One of the first things that happened as part of President Donald Trump’s “flooding of the zone” in January was the disappearance of the site visit as part of the Cancer Center Support Grant review.
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In last week’s cover story, Paul Goldberg, editor and publisher of The Cancer Letter, wrote about “the high level of consternation over the disappearance of the site visit from the CCSG review” and how cancer centers are adapting to the new, centralized review process.
In this episode of The Cancer Letter Podcast, Paul and Jacquelyn Cobb, associate editor of The Cancer Letter, talk about how the oncology community initially expressed a lot of concern about NIH taking over the Cancer Center Support Grant review.
“But at the AACI meeting, which was here in town [Washington, DC] Oct. 19 to 21st, there was some really interesting discussion of this and about what actually is happening.”
NIH convened a review group that is “pretty spectacular,” Paul said. “I mean, uber-experienced people, focused, who were able to do the reviews, and some actually are saying, ‘You’re going to like this more than you like the previous system,’ which runs counter to our expectations. Because we were catastrophizing, and with good reason. I mean, sometimes, you really have to catastrophize if you’re realistic.
But in this case, what seems to have happened is the cuts did not materialize, thanks to Republicans in Congress and Democrats, as well. It was bipartisan. Support for NIH is still there.”
Stories mentioned in this podcast include:
- Cancer centers adapt to life without site visits as NIH changes CCSG review
- Class action complaint alleging GRAIL insider fraud resubmitted after dismissal
- Friends publishes three white papers ahead of annual meeting Topics: Clinical trials on rare cancers, combination drug trials, multi-regional studies
- How GLP-1RA drugs are reshaping patient physiology and the future of oncology
This episode was transcribed using transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter podcast:
Jacquelyn Cobb: This week on The Cancer Letter Podcast…
Paul Goldberg: It would be prudent to mark the calendar, to mark November 25 as the date to look at the calendar and look at the NCI websites to see whether FOA for Cancer Centers has been published. Because if that thing dropped, it will … Set aside everything, and read, read, read, because you might get a call from The Cancer Letter, as well—
Jacquelyn Cobb: Yes.
Paul Goldberg: But it would be very interesting to have a list of reactions to it, because that’s an FOA that’s going to … probably expected to last three years.
Jacquelyn Cobb: FOA is funding opportunity announcement; right?
Paul Goldberg: And it will define CCSG for the next three years.
You’re listening to The Cancer Letter Podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter.
Jacquelyn Cobb: And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research, and critical conversations shaping oncology.
Paul Goldberg: So, let’s get going.
Jacquelyn Cobb: Hello, Paul. How are you doing?
Paul Goldberg: Good morning, Jacquelyn. How are you? Hope you had a great weekend.
Jacquelyn Cobb: I did. It’s really getting chilly up here in Maine. This morning, it was 36 degrees outside, and I got myself to the gym. We’re really entering winter.
Paul Goldberg: That’s so great.
Jacquelyn Cobb: Oh. I forgot you like it, and I was expecting a … Well, is DC still pretty warm? Or no?
Paul Goldberg: It’s kind of fall, and leaves are falling. Squirrels are eating the pumpkins. Yeah. Yeah. That’s great. Yeah, so …
Jacquelyn Cobb: Our squirrels are getting very fat. I really noticed it this year. I don’t know if the Maine squirrels are fatter, if they have to get fatter, I don’t know. But they are chunky. It’s awesome.
Paul Goldberg: Have you considered setting out some Ozempic outside?
Jacquelyn Cobb: Just to help them out?
Paul Goldberg: Yeah. Put it in the pumpkin.
Jacquelyn Cobb: Yeah. That would really not go well for them. I think I would kill a couple squirrels over the course of the next few months.
Paul Goldberg: No. That would be a good patriotic gesture, because that’s one of those things that we Americans do well, which is develop drugs and stage uncontrolled and unmonitored, in the new way, experiments on the entire population. So, we can try on squirrels and then see what happens.
Jacquelyn Cobb: Oh my God. Well, if that is … Well, I will take us through last week’s headline. I feel like I always am able to cut off a crazy conversation before it gets too far down the line with going through the headlines.
Paul Goldberg: Yeah. I can keep going. You know?
