People don't get "cancer." They develop cancer of the breast, the prostate, the lung, or any of over 100 other types of the disease. The recommendations of Progress Review Groups are central to sustaining the best possible science and making the fastest advances against specific cancers. Andrew C. von Eschenbach, M.D. |
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National Agendas for Disease-Specific ResearchOn this page:
Unlike the common belief of 30 or 40 years ago, we know today that there are more than 100 distinct types of cancer. We are also learning that many diseases have subtypes with unique molecular characteristics that influence how they develop and progress and how they can be effectively prevented, detected, and treated. For these reasons, NCI carries out an ambitious program of research on specific types of cancer. These efforts along with the broad-based programs described in this document provide the framework for national agendas for cancer disease-specific research. NCI leads the development and pursuit of disease-specific research by assessing the current understanding of specific cancers, the funded research, our ability to prevent and treat the disease, and the extent of our success. We chart the course primarily through advice from expert Progress Review Groups(PRGs) who work with us to evaluate the state of the science for specific types of cancer or groups of related cancers, identify research gaps and resource needs, and develop recommendations for future priorities. NCI's planning and evaluation process for disease-specific research involves three distinct phases:
This comprehensive and integrated approach to planning helps us demonstrate our progress and the wise use of resources to the scientific community and the public. Through these and other crosscutting efforts, NCI establishes a framework for accountability that is in keeping with the President's Management Agenda and the Congressionally mandated Government Performance and Results Act. The Progress Review Group Process
Developing RecommendationsPRGs are panels of 20 to 30 prominent members of the scientific, medical, private sector, and advocacy communities who are selected to assess the state of the science and recommend future research-related priorities for one type of cancer or a group of closely related cancers. The deliberations of each PRG are informed by a larger group of more than 100 leaders from diverse disciplines and the advocacy community who assemble for a Roundtable Meeting to discuss their understanding of the disease, barriers to progress, and key research and resource priorities for the next five years. PRGs use the input from these Roundtable groups to develop comprehensive and widely distributed reports and recommendations for national research agendas. For example, recently assembled PRGs have identified some specific initiatives they believe are needed to speed research progress.
A number of common themes have emerged across PRG recommendations that parallel priority initiatives identified in this document. For example, the following were emphasized in more than one PRG recommendation and are closely tied to the capacity building initiatives for supporting research collaborations or development of and access to research resources.
Other recommendations may be addressed through our initiatives for supporting research on genes and the environment, signatures of the cancer cell and its microenvironment, molecular targets, cancer imaging, survivorship, and cancer communications.
Implementing Strategies to Address PRG RecommendationsFormal implementation plans that respond to PRG recommendations are now being developed under the leadership of disease-specific research working groups at NCI. The Brain Tumor Working Group proposed the application of new concepts in developmental neurosciences to understand the unique organ-specific mechanisms of gliomas biology in both pediatric and adult patients. The Leukemia, Lymphoma, and Myeloma Working Group suggested convening a meeting of leaders from academia, industry, the advocacy community, and government to examine models for establishing public-private partnerships for drug discovery. This could lead to a concept for the funding of planning grants and eventually drug development centers. The Pancreatic Cancer Working Group encouraged the funding and training of new investigators, imperative in advancing research on pancreatic cancer. NCI does everything in its power to expedite progress against all types of cancer. We implement as many of the proposed initiatives in the disease-specific strategic plans as possible, and encourage and enable other organizations to take leading roles on those initiatives where additional collaboration is needed. PRG recommendations are implemented through ongoing NCI initiatives, new or expanded research programs, infrastructure support, partnerships, or a combination of these approaches. Our ability to implement any new initiative is dependent on:
Reporting on ProgressWe close our accountability feedback loop by providing details to the community on actions we have taken to address PRG recommendations. Recognizing that some actions take longer to demonstrate results, NCI monitors implementation and collects progress data for several years and then prepares a progress report. This report is shared with a reassembled PRG. Based on NCI's assessment of progress and PRG input, implementation strategies are revised, retired, or added as needed, and NCI continues to monitor progress. By 2003 we will publish progress reports for prostate cancer and breast cancer, in follow-on to the first two PRG reports issued in 1998. NCI will also complete an evaluation of the PRG process itself before the end of this year. The chart below indicates the current status of reports and plans related to the PRGs established to date.
