Infrastructure Needed for Cancer Research: NCI's Challenge

Centers, Networks, and Consortia

Goal

Create and sustain research infrastructures for collaboration, technology support and development, and access to resources.

The Challenge

NCI's efforts to translate scientific knowledge into more effective cancer interventions increasingly are challenged by the conventional ways in which research is conducted. With today's rapid pace of scientific and technological discovery, NCI must help researchers create integrated research environments that foster the multidisciplinary collaborations needed to address the "big picture" problems in cancer research.

We must functionally link basic, clinical, population, and behavioral scientists to each other and to newly developing, diverse fields of science and technology. Investigators must have easy access to many different patients and at-risk populations, tissue banks, new technologies, and state-of-the-art informatics. They must be able to work together with ease and flexibility in multi-institutional research settings as well as within the same institution.

NCI must continue to create and nurture an overarching structure for research composed of:

These centers, networks, and consortia are enhancing the traditional research enterprise in ways that promote and facilitate complex scientific interactions, provide the critical resources essential for the research, and encourage the easy exchange of information and ideas through new communication linkages.

While these interactive structures are critical to progress, this challenge also requires that NCI find ways to integrate these centers and networks with each other when broader interactions will allow investigators to seek answers to major questions more efficiently and effectively.

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NCI-Designated Cancer Centers

NCI-designated Cancer Centers organize and integrate multidisciplinary research across departments and schools within a single institution. They:

• Provide scientists access to the most advanced technologies and new research opportunities
• Bring the benefits of their research directly to the public in the form of patient care
• Link state-of-the art research and clinical care activities within the institution
• Form key partnerships with industrial, community, and state health organizations outside the institution

For example:

• The disease-specific Specialized Programs of Research Excellence, designed to move discoveries between the laboratory and patient and population research settings, had their origins in Cancer Centers.



• The new Special Populations Networks for Cancer Awareness Research and Training are designed to link local, community, and regional problems of cancer in underserved populations to the broad-based research capabilities of NCI-designated Cancer Centers.



• Centers are critical in a new NCI initiative to incorporate Minority-Serving Institutions (MSIs) into NCI's cancer research, education, training, and outreach activities.



• The Cancer Genetics Network sites are headquartered in Centers.



• Nearly all the participants in the Mouse Models of Human Cancers Consortium are in NCI-designated Cancer Centers.



• Centers have worked closely with industry in developing new cancer therapeutic agents and are rapidly becoming significant partners with industry for new technology development.



• Approximately 70 percent of cancer clinical trials are conducted in Cancer Centers.

NCI is planning to establish Regional Enhancement Cancer Centers to facilitate partnerships between smaller institutions and the large, existing NCI-designated Comprehensive Cancer Centers. These partnerships will provide patients and populations with much improved access to the newest trials in early detection, prevention, and therapeutic research. NCI anticipates that the centers also will play a key role in integrating and coordinating NCI-supported centers of excellence and networks into one overarching, unified research framework.

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Centers of Research Excellence

Centers of Research Excellence bring together interdisciplinary and translational research teams focused on a specific disease, modality, biologic process, or scientific area. They are awarded sizeable amounts of flexible funding to enable them to rapidly address emerging scientific opportunities.

The first of these centers, the Specialized Programs of Research Excellence (SPOREs), were created in 1992 and focus on specific cancers. They serve as highly effective hubs for translational research, moving discoveries back and forth among laboratory, clinic, and population research settings. To date, SPOREs have been established in breast, lung, gastrointestinal, ovarian, prostate, genitourinary, and skin cancer.

The SPORE blueprint has been used to establish similar programs in other cancer research areas, including:

• 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

Like the SPOREs, all of these centers support interactive, multidisciplinary research and provide research resources and flexible exploratory funds, as well as research training and career development opportunities.

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Networks and Consortia

Networks and consortia link the expertise and innovation of scientists from different disciplines and diverse research backgrounds to address important questions and issues about cancer.

For example:

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Progress Toward Meeting the Challenge

Cancer Centers

Through its Cancer Centers Program, NCI has established the foundation for an overarching research framework that will bring diverse scientific disciplines together across institutional boundaries. NCI-designated Cancer Centers continue to evolve as key strategic partners of NCI.

