Building the Nation's Cancer Research Capacity

Expanding the Capacity of Centers, Networks, and Consortia

The Challenge

Today's cancer researchers cannot excel in an intellectual or administrative vacuum. To maximize innovation, researchers must work effectively in an interdisciplinary environment that allows and encourages them to engage in newly emerging areas of research and technology development and to take full advantage of opportunities to move the science forward to benefit patients and the public health. In order for researchers to make meaningful progress, this environment must include:

• Sophisticated tools;
• Extensive - and expensive - information resources;
• Trained associates;
• Research infrastructures that promote collaboration in basic, clinical, and population research and among scientists in fields such as physics, computer science, and engineering;
• Access to patients and at-risk populations;
• Access to tissue banks, new technologies, and state-of-the-art informatics;
• and, Effective linkages among oncologists, researchers, the pharmacuetical industry, cancer advocates and policy makers.

NCI's challenge is to address these critical needs by continuing to expand the capacity of centers, networks, and consortia to most effectively:

• Build and sustain research infrastructures that encourage and reward multidisciplinary research and scientific collaborations.
• Broaden the geographic distribution and impact of NCI-designated Cancer Centers.
• Improve the access of underserved populations to state-of-the-art research and resources.
• Engage in new areas of research and technology development.
• Make expertise, facilities, clinical practice and public health guidelines, and other resources broadly available to physicians and other caregivers, patients and families, and appropriate health agencies.

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Progress Toward Meeting the Challenge

Building and Sustaining Infrastructures for Translational Research

• NCI-designated Cancer Centers,
• Centers of Research Excellence,
• Research networks and consortia, and
• Individual investigators.

This framework helps create an environment conducive to complex scientific interactions, provides the resources essential for the research, and encourages the easy exchange of information and ideas.

The challenge of the future will be to ensure that our numerous interactive linkages function at peak effectiveness, allowing investigators to seek answers to major questions more efficiently and effectively. Within this structure, there are several levels of interaction.

NCI-designated Cancer Centers organize and integrate multidisciplinary research across departments and schools within a single institution or consortium of institutions. They provide scientists access to the most advanced technologies and new research opportunities.

These Centers, in turn, have given rise to Centers of Research Excellence that bring together interdisciplinary and translational research teams focused on specific diseases, modalities, biologic processes, or scientific areas. They are awarded sizeable amounts of flexible funding to enable them to rapidly address emerging scientific opportunities.

• Specialized Programs of Research Excellence (SPOREs) provide platforms for interaction, collaboration, and intervention development for specific cancers. They serve as highly effective hubs for translational research, moving discoveries among laboratory, clinic, and population research settings. In just 10 short years this program has grown substantially, with 40 SPOREs conducting and facilitating translational research in brain, breast, gastrointestinal, pancreatic, genitourinary, head and neck, lung, lymphoma, ovarian, prostate, and skin cancers.
• Modeled on the SPORE blueprint, other strategic Centers of Research Excellence include:
  • Transdisciplinary Tobacco Use Research Centers
  • In Vivo Cellular and Molecular Imaging Centers
  • Interdisciplinary Research Teams for Molecular Target Assessment
  • Centers of Excellence in Cancer Communications Research
  • Centers for Population Health and Health Disparities

NCI is working to build better ways for these Centers of Research Excellence to share data, research concepts, and mechanisms for developing interventions. It is through these collaborative efforts that NCI can further leverage its resources and ensure the best stewardship of Federal funding.

NCI-supported networks and consortia are also integrated with Cancer Centers and other programs in important ways.

• Special Populations Networks for Cancer Awareness Research and Training build relationships between large research institutions and community based programs to find ways of addressing important questions about the burden of cancer in minority communities.
• Through the NCI Minority Institution/Cancer Center Partnership program, Cancer Centers are developing long-term relationships with the Minority Serving Institutions to increase research, training, and outreach dedicated to reducing the disproportionate cancer incidence and mortality in minority populations. Five of these partnerships have been initiated to date and other collaborative efforts are underway through planning grants.
• The Cancer Genetics Network is a national network of researchers located in NCI-designated Cancer Centers who specialize in the study of inherited predisposition to cancer.
• The Mouse Models of Human Cancers Consortium, a valuable resource for cancer researchers engaged in a variety of basic, translational, clinical, and epidemiological investigations, has components in Cancer Centers. Consortium participants collaborate with investigators in the NCI Director's Challenge program, the SPOREs, and the Early Detection Research Network (EDRN) to evaluate various high-throughput technologies to ensure that compatible technologies are developed for mouse research.
• Further interactions are ongoing among EDRN investigators, SPORE investigators, and other interdisciplinary groups to facilitate the discovery, development, and initial steps in clinical validation of molecular markers and assays that detect early signs of cancer.

