publication date: Sep. 9, 2016

Conversation with The Cancer Letter

Lowy: Implementation Will Depend on NCI Funding in Fiscal Year 2017 and 2018

NCI will urge increased and sustained appropriations for carrying out ten recommendations put forward by the Blue Ribbon Panel, the institute’s scientific advisory panel to the National Cancer Moonshot Initiative.

On Sept. 7, NCI Acting Director Douglas Lowy accepted the recommendations of the Blue Ribbon Panel, which presented its report to the National Cancer Advisory Board.

“To the extent that NCI would be involved in making a case to Congress, we would be talking about the scientific validity of what is being recommended as a really important way of augmenting what NCI is already doing,” Lowy said.

Lowy spoke with Matthew Ong, a reporter with The Cancer Letter.

Matthew Ong: The Blue Ribbon Panel’s report has been highly anticipated—from NCI’s standpoint, how has the cancer community responded to the panel’s recommendations?

Doug Lowy: It’s too early to know in detail what the cancer community’s response is. Certainly, the American Association for Cancer Research and the American Society of Clinical Oncology had very positive responses in what they put out. We have heard that many people in the cancer advocacy community had positive responses to the report, and the articles that have been written thus far have been largely positive.

I think it’s really important to recognize that this is a time when the cancer community has come together, perhaps as never before. Many busy people devoted a lot of time despite their busy jobs to develop the Blue Ribbon Panel recommendations.

NCI applauds and appreciates all of what they have done. The recommendations that they made really are, on the one hand, highly specific, and on the other, deal with the many important areas of research on cancer, that is basic to improve understanding of cancer, prevention, screening, and treatment, so that we can reduce the incidence of cancer and improve the outlook and quality of life for people who develop it.

MO: Which agencies will be working with NCI to achieve these multidisciplinary goals? Will NCI eventually create a working blueprint, or is the moonshot task force responsible for that?

DL: I think that it’s hard to make a clean separation, if you will, between what the NCI is doing and what the moonshot task force is doing, in part because we are active participants within the task force.

We have established collaborations with the Department of Defense, the Veterans Administration, and the Department of Energy. We also will be working closely with the Food and Drug Administration and interacting with the Centers for Medicare and Medicaid Services.

MO: Do you see opportunities for improving the report? Were there any areas that NCI or the NCAB felt were not appropriately represented in the recommendations?

DL: My view is that the report and its recommendations represent a compelling group of initiatives which would have an enormous impact on understanding of cancer and on patients for preventing cancer, detecting it earlier, and treating it more effectively.

The panel report and its recommendations are an important subset of what the panelists are arguing that NCI should implement and carry out in the near term.

It is not all of the important research NCI is already conducting and will continue, nor is it all of the important new meritorious research that the NCI will initiate in the future.

MO: Dr. Dinah Singer mentioned that changes in policy would be needed to achieve some of the goals that the panel has identified. Could you provide an example of a low-hanging fruit that will boost progress for a near-term scientific goal in the moonshot?

DL: One clear example is a recommendation to increase the uptake and dissemination of colorectal cancer screening, which is already standard of care. There are a number of policy recommendations along these lines.

In colorectal cancer screening, one of the issues is to make it, as much as possible, so that people being screened won’t have co-pays in association with the screening. This is really a policy issue that is beyond the research that NCI would conduct.

MO: What public-private partnerships do you envision coming out of the panel’s recommendations? How does NCI or the moonshot plan on incentivizing these collaborations?

DL: The public-private partnerships are still in development. One area, which Dr. James Doroshow [director of the NCI Division of Cancer Treatment and Diagnosis and deputy director for clinical and translational research] mentioned at the NCAB meeting, is the development of the virtual drug formulary, which is essentially a repository of multiple drugs from various pharmaceutical and biotech companies that would be approved in advance (at least in principle) to be used for combination treatment.

We look forward to this kind of public-private partnership having the potential to drastically shorten the turnaround time for initiating clinical trials.

In addition, we look forward to the possibility of working with pharmaceutical companies to increase data sharing with them. Project Data Sphere, of the pharmaceutical industry, is an area where we are discussing efforts to make public, not only the data that they have already made public, but to increase data sharing.

I also think that the area of private philanthropy is a very important one, which we have not yet explored in detail, but there should be multiple opportunities for mutual benefit of leveraging each other’s resources and investments to make faster progress.

MO: What is NCI’s plan for implementing the panel’s recommendations? What concrete decisions can NCI and its partners make to ensure more funding and political continuity for the moonshot?

DL: To the extent that NCI would be involved in making a case to Congress, we would be talking about the scientific validity of what the panel recommended as a really important way of augmenting what NCI is already doing.

The way in which the recommendations are implemented will depend on how much funding we receive for the implementation.

If there is no funding, clearly, we would only be able to start on a small part, with perhaps some pilot projects.

If there is substantial funding, then we could think about implementing the majority of the recommendations during FY17 and the others during FY18. We have not prioritized them yet. We have not had sufficiently detailed discussions for me to be able identify which recommendations would start soon, and which would start later.

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