The National Cancer Institute (NCI) and its director Norman Sharpless, MD, recently released their annual plan and budget proposal for fiscal year 2020, in which the agency presents the optimum funding needed to make the most rapid progress against cancer.
In the proposed budget, the NCI calls for a 2020 budget of $6.52 billion – a $380-million increase from its 2019 budget of $6.14 billion. This number includes $195 million in funding for the Cancer Moonshot program.
With this plan, which is used in congressional budget requests, the NCI hopes to direct attention to four key areas with the unique potential to improve the prevention, detection, and treatment of cancers: basic science, workforce development, big data, and clinical trials.
These focus areas align closely with the priorities the American Society of Hematology (ASH) set forth in its ASH Agenda for Hematology Research and has pursued through other societywide initiatives. According to Alan Rosmarin, MD, chair of ASH’s Committee on Government Affairs, that’s not a coincidence.
“We have engaged the NCI and the National Institutes of Health more broadly and are in ongoing conversations with these agencies,” he explained, referencing ASH’s advocacy efforts. “We’re thrilled to have, for the first time, a hematologist at the helm of the NCI and we look forward to interacting with him further.”
“This plan is promising,” agreed Ulyana Desiderio, ASH’s Chief Scientific Officer, “and ASH looks forward to working with the NCI to ensure that hematology is well-represented in these efforts.”
“We were very encouraged to see that the ideas that we have been talking about are quite congruent with where the NCI believes the field needs to go and where investments should go,” added Ross Levine, MD, vice chair of ASH’s Committee on Scientific Affairs, which oversees the Society’s scientific agenda.
Major components of the NCI’s Annual Plan are summarized below.
Develop the Workforce of Cancer Investigators
In its vision for 2020, the NCI vowed continued support for early-career investigators, preparing individuals for careers in cancer research through training, career development, and mentored research opportunities on its campuses.
“Career development is a major thrust of what ASH is doing, too,” Dr. Rosmarin said. The ASH Trainee Council was established to provide early-career hematologists a forum to discuss issues relevant to fellowship training. This group also develops and implements programs of interests to trainees and is a major engine for new member recruitment. “We strongly believe that we have a role in cultivating and sustaining the success of young hematologists in these domains of science.”
Innovate Clinical Trials
One of the NCI’s stated goals is to “fully realize the power of clinical trials through innovative design, administration, and analyses.” That includes continuing work on the NCI Molecular Analysis for Therapy Choice (NCI-MATCH) and NCI-COG Pediatric MATCH trials, which assign patients to treatment based on genomic sequencing results.
“NCI is calling out an idea that we all agree with: Doing large trials to look for small effects in unselected populations is not in patients’ best interest or in science’s best interest,” Dr. Levine said. “We need to figure out how to look at more enriched populations who we think will benefit from a therapy, so we can look at smaller populations and ask the right questions.”
“Obviously, we’re gratified to see this as a priority for the NCI, and they’re not satisfied to just do it because that’s the way it always was done,” Dr. Levine added.
Fund Basic Science
The NCI’s Annual Plan stresses the importance of committing to basic science and increasing funding opportunities for investigators, citing the development of targeted therapies as examples of the high “return on investment.”
“Progress against cancer requires long-term investments in basic research, which lay the foundations for tomorrow’s clinical advances,” the agency wrote.
ASH also is supporting high-risk, high-reward research projects through its awards programs. For example, since its inception in 2012, ASH’s Bridge Grant program has been supporting ASH members whose R01 (or equivalent) grant proposals could not be funded by the NIH, despite earning high scores. The Society’s Abstract Achievement Awards, Physician-Scientist Career Development Awards, and others offer short- and long-term opportunities for researchers at various stages of their careers.
“We are now seeing the fruit of that basic science, with new developments like precision medicine, gene-editing and gene therapy, and epigenetics and epigenomics,” Dr. Rosmarin noted. “These are the direct outflow from years of fundamental basic science.”
Harness the Power of Big Data
Embracing the potential of big data will be an important step in bringing tailored treatments to patients, according to the NCI, which is looking at new methods for sharing, aggregating, and analyzing this information in a secure manner. For example, the Cancer Research Data Commons provides cloud-based, secure access to data from across scientific domains.
“Big data isn’t about one study or registry; it’s about using the large amount of information that we generate every day, at a rate and capacity we’ve never before seen,” Dr. Levine said. “The NCI, to its credit, is thinking broadly about how advanced analytic tools can help everything we do from basic science to patient care. As hematologists, we have to ensure that the hematology community is engaged with the people who are developing these tools.”
In 2017, ASH announced plans to develop a research-focused registry that will harness the power of big data to conquer blood diseases worldwide. ASH has since established a separate nonprofit entity, the ASH Research Collaborative (ARC), to focus efforts on developing partnerships to advance the field of hematology. With the core data collection infrastructure (formerly known as the ASH Research Registry) now in place, the ARC is soliciting initial data contributors for the first two diseases, multiple myeloma and sickle cell disease.
The NCI should be commended for recognizing the needs of hematologists and cancer researchers, Dr. Rosmarin noted, adding that these efforts came to its attention through advocacy efforts from ASH and other organizations. “Advocating for science should be the work of every hematologist – whether you’re a clinician, a scientist, or a trainee,” he said, encouraging interested members to join the ASH Grassroots Network and speak up to legislators in their home districts about the importance of science. “This is something that belongs to everyone.”
Sources: National Cancer Institute, “Annual Plan & Budget Proposal for Fiscal Year 2020”; National Cancer Institute, “Director’s Message: A Time of Great Hope and Great Challenge.”