NCI Director Reviews Advances and Future Plans for NCI

BETHESDA, Md--In an effort to increase participation in clinical trials, the National Cancer Institute is developing a marketing campaign aimed at selling patients on the importance of taking part in experimental treatments. "This effort represents a new and an important activity by NCI," director Richard D. Klausner told the National Cancer Advisory Board (NCAB). "The marketing initiative is aimed at developing approaches to getting the word out about the value and the opportunities of clinical trials," he said.

A meeting between NCI officials and marketing executives from some major national corporations will focus "on how to bring the concept of clinical trials to the public’s attention in the same way that companies market nationally known products," Dr. Klausner said. "Let me emphasize that this will not be done in isolation of other NCI clinical trial initiatives or those of other national oncology groups," he added.

Dr. Klausner announced the NCI’s effort to develop the marketing strategy during a wide-ranging and unusually lengthy "Director’s Report" to the advisory board. His presentation included discussions of the NCI’s extensive and long-running reorganization, the institute’s therapeutic priorities (see box ), creation of new chemistry-biology centers, the success of revised cancer center guidelines, and steps to include consumer advocates on peer review panels.

NCI Does Not Play Favorites

Obviously irked by a recent New York Times article, NCI director Richard Klausner, MD, addressed the issue of NCI priorities. The article suggested that two antiangio-genesis drugs--angiostatin and endostatin--could cure cancer in 2 years and quoted Dr. Klausner as saying the NCI was giving the drugs its top priority, a statement he denied ever making.

"Let me make it clear, as I thought I had in all my interviews, that in the area of therapeutics, the NCI’s top priority is never to choose one drug, two drugs, four drugs," he told the NCAB.

"We do not, as an institute, have a favorite gene; we do not have a favorite molecule," he continued. "Our top priority is to capture the new approaches of science and facilitate the rapid translation of that new science to testing, and among the promising and exciting areas on the horizon is the area of angiogenesis."

Upon assuming the directorship nearly 3 years ago, Dr. Klausner began a major restructuring of NCI, guided in part by two detailed reports critical of its organization and operations. Now that effort is essentially over.

"By and large, the major structural changes for this institute--I hope, we all hope--have been completed," he said. "The new administrative structure that underlies the management of the Institute has been put in place. It’s an administrative structure that is less hierarchical and more integrated across administrative functions."

Perhaps the most profound change was the separation of the intramural and extramural research programs. The NCI now has seven operating divisions: three for intramural programs and four for extramural operations. Six of the divisions are headed by new recruits to the NCI and four are headed by women or minority scientists "in contrast to the long previous history of the Institute," Dr. Klausner said.

Division directors of both programs meet separately every 2 weeks to discuss ways to coordinate activities. "There is clearly a new spirit and, importantly, a new set of mechanisms for transdivisional collaborations," the NCI director said.

Chemistry-Biology Centers

The NCI has created a new program of chemistry-biology centers in an effort to exploit what Dr. Klausner called "a very interesting and in some ways quite extraordinary development in chemistry, the area of genetic chemistry or Darwinian chemistry."

The centers will bring together biologists, chemists, and specialists in developing technology in an effort to devise molecules that can target very specific points in the extremely complex set of chemical interactions that transform cells and to help develop these into chemopre-ventive and chemotherapeutic agents. "One of the goals of the chemistry-biology centers is to capture some relatively new, but at this point not well-developed, concepts in chemistry that are based on the principles of evolutionary biology," Dr. Klausner commented.

Chemists have used these concepts over the last several years to develop large collections of new molecules. "Now with new ways of generating in a very short period of time in the laboratory probably more molecules than have been developed through biological evolution, the question is: how would one go about relating that to our developing knowledge about very specific targets," Dr. Klausner said. "So the goal of these centers is to develop these technologies in academic settings and to link the development of these chemical technologies directly to the biology."

Four Chemistry-Biology Centers

The NCI has now funded four such centers: at Harvard University and the University of Pittsburgh, and at the Scripps Research Institute and the Torrey Pines Institute for Molecular Studies, both in San Diego. Dr. Klausner said that the NCI is now seeking applications to establish additional chemistry-biology centers.

New guidelines are providing more flexible peer review to cancer centers and have resulted in an increase in the number of centers now designated as comprehensive cancer centers, Dr. Klausner said. "The new guidelines have incorporated the evaluation of comprehensiveness as an integral part of the scientific evaluation of cancer centers," he said. "The number of comprehensive cancer centers has risen from 26 to 33 of the 59 US cancer centers."

He said that the NCI had hoped the new guidelines would attract new institutions and new models of centers to the comprehensive center program. Ten new applications have been received, and two new centers will get funds by Sept. 30, the end of the current fiscal year. These are the University of South Florida’s H. Lee Moffitt Cancer Center, Tampa, and the University of Minnesota Cancer Center, Minneapolis.

The NCI is committed to having consumers involved in all of its peer review processes, including applications for funding scientific research, Dr. Klausner said. The recently formed Director’s Consumer Liaison Group, a panel of 15 consumer advocates, is currently developing initial criteria for selecting consumer advocates for peer review duties.

The consumer group is also working with Marvin R. Kalt, PhD, director of the Division of Extramural Activities, to develop a process for training consumer advocates selected as peer reviewers.