as one 
application; and

2. Minimal or no funding gap between R21 and R33. 

The award of R33 funds will be based on program priorities, on the 
availability of funds, and on successful completion of negotiated scientific 
milestones as determined by NCI staff in the context of peer review 
recommendations.

To be eligible for the Phased Innovation Award, the R21 phase must include 
well defined quantifiable milestones that will be used to judge the success 
of the proposed research, as well as a credible plan for the clinical study 
for the R33 phase.  The Phased Innovation Award must have a section labeled 
Milestones at the end of the Research Plan of the R21 application.  This 
section must include milestones for completion of the R21 part of the 
application, a discussion of the suitability of the proposed milestones for 
assessing the success in the R21 phase, and a discussion of the implications 
of successful completion of these milestones for the proposed R33 study.

This PA uses just-in-time concepts.  It also uses the modular budgeting as 
well as the non-modular budgeting formats (see 
http://grants.nih.gov/grants/funding/modular/modular.htm).  Specifically, if 
you are submitting an application with direct costs in each year of $250,000 
or less, use the modular budget format.  Otherwise follow the instructions 
for non-modular budget research grant applications.  (See additional SPECIFIC 
INSTRUCTIONS below.)  This program does not require cost sharing as defined 
in the current NIH Grants Policy Statement at
http://grants.nih.gov/grants/policy/nihgps_2003/NIHGPS_Part2.htm#_Toc54600040 .  

ELIGIBLE INSTITUTIONS 

You may submit (an) application(s) if your institution has any of the 
following characteristics:    
o For-profit or non-profit organizations; 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories; 
o Units of State and local governments;
o Eligible agencies of the Federal government; and
o Domestic or foreign institutions/organizations.

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always 
encouraged to apply for NIH programs. 

SPECIAL REQUIREMENTS 

Prior to funding an application, the NCI Program Director will contact the 
applicant to discuss the proposed milestones and any changes suggested by the 
review panel as indicated in the Summary Statement.  The Program Director and 
the applicant will negotiate and agree on a final set of milestones. These 
will be the basis for judging the success of the R21 work.  At least one 
interim progress report will be required during the R21 phase.

For funded applications, completion of the R21 milestones will elicit an 
expedited review by the NCI that will determine whether or not the R33 grant 
should be awarded. The release of R33 funds will be based on successful 
completion of negotiated scientific milestones, program priorities, and on 
the availability of funds. The expedited transitional review may result in 
additional negotiations of award.

An annual meeting of all investigators funded through this program will be 
held to share results and research insights that may accelerate progress.  
Applicants should request travel funds in their budgets for the principal 
investigator and one additional senior investigator to attend this annual 
meeting.

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this PA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into two 
areas:  scientific/research and financial or grants management issues:

o Direct your questions about scientific/research issues to:

Tracy G. Lugo, Ph.D.
Division of Cancer Treatment and Diagnosis
National Cancer Institute
6130 Executive Blvd., EPN Room 6035A
Bethesda, MD  20892
Rockville, MD  20852 (for express/courier service)
Telephone:  (301) 496-1591
FAX: (301) 402-7819
Email: lugot@mail.nih.gov
(for general inquiries and for projects specifically related to breast 
cancer, lung cancer, gynecologic cancers, or brain tumors)

Magdalena Thurin, Ph.D.
Division of Cancer Treatment and Diagnosis
National Cancer Institute
6130 Executive Blvd., Room EPN 6035A
Bethesda, MD  20892
Rockville, MD  20852 (for express/courier service)
Telephone:  (301) 496-1591
FAX: (301) 402-7819
Email: thurinm@mail.nih.gov
(for projects related to colon cancer, gastric cancer, pancreatic cancer, 
skin cancers including melanoma, sarcomas, or acute leukemias)

James V. Tricoli, Ph.D.
Division of Cancer Treatment and Diagnosis
National Cancer Institute
6130 Executive Blvd., Room EPN 6035A
Bethesda, MD  20892
Rockville, MD  20852 (for express/courier service)
Telephone:  (301) 496-1591
FAX: (301) 402-7819
Email: tricolij@mail.nih.gov
(for projects related to prostate cancer, renal or bladder cancer, head and 
neck cancer, esophageal cancer, liver cancer, lymphomas, or chronic 
leukemias)

o Direct your questions about financial or grants management matters to:

