Wednesday, November 12, 2008

1st Lesson learned at NCI Translates

No, I still don't know anything regarding Sydney's results. The waiting is torturous. So, in complete defiance of my worry I am going to talk about my trip to Washington, D.C. and the NCI Translates meeting.

Now, the first thing that everyone should know about the NCI Translates meeting is its purpose. While I am sure there is a much more technical and well worded definition somewhere it comes down to this: the purpose of the meeting was to speed up cancer research. To me this is very interesting. Think about it. This is a government agency and they are working very hard to increase efficiency. Who would have thought? I did not think that was possible. This says something very important about our leaders within the NCI. They are clearly committed to hastening a cure. I found this very impressive. I have always envisioned them as being just another slow moving cog in the wheel of research bureaucracy but I must be the first to admit that my perception is changing.

I walked away from this meeting with 3 key messages. Today, I will do my best to address the first. I am quite sure that these messages were not shared universally but they are, none the less, my opinions. At this meeting the NCI unveiled 6 new pathways. One of the primary goals was to get the researchers to start thinking in terms of these pathways. What are pathways? Well, think of a pathway as a road map. They include specific directions on how to take a lab result or idea all the way to a specific cancer treatment or intervention. The pathway describes each step in the process and every key decision that needs to be made. The end result of following these "directions" is either a new cancer discovery that can be applied to a patient or a productive failure. Either way the research impacts the the patient. Either they have a new treatment or preventative measure or we have proven that the new discovery does not work and should be abandoned.

Now, from a patient perspective this may seem nonsensical. Well, of course, this is the way they should be thinking. Sadly, in reality it is not. The bulk of research is done with no end goal in mind. Research is done as a discreet project. It is chosen and pursued because it was what was funded. Finally, it is done regardless of how the science ultimately effects the patient. Read that again - most research is done without regard of what impact it will have on the cancer or the patient. The NCI has stepped in and said we no longer want to fund discreet projects. If you want us to fund your research you have to show us where it fits within these pathways and how you plan to impact patients. For many researchers this is a completely different way of thinking about cancer research.

In fact, this was our job at the NCI. We were their to get researchers thinking about the patients. We asked questions to get them thinking about how their research will get to patients. What are the challenges? What are the steps? What resources do they need to get to the next step. How is their discovery going to make a difference in a cancer patients life.

Ironically much of the research presented had already reached the end of the pathway. A perfect example is the work of the NANT. This is why their work is held in such high regard. They are very good at translating basic research into clinical therapies. Overall, I found that pediatric researchers were much more adept at this process. I think this is largely due to their lack of patients and resources. They have no choice. But, then again, this could just be my bias showing.

Will these new pathways speed up our search for a cure? Well, yes and no. If the pathways are actually referred to and implemented I think it is very likely that research could speed up. Bottom-line, more people will be aware of the steps necessary to get their discoveries into the clinic. This is likely to get them addressing road blocks more quickly. For example, if they now know that they will face intellectual property issues or IRB issues in a future step they can start preparing for them early. If they believe their research will only get funded if their is an efficient plan to get the discovery into the clinic, then they will make sure is has one. These simple steps can literally shave months, years, and decades off of some projects. The pathways also encourage (rely on) collaboration which I think could be extremely helpful in speeding the process. If we are going to move more quickly we have to break down the walls. We have to get the researchers talking and collaborating. We have to tear down the research silos.

There are still problems though. While it is great that we now have the recipe for success. We are still lacking some critical ingredients. For example, while the NCI can demand that the research they fund fits within these pathways and is translational in nature they don't have any authority to do so. It turns out that the NIH actually sets the standards and guidelines for what research is funded and how it is evaluated. Until the guidelines change, there is little meat behind this idea. There is no carrot on the stick. Right now, research is not funded on whether it can translate into the clinic. It is funded on the merit of the research as it sits alone. Until researchers are funded (and only funded) by how their research fits into the translational picture I fear they will continue to work the same way.

The good news is that there are grants that are starting to appear and the carrots are significant. The NCI has created a mechanism to help move truly translational research forward. Although there are just a few awards to date I truly believe that it is the wave of the future. If you want to get funded by the NCI you are going to have to show how your research will translate into the clinic. In this sense, they are hastening a significant change.

I was honestly, and pleasantly, surprised at how much purpose the NCI has.

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