Jacquelyn Cobb: No. It’s okay. No. I’ll take us through last week’s headlines.
So, our cover story was Paul’s monster of a story, which is what we’re going to be talking about in today’s episode. It is about how Cancer Centers are adapting to life without site visits as NIH changes, CCSG, or Cancer Center Support Grant review. So we’ll dive into that in a lot more detail, but the rest of the issue last week was really strong. I had a follow-up story about GRAIL. Last year, we had written a really in-depth coverage of a class action lawsuit brought against them, primarily about insider fraud and overstating the clinical promise of GRAIL’s multi-cancer detection test called Galleri.
This shorter story is about a resubmission of that complaint, because it had been dismissed on some fancy legal grounds that I don’t … It’s like causation of damages or something. I’m not a law person at all, but the story is that they’re basically continuing with the lawsuit. So, that’s the gist of that story.
Then, we had a roundup, which will hopefully be the first of a yearly series where we give a roundup of what the Friends of Cancer Research’s annual meeting will be focusing on.
Really interesting, juicy stuff, I think, for Paul and I, that sort of clinical trials, regulatory nerding out. It was a very interesting roundup. A big part of me wanted to go deeper into each of them, but alas, there’s too much news. Then, we had a really, really, really awesome guest editorial by Deborah Phippard, Chief Scientific Officer at Precision for Medicine, about how GLP-1s like Ozempic, funny you mentioned it, Paul, but just-
Paul Goldberg: The squirrel use, veterinary use. I don’t even know if it’s veterinary technically.
Jacquelyn Cobb: No. Yeah.
Paul Goldberg: Yeah. It is.
Jacquelyn Cobb: It’s like wild animals, though. I don’t know, actually.
Paul Goldberg: Wild animal use of it.
Jacquelyn Cobb: Yeah.
Paul Goldberg: Yeah.
Jacquelyn Cobb: Intervention? I don’t know. But the guest editorial was not about squirrels. It was about humans and how GLP-1 drugs are reshaping patient physiology and the future of oncology. It’s a really, really comprehensive guest editorial. It goes into how these drugs impact cancer biology, cancer incidence, cancer therapy, clinical trial design, advanced precision medicine, blah, blah, blah, et cetera, et cetera, et cetera. It goes on.
It is a really, really awesome, comprehensive story. So, I would definitely recommend checking that out. So yeah. That was last week’s issue. Definitely a powerhouse. It felt like a really good issue. But Paul, let’s dive into your story. Do you want to just start? I’m happy to just hand the floor over to you.
Paul Goldberg: Yeah. Well, it was about the high level of consternation over the disappearance of the site visit from the CCSG review, which is sort of the first thing that happened during the flooding of the zone. NIH took over the Cancer Center Support Grant review, and there was a lot of concern about it. Some people saw and still see implications from, perhaps, the 2025 plan, all of this stuff. But at the AACI meeting, which was here in town in October 19 to 21st, there was some really interesting discussion of this and about what actually is happening.
Interestingly, what’s really happening is NIH convened a review group, and really, everything is about the quality of your reviewers always. That review group was pretty spectacular, I mean, uber-experienced people, focused, who were able to do the reviews, and some actually are saying, “You’re going to like this more than you like the previous system,” which runs counter to our expectations. Because we were catastrophizing, and with good reason. I mean, sometimes, you really have to catastrophize if you’re realistic. But in this case, what seems to have happened is the cuts did not materialize thanks to Republicans in Congress and Democrats, as well. It was a bipartisan. Support for NIH is still there.
All of the cuts to the indirect cost rate didn’t materialize. All of this is really happening, and the Cancer Centers’ move from NCI to the Center for Scientific Review at NIH really didn’t seem to have produced catastrophic results as predicted. But there is something that’s actually happening, which is really interesting, which is the cancer program is different from everything else in medicine and at the NIH. It’s got its own institutions. It’s got its own traditions, and one of those traditions is the site visit. Actually, I got deep into the history, because I kind of had to. I couldn’t keep from doing that, because for as long as I’ve known this, there have been site visits.
Jacquelyn Cobb: Yeah.
