As administrations change, cancer research stands in an unusually strong position, NCI Acting Director Douglas Lowy said in an interview with The Cancer Letter.
“We’re very fortunate that both Republicans and Democrats strongly support biomedical research in general, and cancer research in particular,” Lowy said in a wide-ranging interview. “The leadership of the House and Senate appropriations subcommittees was responsible for the increase in FY16 for the NIH appropriation.”
With the importance of cancer research catapulted to a new level of visibility by Vice President Joe Biden’s Cancer Moonshot, the White House Precision Medicine Initiative, and the 21st Century Cures Act, Congress is likely to continue investing in biomedical research during the Trump administration, Lowy said.
“[House and Senate leaders] have both said they don’t want to be one-year wonders,” he said. “They both strongly support increasing the NIH budget, including increases for NCI, and I look forward to that being a very important aspect of an accomplishment for the incoming Congress.”
In the past, NCI directors moved on when administrations changed, but not immediately. Richard Klausner, for example, started his job as institute director 31 months into the Clinton administration (The Cancer Letter, Dec. 9, 2016).
Lowy’s case is unique because he is an acting director, and therefore not a presidential appointee. While other appointees were expected to submit their letters of resignation, Lowy wasn’t.
“I’m the acting director of the NCI, so I am not a presidential appointee; therefore, I am simply staying on,” Lowy said. “I would be very happy to continue as acting director or to become the permanent director, but those decisions are above my pay grade.”
Lowy, who is known for his decades of research into HPV and cancer, became acting director of NCI on April 1, 2015, when Harold Varmus, the institute’s 14th director, left for Weill Cornell Medical College’s faculty as the Lewis Thomas University Professor of Medicine, and teamed up with the New York Genome Center as a senior associate core member to promote the use of cancer genomics (The Cancer Letter, March 6, 2015).
NCI is working with Big Data leaders and cancer centers to aggregate and share molecular and clinical information in a federated, interoperable system, Lowy said.
“NCI can be a leader, but this is a problem that goes far beyond NCI, and we need to work with many entities in order to accomplish this goal,” he said. “In the long run, I suspect that this will be an international system that will include data from other countries as well as data from different sources in the United States.
“For the NCI, we have the Genomic Data Commons, which is one of the signature achievements of this past year.” (The Cancer Letter, June 10, 2016).
On Lowy’s watch, NCI increased funding for investigator-initiated research and the cancer centers. Though NCI is slated to receive new money for its moonshot activities, these funds will flow to NIH (The Cancer Letter, Dec. 2, 2016).
“I can safely say that we are working very closely with [NIH Director] Francis Collins to make sure that the quality of the research and its scope are very much in keeping with the Beau Biden Cancer Moonshot initiative and the recommendations of the [NCI Blue Ribbon Panel],” Lowy said (The Cancer Letter, Sept. 9, 2016).
Lowy spoke with Paul Goldberg, editor and publisher of The Cancer Letter, and Matthew Ong, a reporter with The Cancer Letter.
Paul Goldberg: Dr. Lowy, you’ve been the acting director for almost two years. How do you like the job?
Douglas Lowy: It’s really a terrific job. It is a great opportunity for me to lead the cancer research effort here in the U.S.
PG: What’s the best part of the job? What’s the most difficult?
DL: The best part of the job, really, I would say there are two aspects:
The first is seeing the tangible benefits that come from research that we are supporting, and those benefits include increased understanding of cancer, and then tangible benefits to our patients.
The second part is being able to work with a large number of fantastic people at the NCI and cancer researchers throughout the country and the world, and also the cancer advocacy
Matthew Ong: What are NCI’s most notable accomplishments during your time as acting director?
DL: This has been a really active time for cancer research, and so there really are quite a few accomplishments that have occurred.
First, we have increased the funding for investigator-initiated research and, second, we have increased the funding for the NCI cancer centers, which is where the majority of our extramural funding actually goes.
In addition, we have given renewed emphasis to cancer health disparities with new initiatives in that area, and we have been extraordinarily fortunate in having not one, but two initiatives from the White House that shine a light on the importance of cancer research: the Precision Medicine Initiative in oncology, which was in 2015 for the FY16, and most recently the Beau Biden Cancer Moonshot, which was very recently funded.
This is enabling us to make substantial progress and more strongly support precision medicine and a broad area of research that we have been supporting up to now, but can do so in a much more effective and efficient way.
PG: You’ve been able to do this without overpromising too, which—just noting it—that must have been difficult.
DL: I feel that cancer is a problem that has been with us since, really, men have walked the Earth, and there are Egyptian mummies that have evidence
And even though I look forward to us making tremendous strides, we are going to continue to be faced with people being at risk of developing cancer, and for the foreseeable future, developing cancer, because we all understand that, while, cancer, when it develops in children is a terrible thing, in terms of overall incidence and mortality, it really is a disease of older people, and because we are living longer, cancer, of necessity, is going to affect a lot of us.
PG: We know that you’ve saved lives through your work on the HPV vaccine, but we don’t know much, actually, we don’t know anything about your politics. How do you see politics coming into play in terms of your staying or going?
DL: Fortunately, cancer and cancer research transcend politics. I think that this is a disease that people of all different persuasions are affected by and everyone understands that in order to make progress, there needs to be research and we’re extremely fortunate that there is bipartisan support that is very strong for cancer research.
PG: But in terms of your predecessors staying or going and when administrations change …
DL: Well, I’m the acting director of the NCI, so I am not a presidential appointee; therefore, I am simply staying on. I would be very happy to continue as acting director or to become the permanent director, but those decisions are above my pay grade.