Amy Connolly
Grants Administration Branch
National Cancer Institute
6120 Executive Blvd, Room 243
Bethesda, MD 20892-7150
Rockville, MD 20852 (for express/courier service)
Telephone:  (301) 496-8786
Fax:  (301) 496-8601
Email:  amyconnolly@nih.gov 

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  Applications must have a Dun and 
Bradstreet (D&B) Data Universal Numbering System (DUNS) number as the 
Universal Identifier when applying for Federal grants or cooperative 
agreements. The DUNS number can be obtained by calling (866) 705-5711 or 
through the web site at http://www.dunandbradstreet.com/. The DUNS number 
should be entered on line 11 of the face page of the PHS 398 form.  The PHS 
398 document is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance, contact GrantsInfo; Telephone: (301) 435-
0714; Email: GrantsInfo@nih.gov.

The title and number of this program announcement must be typed on line 2 of 
the face page of the application form and the YES box must be checked.

SUPPLEMENTARY INSTRUCTIONS

SPECIFIC INSTRUCTIONS FOR PREPARING THE COMBINED R21/R33 PHASED INNOVATION 
AWARD APPLICATION:

(See below for instructions for preparing an R33 application without the R21 
phase.)

R21/R33 applications must include specific aims that are relevant to each 
phase as well as feasibility milestones that would justify transition to the 
R33 phase.  Applications must include a specific section labeled Milestones 
following the Research Plan of the R21 phase.  Milestones should be well 
described, quantifiable and scientifically justified and should not be simply 
a restatement of the R21 specific aims. A discussion of the implications of 
successful completion of the milestones for the R33 phase should be included.  
This section should be indicated in the Table of Contents.  Applications 
lacking this information, as determined by CSR or NCI staff, will be returned 
to the applicant without review.  

The R21/R33 application must be submitted as one application with one Face 
Page.  Although it is submitted as a single application, it should be clearly 
organized into two phases.  To accomplish a clear distinction between the two 
phases, applicants are directed to complete Sections a-d of the Research Plan 
twice: one write-up of Sections a-d and milestones for the R21 phase and 
Sections a-d again for the R33 phase.  The Form 398 Table of Contents should 
be modified to show Sections a-d for each phase as well as the milestones.  
There is a page limit of 25 pages for the combined text (i.e., Section a-d 
and milestones for the R21 and Section a-d for the R33 phase must be 
contained within the 25 page limit.)  Background material or preliminary data 
presented in the R21 research plan need not be repeated in the plan for the 
R33.  Sections e (Human Subjects) and f (Vertebrate Animals, if applicable) 
should be included for each phase; the page limits do not apply to these 
sections, but be concise.

In preparing the R21/R33 application, investigators should consider the fact 
that applications will be assigned a single priority score. For these 
reasons, the clarity and completeness of the R21/R33 application with regard 
to feasibility milestones and specific goals for each phase are critical. The 
presentation of milestones that are not sufficiently scientifically rigorous 
to be valid for assessing progress in the R21 phase will reflect upon the 
scientific judgment of the applicant.

1.  FACE PAGE OF THE APPLICATION:

Item 2.  Check the box marked “YES” and type the NUMBER AND TITLE of this PA.  
Also, indicate that the application is submitted as an R21/R33.

Item 7a, DIRECT COSTS REQUESTED FOR INITIAL PERIOD OF SUPPORT:
For the R21 phase of the combined R21/R33 application, direct costs 
(excluding subcontractual party Facilities and Administrative costs) are 
limited to a maximum of $275,000 for the 2-year period, and the award may not 
be used to supplement an ongoing project.  Insert the total costs requested 
for the first year of R21 support in item 7a.

Item 8a, DIRECT COSTS REQUESTED FOR PROPOSED PERIOD OF SUPPORT:
The R21 phase may be either 1 or 2 years in duration. For the R21 phase, 
direct costs requested for the proposed period may not exceed $275,000 for 2 
years of support.  Insert the sum of all years of requested support (R21 plus 
R33) in item 8a.

2.  PAGE 2 - DESCRIPTION:

As part of the description, identify concisely the diagnostic strategy to be 
developed, the specific clinical question to be addressed, the relationship 
to presently available capabilities for cancer prognosis or prediction and 
the expected impact on patient care.