NCI Programs Support Disease-Specific ResearchA number of NCI's existing programs support research focused on specific types of cancer.
Stalking a Silent Killer - Pancreatic CancerPancreatic cancer is often called a "silent" cancer because it has no clear symptoms until it is advanced. This malignancy metastasizes early, with many tumors as small as 1 or 2 centimeters in diameter spreading beyond the pancreas, and it is resistant to both chemotherapy and radiation treatment. Most patients live six months or less after diagnosis. In 2002, approximately 30,300 new cases will be diagnosed. Experts estimate that 29,700 people will die from this disease in the same time period. Finding better ways to detect, diagnose, and treat pancreatic cancer is absolutely critical. Researchers are pursuing a number of avenues in search of answers about pancreatic cancer:
NCI's Pancreatic Cancer Progress Review Group emphasized in its 2001 report that insufficient research funding and the limited number of researchers dedicated to studying the disease have hampered progress against this silent killer. NCI is taking specific steps to help increase volume of research on this highly fatal disease and to encourage researchers to commit to improving care for patients and those at risk for pancreatic cancer. Targeting a Tumor on the Rise - Kidney CancerThe incidence of kidney cancer has been increasing about two percent per year for the past several decades. For African Americans, it is rising more rapidly than any other cancer - about four percent per year. Kidney cancer, including tumors of the main part of the kidney and the lower renal pelvis, is now diagnosed in nearly 32,000 people each year in the United States. About 200,000 people are living with kidney cancer. Mortality from the disease is also high and rising, with an estimated 11,600 deaths expected in 2002. Median age at diagnosis is 65 for men and 68 for women. Four main types of kidney cancer have been identified. Clear cell renal tumors are the most common type, accounting for about 75 percent of cases. The reasons for the increase in incidence are not fully understood.
More than 40 percent of kidney cancers are not diagnosed until advanced stages. Five-year survival of patients who present with advanced kidney cancer is nine percent. By contrast, approximately 90 percent of patients diagnosed with Stage I disease survive at least five years. Scientists are actively exploring the growing field of proteomics to identify growth factors and other circulating proteins that may be indicators of disease and that can serve as biomarkers for early detection. Currently, for localized kidney cancer, surgery is the only effective treatment. Minimally invasive and kidney-sparing surgical techniques are becoming more widely used. For metastatic kidney cancer, Interleukin-2 (IL-2) is the only approved treatment. Though highly toxic, IL-2 cures about 10 percent of patients. Scientists are investigating several important molecular pathways as potential targets for less toxic treatments. For example, anti-angiogenesis agents may prove beneficial against clear cell renal tumors, which are known to secrete several proteins that spur the blood vessel development required for the cancer to continue to grow. In a recent NCI-funded Phase II clinical trial, high doses of the antibody bevacizumab, that neutralizes one such protein, vascular endothelial growth factor (VEGF), slowed tumor growth considerably in patients with metastatic kidney cancer. More than 20 other trials are now underway to evaluate this antibody as a treatment for various types of cancer. Phase III trials in breast and colorectal cancer are underway, as are Phase II trials for prostate, breast, colorectal, cervical, ovarian, pancreatic, and lung cancers, as well as for mesothelioma and several types of leukemia. In 2001, NCI convened a Kidney and Bladder Cancer Progress Review Group to assess our understanding and treatment of these diseases and identify research priorities and supporting infrastructure needs to accelerate progress over the next 5 to 10 years. An NCI implementation planning group has been convened to analyze the recommendations contained in the 2002 PRG report and begin the process of determining how the recommendations can be implemented. |