CLC Urges Strong Support for Cancer Clinical Research
(June 20, 2007)
June 20, 2007
The undersigned organizations,
representing cancer survivors, physicians, and researchers, are writing
to urge Congress to protect and foster the nation’s cancer research
infrastructure. The current system for investigating new strategies for
the prevention, diagnosis, and treatment of cancer is under significant
pressure, and the challenges to the system will be felt most acutely by
the 10 million Americans living with cancer and the 1.5 million more who
will be diagnosed with cancer this year. For all of them, the hope of
surviving cancer and enjoying a high quality of life depends on research.
Funding for cancer
research has been static, which translates to a decline in real terms.
Of grave concern to cancer advocates is the impact of the budget on clinical
cancer research. We have already observed the elimination of clinical
trial enrollment opportunities, termination of research efforts directed
at those cancers with the most limited early detection and treatment options,
and an overall slowing of the pace of clinical investigation for all types
of cancer. This is not an acceptable trend.
Clinical Research Infrastructure
The federal government
has invested in cancer research for decades, a commitment that intensified
after we declared War on Cancer and reached its pinnacle during the period
from 1998 to 2003 when the entire National Institutes of Health (NIH)
budget was doubled. Strong financial support for the National Cancer Institute
(NCI) has yielded important benefits, including:
- Development of
a cancer clinical trial cooperative group program that supports clinical
trials to evaluate new cancer treatments, diagnostic tools, and preventive
- Support for 63
cancer centers located around the country that are specialized centers
for research on the nature of cancer and improved therapies for all
forms of cancer.
- Mechanisms to encourage
and facilitate the participation of community oncologists in clinical
trials, which ensures broad patient access to clinical trials and rapid
dissemination of new treatment opportunities.
- Support -- both
financial and scientific -- for a dynamic research community that has
provided a supportive environment for established researchers and new
- Funding through
special mechanisms -- including the Specialized Programs of Research
Excellence (SPOREs) -- for translation of basic research findings into
new therapeutic candidates.
The core of the cancer
research system is the ability to efficiently test therapies to determine
if they are safe and effective. Through the clinical trials system, we
have realized incremental but important advances in treatment that are
improving survival rates for many cancers and turning certain forms of
cancer into a manageable chronic disease.
Cancer Clinical Research Advances
Among the recent cancer
research accomplishments are:
ability to identify molecular markers that predict prognosis.
Research in the NCI cooperative groups has led to the identification
of tumor characteristics that may predict the prognosis of patients
with oligodendroglioma, a form of brain tumor, and research is yielding
comparable information about patients with other forms of cancer, as
of therapies that prevent cancer recurrence and improve survival.
Federal funds were critical to the completion of a trial that concluded
that trastuzumab (Herceptin) cuts breast cancer recurrence in half and
increases survival and a trial that concluded that bevacizumab (Avastin)
improves the survival of lung cancer and colorectal cancer patients.
In addition, a recent cooperative group study in advanced prostate cancer
patients found that radiation therapy after surgery resulted in a three-fold
improvement in cancer-free survival.
strategies for the prevention of invasive breast cancer.
The cancer cooperative groups played a critical role in identifying
the role of hormonal agents in reducing the risk of invasive breast
the genetic basis for familial clustering of pancreatic cancer.
This research was undertaken through two SPOREs and PACGENE, a consortium
of centers with pancreatic cancer experience. This consortium has also
identified major risk factors for pancreatic cancer, including smoking.
the quality of life of cancer survivors through research on side effects
of treatment and interventions to address late and long-term effects.
Report from a major study of adult survivors of childhood cancers identified
significant side effects from treatment and recommended enhanced, long-term
follow-up medical care for these survivors.
certain forms of cancer into chronic disease. Cooperative group
investigations concluded that maintenance use of Rituxan slows disease
progression in those with advanced follicular lymphoma.
None of these important
research advances would have been possible without the existence of the
current system of cancer clinical research supported by federal dollars
Research System at Risk
The cancer clinical
research enterprise is at grave risk because the federal cancer research
budget has been static in years since 2003 or has suffered minor cuts
in funding. But even a static budget is a reduced budget because it does
not account for the biomedical research inflation rate. Moreover, the
climate of uncertainty about funding has already had a negative impact
on clinical research.