3.  BUDGET:

The application should contain a modular budget for the R21 phase (see below, 
SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS.)  For R33 applications 
requesting up to $250,000 direct costs per year, submit a separate modular 
budget for the R33 phase.  For applications requesting more than $250,000 
direct costs in any year of the R33 phase, the modular format is not to be 
used for the R33 phase.  In this case the application should provide a 
DETAILED BUDGET for Initial Budget Period (form page 4) for the initial year 
of the R33 phase as well as a budget for the entire proposed period of R33 
support (form page 5).  Form pages should indicate which years are R21 and 
R33.  

4.  RESEARCH PLAN:

Item a:  Specific Aims:
The applicant must present specific aims that the applicant considers to be 
scientifically appropriate for each of the two phases of the project.  The 
instructions in the PHS 398 booklet for this section of research grant 
applications suggest that the applicant state the hypotheses to be tested. 
Since the goal of this PA is to develop new methods for cancer prognosis and 
prediction, clearly state the clinical questions to be addressed.  Identify 
the patient population(s) to be studied and the assay(s) or test system(s) to 
be employed.

Item b: Background and Significance:
Clarify how the prognostic or predictive strategy proposed for evaluation in 
this project is a significant addition to existing approaches. Explain the 
potential of the proposed technology for a broad impact on patient care and 
improvement in patient outcomes. Clearly identify how the project, if 
successful, would result in new capabilities for cancer prognosis or 
prediction.  If preliminary data from the applicant’s own laboratory are not 
available, this section must provide current evidence from the literature or 
from other investigators to substantiate the potential clinical utility of 
the proposed strategy.

Item c:  Preliminary studies/Progress report:
While preliminary data are not required for the R21 phase, easily 
understandable data that provide relevant information to aid review should be 
included when available. An applicant may use preliminary data obtained with 
the support of a previous R21 award. The R33 section of the application need 
not repeat information already provided in the R21.  

Applicants are encouraged to include all information required for adequate 
evaluation by reviewers.  However, in the event that assays and technology 
are not yet patent protected and the applicant does not wish to include 
complete details, the application should at a minimum provide a demonstration 
(results) of the capabilities of the proposed approach.

Item d:  Research Design and Methods:
Instructions for PHS 398 should be followed.  In addition, for the R21 phase 
only, the following information must be included as a final section of Item 
d:

Applications must include a specific section labeled Milestones following the 
Research Design and Methods of the R21 phase.  Milestones should be well 
described, quantifiable, and scientifically justified and not be simply a 
restatement of the specific aims.  A discussion of the milestones relative to 
the success of the R21 phase, as well as implications of successful 
completion of the milestones for the R33 phase should be provided.  The page 
number of the Milestones section should be listed in the Table of Contents. 
Applications lacking this information, as determined by NIH staff, will be 
returned to the applicant without review.  

The following examples are provided to illustrate the recommended level of 
detail for milestones, but should not be considered an exhaustive list of 
potentially appropriate milestones.  Nor is this list intended to recommend 
the use of specific statistical tests.  You should apply those methods that 
are most appropriate for your data.

o  Assay conditions will be optimized to achieve conditions where the 
analytic sensitivity is at least X and the specificity is at least Y when Z 
samples, half of which are truly positive for the analyte, are studied.
 
o  The assay to be used in the R33 phase will perform reproducibly as defined 
by a coefficient of variation less than Y in a series of X test specimens.

o  Show that the marker, as defined by a cut-off value of X, is correlated 
with the outcome of interest in the patient population for the R33 phase by 
demonstrating that there is a difference of at least Y percent in the 
prevalence of the marker when comparing N1 patients with outcome type 1 to N2 
patients with outcome type 2.

o  The prognostic significance of molecular profiles defined in the training 
set will be demonstrated in an independent set of X specimens. This milestone 
will be met if values of Y percent or higher are achieved for both 
sensitivity and specificity in predicting the clinical outcome of interest 
for the R33 phase.    

For the R33 phase, Item d of the Research Plan should include a statistical 
section that discusses the choice of the study design and laboratory methods. 
Sample sizes must be clearly stated and justified with power calculations. 
The statistician involved with the project should be identified and a letter 
of support included if no effort is requested in the budget. Plans for data 
management and verification of clinical research data should also be 
described. Collaborative arrangements should be clearly documented, and where 
collaborations involve NCI-sponsored clinical trials the protocol numbers 
should be provided.  Letters of support should be included in the application 
to substantiate plans for collection of follow-up information beyond the 
period of award. Where appropriate, applicants are strongly encouraged to 
include a copy of the complete clinical protocol in the Appendix.