• In 2001, NCI added a Center in Missouri and will fund a new planning grant for developing a Center in South Carolina. M
• The number of Cancer Centers with the "Comprehensive" designation increased in 2001 to 38.
• NCI has been working with institutions in more than ten other states to develop Cancer Centers.

NCI launched the Minority Institution/Cancer Center Partnership (MICCP) Program in Fiscal Year 2001 by funding 2 comprehensive partnerships, 2 planning grants for comprehensive partnerships, and 12 planning grants dedicated to more focused collaborative projects and programs, ranging from research to training.

This program reaches out to the 5 major minority institutions with medical schools, as well as to more than 300 smaller institutions dedicated to educating African Americans, Hispanics, Native Americans, and other groups underrepresented in biomedical research.

Research-intensive NCI Cancer Centers, together with culturally sensitive MSIs, offer an entirely new set of opportunities for:

• Training more minority scientists
• Expanding the cancer research capability of MSIs
• Focusing more research and community outreach programs of Cancer Centers on understanding and addressing minority health disparities.

In the next year, the MICCP will seek ways to integrate its efforts with NCI's Special Populations Networks for Cancer Awareness Research and Training and the Minority Biomedical Support Grant Program, sponsored by the National Institute of General Medical Sciences at the NIH.

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Centers of Research Excellence

As NCI's Specialized Programs of Research Excellence (SPOREs) have become more established, SPORE investigators have begun to make significant contributions to translational research. Similarly, the multidisciplinary collaborations fostered by other centers of research excellence are starting to yield some impressive results.

The SPORE program is poised to establish research centers for a number of new cancer sites every year for the next two years until there are centers devoted to every major cancer site.

Research Results Show Value of SPOREs

Some recent advances reported by SPORE researchers include:

• The discovery in one of the lung SPOREs that smokers who carry certain gene types are less likely to successfully quit smoking than others. This finding helps explain why some smokers find it much more difficult to quit than others, and raises the possibility that specially tailored smoking cessation programs may help smokers with these gene types to successfully quit.



• A better approach to detecting the early signs of lung cancer. Physicians usually rely on a thin, lighted tube known as a bronchoscope to examine the lungs of patients suspected to have lung cancer. Investigators at one of the lung SPOREs found that the use of fluorescent light in bronchoscopy dramatically improved physicians' ability to identify the early signs of cancer.



• Confirmation that family clusters of pancreatic cancer have a genetic basis. After tracking relatives of pancreatic cancer patients since 1994, researchers in one of the gastrointestinal SPOREs recently confirmed that those with two or more relatives with pancreatic cancer are at higher risk for the disease. This finding not only provides important information for these relatives and their physicians, but also supplies scientists with a vital first step toward identifying the responsible genes.



• Promising results in an initial clinical trial of a "treatment vaccine" that stimulates the immune system of pancreatic cancer patients into action against their tumors. Investigators have now expanded testing of this new treatment to a larger number of patients.



• Confirmation that variations in the "molecular profiles" of different types of breast cancer tumors can yield important clues about prospects for relapse and long-term patient survival. Other SPORE investigators studying breast cancer reported encouraging results from their studies of ductal lavage, a new approach to early breast cancer detection.

Expansion in the SPORE Program

Since their start in 1992, NCI's Specialized Programs of Research Excellence (SPOREs) have grown to include 27 centers of research excellence in breast, lung, gastrointestinal, ovarian, prostate, genitourinary, and skin cancer.

In the coming years, we plan to expand the SPORE program by continuing to build on the existing cancer sites under study and by establishing new centers of research excellence in brain, gynecologic, and head and neck cancers, as well as leukemia, lymphoma, and myeloma. The expansion is expected to proceed as follows:

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The Plan - Centers, Networks, and Consortia

While NCI's goal for collaborative research applies to all NCI-designated Cancer Centers, networks, and consortia, this plan focuses primarily on the objectives and resources for the Centers and SPOREs. Many other research networks are budgeted and discussed in the Extraordinary Opportunities and NCI Challenge sections throughout this document.

Goal
Create and sustain research infrastructures for collaboration, technology support and development, and access to resources that enable multiple scientific disciplines to address large problems in cancer that could not be solved by individual investigators.

Fiscal Year 2003 Objectives, Milestones, and Funding Increases Needed

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