Proton radiation therapy is used to treat melanoma cancer oft he choroidea, the middle layer of the vertebrate eye, between the retina and sclera. |
Radiation oncologists provide care for increasing numbers of cancer patients at some point during the course of their disease. Radiation is used both alone and in combination with other modes of therapy. Examples of its use include the following:
- Radiation oncology is at the forefront of image-guided therapy. Beam-shaping techniques such as 3D-conformal therapy and intensity-modulated radiation therapy (IMRT) allow health care providers to administer higher doses of radiation to the tumor while exposing normal tissue to reduced amounts.
- Technological advances in brachytherapy permit radiation sources to be placed within certain tumors.
- Proton particle beam therapy allows more precise administration of radiation to cancerous tissue.
- Radioimmunotherapy involves the use of radioactive molecules attached to monoclonal antibodies to attack cancer cells throughout the body.
- Combination radiation and chemotherapy permits organ-sparing curative treatment and has increased patient survival rates for a number of diseases, compared to using either type of therapy alone.
- New molecularly targeted anti-cancer drugs are often more effective when administered in combination with radiation therapy. Basic and clinical researchers are studying cancer-related molecular pathways to design improved chemo-radiation approaches.
NCI places a high priority on cross-cutting research into new radiation technologies. NCI's intramural researchers collaborate with universities and industry, linking studies in molecular imaging, molecular biology, and molecularly targeted therapy. This multidisciplinary research is helping oncologists to understand molecular processes affected by radiation, improve tumor control, and lessen injury of normal tissue. Research in normal tissue radiation toxicity will also help the Nation to prevent and/or treat possible injury from radiological or nuclear terrorism.
Beyond intervention development, NCI has been a leader in radiation oncology quality assurance, pioneering the Patterns of Care studies over three decades ago to investigate adoption of recommended treatments for the most common cancers (See NCI's Patterns of Care/Quality of Care (POC/QOC) program).
NCI is now implementing shared quality assurance programs that will improve the technological sophistication of radiation oncology worldwide and create data-sharing abilities via telemedicine. This improvement in technological resources is the backbone of the new cancer disparities research partnership program, designed to enable research at institutions that primarily serve low-income, underserved, and ethnic and minority populations. (See Bridging the Gap between Discovery and Delivery to Address Disparities) NCI's radiation oncology research embraces the goal of ensuring that highly effective cancer interventions are accessible to all who need them.
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 "I was invited to be the patient representative on an NCI peer review panel for a proposed clinical trial. The other members of the panel were well respected scientists who focused with diligence and purpose on the scientific merit of the clinical trial. I, by raising issues related only to the patients, sharpened that focus. As one scientist said, 'You remind us why we are here.'" - Cancer Advocate |
Cancer advocates may be cancer survivors, family members or life partners, or people integrally involved in cancer-related activities, such as support group leaders or hotline workers. They come from diverse age groups, races, ethnicities, educational levels, and geographic locations.
Cancer advocates are intimately familiar with the hopes, struggles, joys, losses, and successes of cancer patients, those at risk for cancer, and their loved ones. Their advocacy helps present the human face of cancer to scientists, administrators, and the general public, reminding us of the "why" in cancer research.
NCI draws upon the expertise of cancer advocates through two major vehicles:
NCI is highly dependent on cancer advocates and the perspectives they bring to all aspects of the cancer research planning process, and cancer advocates are impacting NCI's research efforts. For example, recent advocacy efforts have contributed to:
- Increased research focus on quality of cancer care, quality of life for cancer patients and survivors, and cancer health disparities.
- A more streamlined clinical trials process designed to move promising agents to the market earlier.
- An improved informed consent process for clinical trials that helps patients better understand the potential risks and benefits of participation.
- More consistent use of plain language in NCI consumer publications and Web sites.
- Better public understanding of the importance of, and NCI's role in, cancer research.
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Researchers face distinct obstacles to the development of new treatments for cancer in children. For example:
- Even cancers that are common in children are rare compared to most adult malignancies. Accumulating enough cases to test a new treatment requires collaboration among multiple research organizations.
- Drug development costs for agents that specifically target pediatric tumors can be prohibitive for the pharmaceutical industry given the relative rarity of childhood cancers.
- Twenty-first century anti-neoplastic drug development often focuses on agents that target specific molecular pathways in adult cancer cells. These same molecular pathways may also promote the growth and survival of childhood cancers. However, the drugs targeting these pathways need to be tested in the laboratory against pediatric cancer models to identify those drugs that might be effective for treating childhood cancers.
NCI is addressing these obstacles through a research strategy focused on the development of new treatments for pediatric cancers — treatments that are not a by-product of drug development for adults. The new strategy spans the spectrum from preclinical drug discovery through Phase III studies aimed at obtaining FDA approval. For example:
- The newly established Pediatric Preclinical Testing Program aims to annually screen 10 to 15 new agents, or combinations of agents, against a panel of preclinical models for common pediatric tumors (e.g., mouse models). In this way, researchers can rapidly identify agents with activity against pediatric tumors. These preclinical models will also allow researchers to screen cancer drugs developed for adults for their potential applicability to pediatric tumors.