Item e, Human Subjects:  Refer to the instructions for the PHS 398.  For each 
phase of the project provide a separate description of the participation of 
human subjects in research, and place it following item d of the Research 
Plan. The description for each phase must include sections that respond to 
the instructions in the PHS 398 for “Human Subjects Research,” “Women and 
Minority Inclusion in Clinical Research" and the "Inclusion of Children" and 
“Data and Safety Monitoring” if the research involves a clinical trial.  
Although no specific page limits apply to these sections of the application, 
be succinct.

Item f, Vertebrate Animals: Refer to the instructions for the PHS 398.  If 
applicable, for each phase of the project provide a separate description of 
the use of vertebrate animals in the proposed research that responds to the 
instructions in the PHS 398.  Place it following item e of the Research Plan.  
Although no specific page limits apply to these sections of the application, 
be succinct.

5.  CONSULTANTS/COLLABORATORS:  

Include letters of support from collaborators in this section of the 
application.  Do not place them in the Appendix.

SPECIFIC INSTRUCTIONS FOR PREPARATION OF THE R33 APPLICATION WHEN SUBMITTED 
WITHOUT THE R21 PHASE:

1.  FACE PAGE OF THE APPLICATION: 
 
Item 2.  Check the box marked "YES" and type the TITLE AND NUMBER of this PA.  
Also, indicate that the application is for an R33.

2.  DESCRIPTION:  

As part of the description, identify concisely the diagnostic strategy to be 
developed, the specific clinical question to be addressed, the relationship 
to presently available capabilities for cancer prognosis or prediction and 
the expected impact on patient care.

3.  BUDGET:

For R33 applications requesting up to $250,000 direct costs per year, submit 
a modular budget (see below, SPECIFIC INSTRUCTIONS FOR MODULAR GRANT 
APPLICATIONS).  For R33 applications requesting more than $250,000 direct 
costs in any year, the modular format is not to be used.  In this case the 
application should provide a DETAILED BUDGET for Initial Budget Period (form 
page 4) for the initial year of the R33 as well as a budget for the entire 
proposed period of support (form page 5).  

4.  RESEARCH PLAN:  

Item a:  Specific Aims: 
The instructions in the PHS 398 booklet for this section of research grant 
applications suggest that the applicant state the hypotheses to be tested. 
Since the goal of this PA is to develop new methods for cancer prognosis and 
prediction, clearly state the clinical questions to be addressed.  Identify 
the patient population(s) to be studied and the assay(s) or test system(s) to 
be employed.

Item b:  Background and Significance:
Clarify how the prognostic or predictive strategy proposed for evaluation in 
this project is a significant addition to existing approaches. Explain the 
potential of the proposed technology for a broad impact on patient care and 
improvement in patient outcomes. Clearly identify how the project, if 
successful, would result in new capabilities for cancer prognosis or 
prediction.  If preliminary data from the applicant’s own laboratory are not 
available, this section must provide current evidence from the literature or 
from other investigators to substantiate the potential clinical utility of 
the proposed strategy.

Item c:  Preliminary studies/Progress Report: 
R33 applications should clearly state how feasibility for the project has 
already been demonstrated.  Preliminary data relevant to both the laboratory 
assay(s) or test system(s) and the clinical outcome measurements should be 
presented. This section must document that progress has been achieved which 
is essentially equivalent to that expected from an R21 grant.  An applicant 
may use preliminary data obtained with the support of a previous R21 award.

Item d:  Research Design and Methods:
Instructions for PHS 398 should be followed. Item d of the Research Plan 
should include a statistical section that discusses the choice of the study 
design and laboratory methods. Sample sizes must be clearly stated and 
justified with power calculations. The statistician involved with the project 
should be identified and a letter of support included if no effort is 
requested in the budget. Plans for data management and verification of 
clinical research data should also be described. Collaborative arrangements 
should be clearly documented, and where collaborations involve NCI-sponsored 
clinical trials, the protocol numbers should be provided.  Letters of support 
should be included in the application to substantiate plans for collection of 
follow-up information beyond the period of award. Where appropriate, 
applicants are strongly encouraged to include a copy of the complete clinical 
protocol in the Appendix.