PG: But the science is in a different place than it was with your predecessors. Does that argue for your staying, in a sense, because of continuity, for example?
DL: I would very much like to be able to continue to pursue the cancer research efforts that we are initiating, but I certainly also appreciate that there are other people who are capable of doing this, and whatever the new administration decides, that’s what will happen.
MO: And if you do not become a permanent director, will you be continuing your work at NCI?
DL: Yes. I certainly will look forward to doing that, having an opportunity to spend more time in the laboratory would be a little bit like Br’er Rabbit being thrown back in the briar patch.
MO: Right. What would you work on?
DL: My research involves mainly papilloma viruses and also some growth regulatory genes, and I would look forward to being able to continue to do that research. As a matter of fact, my laboratory has its site visit this coming November, and I’m looking forward to our getting a positive review, but, as with all other research endeavors, peer review is critically important.
PG: What do you expect from the incoming administration and Congress? What will they do about biomedical research, based on what you are seeing now?
DL: As I said earlier, we’re very fortunate that both Republicans and Democrats strongly support biomedical research in general, and cancer research in particular. The leadership of the House and Senate appropriations subcommittees was responsible for the increase in FY16 for the NIH appropriation.
They have both said they don’t want to be one-year wonders. They both strongly support increasing the NIH budget, including increases for NCI, and I look forward to that being a very important aspect of an accomplishment for the incoming Congress.
MO: And now that the Cancer Moonshot has actually received funding in the [21st Century] Cures bill and the continuing resolution, has that money come to NCI?
DL: We are working very closely with NIH leadership to make sure that the money from the Cancer Moonshot is spent wisely on meritorious research that is aligned with the recommendations of the Blue Ribbon Panel.
MO: Do you have an estimate of when that might occur in fiscal 2017?
DL: Probably in the near future we’ll have a clearer idea, but right now I can safely say that we are working very closely with [NIH Director] Francis Collins to make sure that the quality of the research and its scope are very much in keeping with the Beau Biden Cancer Moonshot initiative and the recommendations of the BRP.
PG: How will you be prioritizing the implementation of the Blue Ribbon Panel recommendations, and which of the recommendations do you see NCI acting on right away?
DL: All of the recommendations are important, but there are aspects of the recommendations which are easier to implement than others, and so we will be prioritizing according to ease of implementation, in terms of what we do right now, but we are setting up implementation teams and will continue to get input from our advisory groups, as well as from others, to prioritize how the research is done.
I should also point out that we can’t do this alone, and we’re really looking forward to working collaboratively with the private sector, with private philanthropy, as well as with other countries and funders in other countries to help to accomplish the ambitious goals of the Cancer Moonshot.
MO: As a public entity, NCI seems to have been designated as the de facto leader for data sharing in oncology as part of the moonshot. Do you foresee NCI playing a larger role in terms of facilitating and developing standards for aggregating health data?
DL: Yes. Data-sharing clearly has been front and center especially for Vice President [Joe] Biden and we have already had a number of meetings with the NCI cancer centers as well as with leaders from different platforms for large data, and we, I think, all agree that we are working towards the goal of being able to aggregate and share data much more efficiently and comprehensively than has been possible—in the future. Again, NCI can be a leader, but this is a problem that goes far beyond NCI, and we need to work with many entities in order to accomplish this goal.
MO: Right. And you think at some point those standards may actually become a reality?
DL: I think that we will end up with a federated, interoperable system, but, importantly, we will try to have data that’s not only molecular information about cancer, not only clinical information about how people have been treated and the outcome, but putting the two together with a large number of patients, so that we can use that aggregated data to make as much progress as possible through the analysis of large data.
PG: How large a federated, interoperable system will it be? What will it cover?
DL: In the long run, I suspect that this will be an international system that will include data from other countries as well as data from different sources in the United States.
For the NCI, we have the Genomic Data Commons, which is one of the signature achievements of this past year, which was opened and housed at the University of Chicago, and all of the data that’s supported by the NCI, really, is going to be housed in the GDC, and we are offering to other groups, if they wish to put their data into the GDC, to seriously consider it, and we would like to help incentivize that by providing resources to help make it easier for that to happen.
MO: Do you think … is there anyone else in the system that also has as large a role as NCI—an individual entity—is anyone else capable of doing this and leading this work?
DL: To the extent that this is going to be an international effort, we want to work closely with colleagues outside of the United States, because the information that is generated in other countries can be usefully applied to the United States, because cancer has many similarities in other countries to cancer here, and, in fact, for example, we have signed memorandums of understanding to do cancer proteogenomics with a number of different countries, but focusing on the cancers that are of most importance to them.
PG: How do the Big Data players in the industry fit into this?
DL: We have been trying to work closely with Project Data Sphere, which is an activity of the CEO Roundtable on Cancer, and they have been aggregating and de-identifying data from completed clinical trials, and we look forward to being able to make use of those data, not just for standard chemotherapy, but also for more contemporary and newer forms of treatment, such as immunotherapy and targeted treatment.
MO: How do you see the political continuity of the moonshot? I know it’s been approved by the 21st Century Cures and authorized for funding. How do you see it panning out over the next, say, four years?
DL: I think that we have a great start. We are committed to supporting some signature initiatives, utilizing the funds from the Cancer Moonshot, and we think that there will be really compelling evidence, and easy for people to see that this investment is going to pay off, and so we look forward to Congress renewing the funding for the moonshot for its duration.
PG: What’s the most important lesson you’ve learned on this job?
DL: It’s to be decisive, but making decisions only after you have gotten input from different perspectives.
That, really, is by far, I think, the most important lesson that I have learned.