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The Front Line
The Front Line: Charles D. Blanke, MD, SWOG Chair

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The NCTN: Mission Control for Biden's Moonshot

Jan 29, 2016 - Vice President Joe Biden has launched his "cancer moonshot" -- a federal initiative aimed at making big, fast breakthroughs in cancer research. While you have likely read 73 or so commentaries on the subject, I'd like to approach the news from the publicly funded research perspective. Whereas lots of organizations think they should go along for the moonshot ride, SWOG, and our partners in the National Cancer Institute's National Clinical Trials Network, should be NASA.

Why? The NCTN is the nation's largest cancer research network. No other organization has the skills and experience, the data and tools, and the coast-to-coast access to patients that we have. We're uniquely positioned to be agents of change -- the group that can pose, and answer, the bold questions about cancer prevention and treatment that Vice President Biden will pursue.

SWOG, for example, has enrolled more than 200,000 patients onto more than 1,000 trials since our founding in 1956, work that has led to the approval of at least 12 major cancer drugs. We run our trials in over 950 sites, including 32 leading academic cancer centers and hundreds of community hospitals from California to Connecticut. Our biospecimen bank holds over 600,000 samples -- a research treasure trove. Our database holds 60 years of potentially valuable information.

That's just SWOG. The NCTN -- which also includes ECOG-ACRIN, The Alliance for Clinical Trials in Oncology, NRG Oncology Group, and the Children's Oncology Group -- together with the Canadian Cancer Trials Group boasts thousands of researchers working on hundreds of trials annually. When it comes to precision medicine, this size matters.

You all know that many genetic subsets of even common tumors include only a relatively small number of patients. In testing targeted therapies, genetic screening will yield a hit rate of only a few percent. So huge numbers of patients must be screened, and many will be turned away as ineligible. The NCTN is uniquely structured to do the screening, and offer the "bucket" studies that allow a larger percentage of patients to participate under the umbrella of a single "master" study. As you know, the NCTN already has three large-scale precision medicine trials underway. Similarly, the NCTN has decades of data already available to be mined.

Dr. Jeff Abrams, associate director for the Cancer Therapy Evaluation Program at the NCI and a major partner in SWOG's Lung-MAP precision medicine trial, notes that the NCTN has a pretty stellar track record. The network has led, or had a hand in, the development of many major cancer drugs approved in the last 50 years, including tamoxifen. NCTN trials also helped put an end to the radical mastectomy, launch the new wave of immunotherapy, and boost childhood cancer cure rates from 10 percent since the network's start in the 1950s to over 80 percent today.

We can't get to the moon without help, of course. The NCTN needs more money to run trials and more freedom to take risks. Network members need a way to better link up and make our collected data accessible.

Most importantly, we need astronauts. Fewer than 5 percent of all adults with cancer enroll in a clinical trial -- a number that hasn't improved in years. We must improve accrual, as well as develop new drugs and using existing datasets to improve treatment. We applaud the Obama administration's courage to tackle cancer. Now is the time for us to make the next giant leap together.


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