Paul Goldberg: Right? A site visit is a kind of a cultural event, which people show up from all over the institutions, institution, and beat their breasts, saying, “We support the Cancer Center. We love the Cancer Center. We fully support the Cancer Center director, who is the most wonderful person we’ve ever met.” Then, the House member or Senate member, ideally, and the appropriator shows up and says, “My aunt died of cancer 30 years ago, and look at how far we’ve come. Because had she gotten that cancer now, she’d be 180 years old, but she’d be alive.”
So, anyway, that kind of stuff happens at the site visits, and also, there’s a training aspect to the site visit. People love it. People love it, because they can do a little bit better. So we don’t know, historically, whether the first set of Cancer Centers received the site visit. I would guess they probably did, but they were deemed the first bunch. But then, after that, that happened, and there was some discussion about getting rid of it. For a while, it was sort of optional, but if it was optional, people are saying, “This is an option nobody really wanted to exercise,” which was another thing that was really fun with this. As I called Skip Trump as a historian, he said, “Oh. In 2014, when I was director at Roswell Park, I chose not to have a site visit,” and I said, “Ah. That’s a twofer.”
Jacquelyn Cobb: Yeah.
Paul Goldberg: He just … But he didn’t have anyone to impress. It’s a freestanding Cancer Center. It’s not matrix. He didn’t have a dean that he was otherwise fighting with, which is a normal thing. You fight with your dean. The place was running just fine, thank you very much. So he had nothing to really gain. But actually, that’s another thing. People really like site visits, because it allows people or forces people during the review, really through … It takes a long time to prepare for CCSG. During the entire preparation, it forces people to speak to each other, which is kind of the whole idea of the Cancer Center, which is kind of one of the quirks.
So, how do you do this when you’re doing on-desk review? That was much of the discussion at AACI at the session that I focused on, and it’s different. Like in the past, the whole festivities of the site visit would begin with the director’s report, and the director would summarize the whole thing. Then, other people will jump in and so forth. But in this on-desk review, the director’s remarks go last.
Jacquelyn Cobb: Yeah.
Paul Goldberg: You could probably read them first. Who can stop you? Nobody knows how you’re reading. There are some moves, apparently, in Congress to bring back some version of this site visit. I don’t think anybody really objects to that either way, and I don’t believe NCI would have any problem with it. But we don’t know, because NCI has been on shutdown, and they were not represented on any of the panels at the AACI. But it would be nice to find out what the thinking is, but hey. They can do this either way, and some very, very smart people are on the review board, which is very, very focused.
Jacquelyn Cobb: Yeah. Yeah. Well, that was, I think, the main, well, one of the main concerns about moving the review to NIH rather than out of it, being in NCI, was that cardiologists, different types of people who are doing brilliant NIH work might not have the nuanced understanding of cancer and Cancer Centers that is required for review. But you’re saying that they’re pretty good?
Paul Goldberg: Oh. No. These are all Cancer Center people, mostly directors.
Jacquelyn Cobb: Nice.
Paul Goldberg: There were two on that panel. One of them was Mark Evers from Kentucky, and the other was Pavan Reddy from Baylor. So gee, if I had a Cancer Center, I want these guys to be reviewing it. My God.
Jacquelyn Cobb: Heck yeah.
Paul Goldberg: The point that really isn’t stated but probably should be is that if you have a Cancer Center, you probably want these guys reviewing it, because it’s focused. They’re uber-experienced. They know what they’re talking about, and they know the Cancer Centers, too. Then, there’s something else that’s kind of … struck me as fascinating, and as everything with the Cancer Center, it’s all going to be deeply varied from center to center, but the EAB, which is another one of those quirks of the cancer program. Right?
Jacquelyn Cobb: EAB and-
Paul Goldberg: The Cancer Center is a quirk of the Cancer Centers Program. Right?
Jacquelyn Cobb: Yeah.
Paul Goldberg: The-
Jacquelyn Cobb: The review board. That’s the-
Paul Goldberg: Yeah. Yeah, yeah. Yeah, and they’re a board that prepares you to do this and-
Jacquelyn Cobb: Do the site visit, specifically, right?
