The unprecedented commitment to basic and clinical cancer research that came about through the NCA ushered in a revolutionary understanding of the molecular and cellular biology of cancer, which in turn has launched a new approach to treatment based on therapeutic targeting of molecular markers unique to cancer cells.

"If you go back 35 years, much of what is now commonplace was not known," said Dr. Thomas Waldmann, chief of the Metabolism Branch in NCI's CCR. With little support for basic science research available from industry prior to its signing, the NCA provided the funds necessary for investigators to commit their careers to elucidating the biological causes of cancer.

One early initiative funded under the NCA was the Cancer Virus Program, which resulted in the discovery of the first oncogenes. "What really emerged from the Cancer Virus Program was [an understanding of] molecular events that underlie the pathogenesis of cancer," explained Dr. Waldmann. "These, coupled with the results of the Human Genome Project, gave us new molecular targets for therapy, and we are just beginning to see the impact of these new targets, with drugs such as Gleevec and Herceptin."

Identifying these targets requires a large-scale, long-term commitment that was provided by the NCA. "It took us nearly 10 years to identify our first kidney cancer gene - the VHL gene," said Dr. Marston Linehan, chief of CCR's Urologic Oncology Branch, "but the subsequent elucidation of the function of that cancer gene's product has enabled the development and use of therapeutic agents to target the product and its pathway. Two such agents were approved by the FDA within the past year for the treatment of this disease."

Along with extensive support for laboratory science, the NCA has provided for a vast expansion in clinical trials to test new therapies, including the growth of large-scale cooperative groups that pool investigators and patients across the country to amass the data needed for confidence in the answers to clinical questions under study.

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Over 20,000 patients a year now join clinical trials run by members of the Clinical Trials Cooperative Group Program. Funding provided by the NCA supports programs such as the Community Clinical Oncology Program and the Cancer Trials Support Unit, which allow community physicians and their patients to participate in clinical research projects. It also supports research at the NIH Clinical Center, which manages a broad selection of clinical trials that test new cancer agents.

"I think translational research emerged through this act," said Dr. Waldmann. "Today, translational research is a buzzword, but it didn't really exist before then. Now, with the NIH Clinical Center so enormously powerful in allowing this kind of science, we can do basic science and translational research with something that's made here at the NIH. Then after it's approved by the FDA for use in a trial, we get to see the first results in our own patients."