- NCI's Pediatric Oncology Preclinical Protein-Tissue Array Project (POPP-TAP) and the Children's Oncology Group Phase I Consortium are characterizing the molecular features (RNA and protein expression) of pediatric tumors in children and in corresponding preclinical models. This information will help preclinical researchers to select the model that most resembles the childhood cancer under study. Molecular characterization of preclinical tumor models will also point to critical signaling pathways that can be targeted by specific anti-cancer agents.
- NCI-funded Cooperative Groups have successfully brought together pediatric oncologists worldwide to enroll children with cancer into clinical trials. This international cooperation allows oncologists to learn from each case and to accomplish the kind of high quality clinical research that most effectively assesses the safety and efficacy of experimental treatments.
NCI is committed to surmounting current obstacles through focused discovery initiatives that ensure children are not left behind - that they survive cancer through tailored, safe, and effective treatment.
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NCI is increasingly looking beyond its institutional boundaries to engage in diverse partnerships with public, private, and academic sectors. NCI's partnership goals aim to:
Medical researchers examine a sequence gel x-ray to determine the pattern of DNA. |
- Eliminate bottlenecks and foster an "enabling culture" to accelerate progress against cancer.
- Leverage funding to take advantage of expertise outside of the Institute.
- Build synergy and create a feeling within the cancer community that we are all in this fight together.
A few of these partnerships are described here to illustrate the depth and breadth of our partnership portfolio.
Among intra- and extramural investigators . . .
At the heart of the Leukemia/Lymphoma Molecular Profiling Project (LLMPP) is a consortium of NCI intramural and extramural investigators who have pooled resources and talent to create a framework for the molecular classification of lymphomas. In one project, the group used the tissue collections of member institutions to define subtypes of diffuse large B-cell lymphoma that are associated with differing clinical responses to treatment. The large number of samples, substantially more than any single institution could have acquired, has allowed the researchers to draw reliable conclusions about how best to diagnose and treat patients based on the molecular subtype of their disease.
With other Federal agencies . . .
Through an interagency agreement, NCI and the Food and Drug Administration (FDA) recently collaborated to share knowledge and resources to facilitate the development of new cancer drugs and speed their delivery to patients. A task force, with chairs from both NCI and FDA and other senior staff from both agencies, will oversee implementation of this agreement. Insert link to NCI/FDA Partnership feature.
With pharmaceutical companies . . .
In 1999, NCI and the pharmaceutical company Genentech entered into a cooperative research and development agreement (CRADA). Under this CRADA, NCI and Genentech conducted a clinical trial to test treatment of renal cell carcinoma (RCC) patients with the monoclonal antibody Avastin™ (bevacizumab). Avastin targets a protein involved in the angiogenesis (development and maintenance of new blood vessels) that is required for renal cell tumor growth. Cancer progression was slower in patients treated with Avastin in addition to standard interferon therapy than in patients given interferon and a placebo. These preliminary findings provide the basis for a larger, statistically more powerful trial to determine whether Avastin treatment can improve survival in RCC patients. Avastin also looks promising for treatment of breast and colorectal cancers. (See, Building Public-Private Partnerships for Clinical Trials Research.)
A partnership with Millenium Pharmaceuticals yielded Velcade™, a drug that inhibits a class of proteins known as proteasomes, which are implicated in cancer development. The NCI/Millenium partnership is allowing Velcade to rapidly move through the drug development pipeline, expediting its availability to patients. In 2003, FDA approved Velcade for treatment of multiple myeloma patients who have received at least two prior therapies. NCI-sponsored clinical investigators are now evaluating Velcade therapy for newly diagnosed multiple myeloma patients.
With bioinformatics companies . . .
NCI, FDA, and Correlogic Systems Inc., a bioinformatics company, are engaged in scientific collaboration in clinical proteomics (the study of protein structure and function). The partners are developing an approach for early detection of ovarian and prostate cancers based on protein profiling, a complex analysis of proteins present in individual blood samples. A clinical trial using protein profiling to monitor ovarian cancer recurrence is underway. This technology also shows promise for diagnosing cancer, monitoring toxicity, determining the efficacy of therapy, and conducting follow-up surveillance.
Beyond traditional partnerships . . .
NCI, with Cancer Care, the Intercultural Cancer Council, Living Beyond Breast Cancer, and the Lance Armstrong Foundation partnered to produce the teleconference series "Cancer Survivorship: Living with, through, and beyond Cancer." Over 1,000 people participated in each of three sessions in spring 2003. The interest in this series underscores the importance of collaborations for the diffusion and dissemination of evidence-based information to the public.
A new initiative, called the Academic Public Private Partnership Program (AP4), is supporting the discovery of new cancer agents and their rapid translation to human clinical trials. Through this program, NCI fosters collaborations among universities, pharmaceutical companies, biotech companies, and nonprofit organizations. A new funding mechanism to support such broad-based collaboration was called for by several NCI Progress Review Groups. The AP4 initiative represents a new paradigm in drug discovery, development, and delivery for NCI.
NCI has partnered with the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the American Cancer Society to provide evidence-based tools to help communities better understand and address their cancer burden. The Web-based tools are available through a Web portal called Cancer Control PLANET (Plan Link Act Network) located at cancercontrolplanet.cancer.gov. The Agency for Healthcare Research and Quality will be adding links to more cancer prevention Web sites. States and communities can use these tools to plan, implement, and evaluate evidence-based comprehensive cancer control programs.
Other partnerships highlighted in this document: 
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