Paul Goldberg: To do that, not just site visit, to CCSG—
Jacquelyn Cobb: But—
Paul Goldberg: … and they advise the center director. They’re usually people from other Cancer Centers who are very experienced and who understand what to do about all of this. It’s amazing groups, usually, and it’s really fun for them to look at other Cancer Centers. It just builds this cultural cohesion of the entire program. I mean, when I think about EABs, I’m almost sorry I’m not an oncologist or a center administrator, because it would be really fun to look at one of those centers and advise a director. You know?
Jacquelyn Cobb: Yeah.
Paul Goldberg: Could be a totally total blast for a certain kind of nerd.
Jacquelyn Cobb: Yes. Exactly.
Paul Goldberg: But why do you need an EAB without a site visit? The answer is you probably still do. So, there were these jokes about EABs being like Broadway productions, like Phantom of the Opera, and the joke was, “Well, maybe we should do something off, off Broadway, make it kind of a small site visit.” Where, by the way, the other thing with the site visit is you can look at … There’s a lot to the site visit, but it also is kind of a last chance for a center to say, “Hey. You’re missing the point. We do this this way because of this, and we’ve accomplished that.” So doing this all on paper with EAB as your editors rather than your directors, you know, it’s-
Jacquelyn Cobb: Yeah. Yeah. It’s a big adjustment.
Paul Goldberg: Yeah. It’s like … or producers, the producers.
Jacquelyn Cobb: Yeah.
Paul Goldberg: So, it’s kind of … Yeah. It will have a cultural impact. It has had a cultural impact. It would be prudent to mark the calendar, to mark November 25 as the date to look at the calendar and look at the NCI websites to see whether FOA for Cancer Centers has been published. Because if that thing dropped, it will … Set aside everything and read, read, read, because you might get a call from The Cancer Letter, as well, to-
Jacquelyn Cobb: Yes.
Paul Goldberg: But it would be very interesting to have a list of reactions to it, because that’s an FOA that’s going to probably … expected to last three years.
Jacquelyn Cobb: FOA is funding opportunity announcement, right?
Paul Goldberg: And it will define CCSG for the next three years. There could be big changes there. It could be no changes there. I have no idea, because, I mean, the FOA was changed this spring in accordance with the administration’s priorities.
Jacquelyn Cobb: Yeah. Yeah.
Paul Goldberg: Changes weren’t really huge. Well, I mean, site visit’s actually mentioned in there. So we’ll see what happens there, but we haven’t heard from NCI at all on any of this.
Jacquelyn Cobb: Yeah. Yeah. Well, we will definitely be the primary people dropping everything to read that November 25th if possible, or if it comes out.
Paul Goldberg: Oh God. Oh. My schedule is … Yeah. So for this to be-
Jacquelyn Cobb: It’s cleared that day?
Paul Goldberg: That day, I do nothing.
Jacquelyn Cobb: Okay. Sounds good.
Paul Goldberg: I mean, it’s going to be a day of reading the FOA and calling people who are smarter than I to tell me what’s in there.
Jacquelyn Cobb: Which is our job, really.
Paul Goldberg: It’s our job.
Jacquelyn Cobb: It’s basically what we’re doing all the time.
Paul Goldberg: That’s kind of why this is a great job.
Jacquelyn Cobb: Oh. Yeah.
Paul Goldberg: It’s a great time to be a journalist. It’s always a great time to be a journalist, because you get to call people who are smarter than you are.
Jacquelyn Cobb: And ask them to explain things. I know. That’s literally why I like it. It’s awesome.
Paul Goldberg: Then, sometimes, they even talk to you. That’s the part that’s really fun.
Jacquelyn Cobb: Yeah. Like-
Paul Goldberg: So, it’s always a good time to be a journalist.
Jacquelyn Cobb: Always.
Paul Goldberg: But now, it’s a great time to be a journalist.
Jacquelyn Cobb: Whoa. Okay. Stepping up. All right. It’s a great time to be a journalist. All right. Well, thank you, Paul. We will circle back next week.
Paul Goldberg: Same place, same time.
Jacquelyn Cobb: Yeah. Bye.
Thank you for joining us on The Cancer Letter Podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com. With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate, and share. Together, we’ll keep the conversation going.
Paul Goldberg: Until next time, stay informed, stay engaged, and thank you for listening.