Item e:  Human Subjects
Follow all instructions in the PHS 398.

Item f:  Vertebrate Animals
Follow all instructions in the PHS 398 if applicable.

5.  CONSULTANTS/COLLABORATORS:

Include letters of support from collaborators in this section of the 
application.  Do not place them in the Appendix.
 
APPLICATION RECEIPT DATES: Applications submitted in response to this program 
announcement will be accepted at the standard application deadlines, which 
are available at http://grants.nih.gov/grants/dates.htm.  Application 
deadlines are also indicated in the PHS 398 application kit.

SPECIFIC INSTRUCTIONS FOR MODULAR BUDGET GRANT APPLICATIONS:  Applications 
requesting up to $250,000 per year in direct costs must be submitted in a 
modular grant format.  The modular grant format simplifies the preparation of 
the budget in these applications by limiting the level of budgetary detail.  
Applicants request direct costs in $25,000 modules.  Section C of the 
research grant application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.  See also SPECIFIC 
INSTRUCTIONS FOR PREPARING THE COMBINED R21/R33 PHASED INNOVATION AWARD 
APPLICATION above.

SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR:  
Applications requesting $500,000 or more in direct costs for any year must 
include a cover letter identifying the NIH staff member within one of NIH 
institutes or centers who has agreed to accept assignment of the application.   
 
Applicants requesting more than $500,000 must carry out the following steps:
   
1)Contact the IC program staff at least 6 weeks before submitting the 
application, i.e., as you are developing plans for the study; 

2) Obtain agreement from the IC staff that the IC will accept your         
application for consideration for award; and,
  
3) Identify, in a cover letter sent with the application, the staff member       
and IC who agreed to accept assignment of the application

This policy applies to all investigator-initiated new (type 1), competing 
continuation (type 2), competing supplement, or any amended or revised 
version of these grant application types. Additional information on this 
policy is available in the NIH Guide for Grants and Contracts, October 19, 
2001, at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. 

SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten original of 
the application, including the checklist, and five signed photocopies in one 
package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD 20892-7710
Bethesda, MD 20817 (for courier/express service)

APPLICATION PROCESSING:  Applications must be mailed on or before the receipt 
dates described at 
http://grants.nih.gov/grants/funding/submissionschedule.htm.  The CSR will 
not accept any application in response to this PA that is essentially the 
same as one currently pending initial review unless the applicant withdraws 
the pending application.  The CSR will not accept any application that is 
essentially the same as one already reviewed.  This does not preclude the 
submission of a substantial revision of an unfunded version of an application 
already reviewed, but such application must include an Introduction 
addressing the previous critique.  

Although there is no immediate acknowledgement of the receipt of an 
application, applicants are generally notified of the review and funding 
assignment within 8 weeks.  

PEER REVIEW PROCESS

Applications submitted for this PA will be assigned on the basis of 
established PHS referral guidelines.  Appropriate scientific review groups 
convened in accordance with the standard NIH peer review procedures 
(http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific 
and technical merit.  

As part of the initial merit review, all applications will:

o Undergo a selection process in which only those applications deemed to have 
the highest scientific merit, generally the top half of applications under 
review, will be discussed and assigned a priority score
o Receive a written critique
o Undergo a second level review by an appropriate national advisory council 
or board.    

REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments, reviewers will be asked to evaluate the application in 
order to judge the likelihood that the proposed research will have a 
substantial impact on the pursuit of these goals.  The scientific review 
group will address and consider each of these criteria in assigning the 
application’s overall score, weighting them as appropriate for each 
application.   

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The application does not need to be strong in all categories to be judged 
likely to have major scientific impact and thus deserve a high priority 
score.  For example, an investigator may propose to carry out important work 
that by its nature is not innovative but is essential to move a field 
forward.

SIGNIFICANCE: Does this study address an important problem? If the aims of 
the application are achieved, how will scientific knowledge be advanced? What 
will be the effect of these studies on the concepts or methods that drive 
this field?

APPROACH: Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project? Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

INNOVATION: Does the project employ novel concepts, approaches or methods? 
Are the aims original and innovative? Does the project challenge existing 
paradigms or develop new methodologies or technologies?