In response to the
current fiscal situation, some clinical research groups have already terminated
trials that were slow to accrue patients; eliminated research efforts
targeted to certain cancers, including brain tumors, head and neck cancer,
sarcoma, and melanoma; curtailed certain tissue banking efforts; and delayed
initiation of many trials. Other elements of the clinical research effort
are also under stress. Cancer centers are being asked to do more with
less, and SPOREs remain under threat of streamlining or elimination. The
weakening of these clinical research entities will have the effect of
further slowing the pace of discovery of new treatments for cancer.
for the future is the fact that young cancer clinical investigators are
leaving the field and students are declining to consider careers as clinical
researchers. As the population ages and the burden of cancer intensifies,
this is a very disturbing trend.
Recommendations of Cancer Advocates
physicians, researchers, and caregivers recommend several actions to protect
cancer clinical research and the pace of cancer research.
NIH funding by 6.7 percent in FY 2008 and ensure that NCI receives an
increase comparable to the overall enhancement in funding. This
consensus recommendation from the biomedical research community will
do no more than allow NIH to make up ground lost to biomedical research
inflation since 2003 and match inflation in 2008. Comparable increases
will be necessary in FY 2009 and FY 2010 to prevent further erosion
due to inflation.
cancer clinical cooperative group funding. After successive
decreases in funding since 2002, cooperative group funding has been
stabilized at the FY 2006 level for FY 2007. For FY 2008 and beyond,
an increase in funding is needed to restore lost infrastructure; alleviate
the pressure to decrease accrual, delay or eliminate trials; keep pace
with the rising costs of clinical research; and expand the trial portfolio
to accommodate the ever growing number of new molecules and approaches
to treat cancer patients. This recommendation is in keeping with the
overall NIH funding proposal because it focuses on protecting the past
federal investment in cancer research and preventing further deterioration
in the pace of cancer clinical research.
funding to the Community Clinical Oncology Group (CCOP) Program.
The CCOPs are funded through an NCI grant mechanism separate from the
cooperative groups. The 61 CCOPs spread across the nation form the bulwark
of community-based cancer clinical trial treatment and prevention research
in urban and rural communities. The CCOPS have experienced annual budget
cuts from FY 2004 to FY 2007, with the cuts in 2007 ranging from 5 to
8 percent. The CCOPS, which serve rural communities and underserved
populations, must be provided funding in the future that is adequate
to permit them to assist this diverse cancer patient community.
other elements of the cancer research enterprise, including cancer centers
and SPOREs. Important translational research initiatives
will be interrupted or terminated if SPOREs are eliminated. Moreover,
the critical research mission of cancer centers, which are being asked
to shoulder increased research responsibilities, will be disrupted if
their funding remains stagnant.
For all of the above
reasons, the undersigned groups encourage Congress to restore funding
for these vital programs and make a commitment to ongoing support for
them in the future.
Cancer Leadership Council
American Cancer Society Cancer Action Network
American Psychosocial Oncology Society
American Society of Clinical Oncology
American Society for Therapeutic Radiology & Oncology
Bladder Cancer Advocacy Network
C3: Colorectal Cancer Coalition
Cancer Research and Prevention Foundation
The Children's Cause for Cancer Advocacy
Coalition of Cancer Cooperative Groups
International Myeloma Foundation
Kidney Cancer Association
Lance Armstrong Foundation
The Leukemia & Lymphoma Society
The Lung Cancer Alliance
Lymphoma Research Foundation
National Coalition for Cancer Survivorship
National Lung Cancer Partnership
National Patient Advocate Foundation
North American Brain Tumor Coalition
Ovarian Cancer National Alliance
Pancreatic Cancer Action Network
Sarcoma Foundation of America
Susan G. Komen for the Cure
Us TOO International Prostate Cancer Education and Support Network
The Wellness Community
Y-ME National Breast Cancer Organization
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