Bringing State-of-the-Art Research Results to Cancer Patients

NCI-supported Cancer Centers, networks, and consortia can serve as natural hubs for national leadership in the war against cancer and provide a means for fostering coalitions and partnerships with other cancer funding organizations, professional societies, businesses, industry, communities, and local and state governments.

In the last five years, more than 40 of the 60 Cancer Centers have received the "comprehensive" designation. This includes most medical institutions in the United States with major biomedical research programs. Directors and investigators at these Comprehensive Cancer Centers participate proactively with NCI in outreach activities to more rapidly bring the benefits of research to patients, physicians and other caregivers, and communities, especially to those in underrepresented geographic regions of the Nation.

NCI is working to facilitate the establishment of regional cancer centers - partnerships between smaller institutions and the large, existing NCI-designated Comprehensive Cancer Centers - to provide patients and populations with much improved access to the newest trials in early detection, prevention, and therapeutic research.

In the summer of 2002, The National Cancer Advisory Board assembled an Ad Hoc working group to establish a blueprint for NCI-designated Cancer Centers and SPOREs. The Ad Hoc group was charged with considering strategies for balancing the breadth and depth of the centers program, maximizing translation of research discoveries, developing objectives of a national cancer agenda focused on reducing the cancer burden, and facilitating partnerships with other governmental, private, philanthropic, and industrial entities. Recommendations from the working group are expected in early 2003.

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The Plan - Centers, Networks, and Consortia

Goal
Create and sustain infrastructures that facilitate research collaboration, serve as platforms for technology development, and provide access to the full range of research resources.

Objectives, Milestones, and Funding Increases Required for Fiscal Year 2004

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Ongoing Research Shows Value of Centers of Research Excellence, Networks, and Consortia

Specialized Programs of Research Excellence (SPOREs), other Centers of Research Excellence, and NCI-support networks and consortia provide opportunities for research that cannot be conducted by investigators at single institutions.

• Breast Cancer SPOREs are testing the use of imaging and gene array assessments to find markers that predict long-term response to chemotherapy before breast cancer surgery. These kinds of techniques may allow patients and their physicians to make more confident decisions to use the therapy as well as to help identify patients who are likely to relapse and may wish to consider other options.
• Ovarian Cancer SPOREs are participating in a screening trial to test the efficacy of obtaining periodic CA 125 values and to determine if this screening method, along with transvaginal ultrasounds, is effective for early detection in women at high risk for ovarian cancer. The trial is being conducted through collaboration with the Cancer Genetics Network.
• Prostate Cancer SPOREs have worked together to develop the necessary infrastructure to validate relevant biomarkers for prostate cancer using high throughput analysis and technologies that will ultimately bring into clinical practice new biomarkers for diagnosis, prognosis, and treatment. Additionally, the prostate SPOREs are developing microarrays for studies on special populations including African Americans, Hispanics, and Asian Americans.
• The Chronic Lymphocytic Leukemia (CLL) Research Consortium, a multi-institutional research program, brings together the nation's top scientists from different disciplines to conduct an integrated program of basic and clinical research focused on a single disease. CLL is the most common, and currently incurable, adult leukemia. Nine institutions are engaged in six research projects. Five are laboratory based and the sixth is a multicenter program to conduct clinical trials of promising new agents.
• Two adult brain tumor consortia, the New Approaches to Brain Tumor Therapy and the North American Brain Tumor Consortium, have greatly expanded the clinical research agenda for therapy in adults with gliomas and are considered the primary focus nationally for most new agent trials in adult brain tumors. These consortia have successfully evaluated the efficacy and pharmacokinetics of NCI-sponsored agents and incorporated molecular and biological analyses in clinical trials of novel agents aimed at specific molecular targets. Both consortia have established collaborations with industry sponsors.