INVESTIGATOR: Is the investigator appropriately trained and well suited to 
carry out this work? Is the work proposed appropriate to the experience level 
of the principal investigator and other researchers (if any)?

ENVIRONMENT: Does the scientific environment in which the work will be done 
contribute to the probability of success? Do the proposed experiments take 
advantage of unique features of the scientific environment or employ useful 
collaborative arrangements? Is there evidence of institutional support?  

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, the following 
items will be considered in the determination of scientific merit and the 
priority score:

MILESTONES: How appropriate are the proposed milestones to judge the success 
of the proposed R21 project and to determine whether the R33 grant should be 
awarded? Do they set forth specific criteria, in sufficient detail, that will 
permit a straightforward decision about whether or not they have been 
accomplished?  Do the milestones establish feasibility for all aspects of the 
proposed R33 work?  

For the R21/R33 Phased Innovation Award Application, the initial review group 
will evaluate the specific goals for each phase and the feasibility 
milestones that would justify expansion to the R33 phase. A single priority 
score will be assigned to each scored application.  As with any grant 
application, the initial review group has the option of recommending support 
for a shorter duration than that requested by the applicant and basing the 
final merit rating on the recommended portion of the application.  For the 
R21/R33 application, this may result in a recommendation that only the R21 
phase be supported, based on concerns related to the application's specific 
goals and the feasibility milestones justifying expansion to the R33 phase.  
Deletion of the R33 phase by the review panel or presentation of inadequate 
milestones in the application may affect the merit rating of the application.

PROTECTION OF HUMAN SUBJECTS FROM RESEARCH RISK: The involvement of human 
subjects and protections from research risk relating to their participation 
in the proposed research will be assessed. (See criteria included in the 
section on Federal Citations, below.)
 
INCLUSION OF WOMEN, MINORITIES AND CHILDREN IN RESEARCH: The adequacy of 
plans to include subjects from both genders, all racial and ethnic groups 
(and subgroups), and children as appropriate for the scientific goals of the 
research will be assessed.  Plans for the recruitment and retention of 
subjects will also be evaluated. (See Inclusion Criteria in the sections on 
Federal Citations, below.)

CARE AND USE OF VERTEBRATE ANIMALS IN RESEARCH: If vertebrate animals are to 
be used in the project, the five items described under Section f of the PHS 
398 research grant application instructions (rev. 5/2001) will be assessed.  

ADDITIONAL REVIEW CONSIDERATIONS

SHARING RESEARCH DATA:  Applicants requesting more than $500,000 in direct 
costs in any year of the proposed research are expected to include a data 
sharing plan in their application. The reasonableness of the data sharing 
plan or the rationale for not sharing research data will be assessed by the 
reviewers. However, reviewers will not factor the proposed data sharing plan 
into the determination of scientific merit or priority score. (See below, 
SHARING RESEARCH DATA.)
 
BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

AWARD CRITERIA

Applications submitted in response to a PA will compete for available funds 
with all other recommended applications.  The following will be considered in 
making funding decisions:  

o Scientific merit of the proposed project as determined by peer review;
o Availability of funds; and 
o Relevance to program priorities.

REQUIRED FEDERAL CITATIONS 

HUMAN SUBJECTS PROTECTION:  Federal regulations (45CFR46) require that 
applications and proposals involving human subjects must be evaluated with 
reference to the risks to the subjects, the adequacy of protection against 
these risks, the potential benefits of the research to the subjects and 
others, and the importance of the knowledge gained or to be gained.  See 
http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm.

DATA AND SAFETY MONITORING PLAN:  Data and safety monitoring is required for 
all types of clinical trials, including physiologic, toxicity, and dose-
finding studies (phase I); efficacy studies (phase II), efficacy, 
effectiveness and comparative trials (phase III). The establishment of data 
and safety monitoring boards (DSMBs) is required for multi-site clinical 
trials involving interventions that entail potential risk to the 
participants.  (See NIH Policy for Data and Safety Monitoring, NIH Guide for 
Grants and Contracts, June 12, 1998, at 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html.) 

Clinical trials supported or performed by NCI require special considerations.  
The method and degree of monitoring should be commensurate with the degree of 
risk involved in participation and the size and complexity of the clinical 
trial.  Monitoring exists on a continuum from monitoring by the principal 
investigator/project manager or NCI program staff or a Data and Safety 
Monitoring Board (DSMB).  These monitoring activities are distinct from the 
requirement for study review and approval by an Institutional review Board 
(IRB).  For details about the Policy for the NCI for Data and Safety 
Monitoring of Clinical, trials see 
http://deainfo.nci.nih.gov/grantspolicies/datasafety.htm.  For Phase I and II 
clinical trials, investigators must submit a general description of the data 
and safety monitoring plan as part of the research application.  For 
additional information see NIH Guide Notice on “Further Guidance on a Data 
and Safety Monitoring for Phase I and II Trials” at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-038.html.  
Information concerning essential elements of data safety monitoring plans for 
clinical trials funded by the NCI is available at 
http://www.cancer.gov/clinical_trials/.

ANIMAL WELFARE PROTECTION:  Recipients of PHS support for activities 
involving live, vertebrate animals must comply with PHS Policy on Humane Care 
and Use of Laboratory Animals 
(http://grants.nih.gov/grants/olaw/references/PHSPolicyLabAnimals.pdf), as 
mandated by the Health Research Extension Act of 1985 
(http://grants.nih.gov/grants/olaw/references/hrea1985.htm), and the USDA 
Animal Welfare Regulations 
(http://www.nal.usda.gov/awic/legislat/usdaleg1.htm), as applicable.

SHARING RESEARCH DATA: Investigators submitting an NIH application seeking 
more than $500,000 or more in direct costs in any single year are expected to 
include a plan for data sharing 
(http://grants.nih.gov/grants/policy/data_sharing) or state why this is not 
possible. Investigators should seek guidance from their institutions, on 
issues related to institutional policies, local IRB rules, as well as local, 
State, and Federal laws and regulations, including the Privacy Rule. 
Reviewers will consider the data sharing plan but will not factor the plan 
into the determination of the scientific merit or the priority score.

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of 
the research. This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the "NIH Guidelines 
for Inclusion of Women and Minorities as Subjects in Clinical Research - 
Amended, October, 2001," published in the NIH Guide for Grants and Contracts 
on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); 
a complete copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: (a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; 
and (b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: 
The NIH maintains a policy that children (i.e., individuals under the age of 
21) must be included in all human subjects research, conducted or supported 
by the NIH, unless there are scientific and ethical reasons not to include 
them. 

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH 
policy requires education on the protection of human subject participants for 
all investigators submitting NIH proposals for research involving human 
subjects.  You will find this policy announcement in the NIH Guide for Grants 
and Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.  A 
continuing education program in the protection of human participants in 
research is available online at: http://cme.nci.nih.gov/.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application. In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION: The 
Department of Health and Human Services (DHHS) issued final modification to 
the “Standards for Privacy of Individually Identifiable Health Information,” 
the “Privacy Rule,” on August 14, 2002.  The Privacy Rule is a federal 
regulation under the Health Insurance Portability and Accountability Act 
(HIPAA) of 1996 that governs the protection of individually identifiable 
health information, and is administered and enforced by the DHHS Office for 
Civil Rights (OCR).  

Decisions about applicability and implementation of the Privacy Rule reside 
with the researcher and his/her institution. The OCR website 
(http://www.hhs.gov/ocr/) provides information on the Privacy Rule, including 
a complete Regulation Text and a set of decision tools on “Am I a covered 
entity?”  Information on the impact of the HIPAA Privacy Rule on NIH 
processes involving the review, funding, and progress monitoring of grants, 
cooperative agreements, and research contracts can be found at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-03-025.html.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.   Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of "Healthy 
People 2010," a PHS-led national activity for setting priority areas. This PA 
is related to one or more of the priority areas. Potential applicants may 
obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.  

AUTHORITY AND REGULATIONS: This program is described in the Catalog of 
Federal Domestic Assistance at http://www.cfda.gov/ and is not subject to the 
intergovernmental review requirements of Executive Order 12372 or Health 
Systems Agency review.  Awards are made under the authorization of Sections 
301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) 
and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. All 
awards are subject to the terms and conditions, cost principles, and other 
considerations described in the NIH Grants Policy Statement.  The NIH Grants 
Policy Statement can be found at 
http://grants.nih.gov/grants/policy/policy.htm.

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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