Vision for NCI Outlined by New Director

Over the next several years, the NCI, under the leadership of its new director, Norman “Ned” Sharpless, MD, will seek to bolster four areas of its enterprise to accelerate progress in the treatment of cancer: workforce training and development, basic science, “big data,” and clinical trials. In an April 16 speech to attendees of the American Association for Cancer Research (AACR) Annual Meeting 2018, Sharpless broadly outlined some of the advancements he wants to see in each area.

“The NCI is enormous, huge, gigantic,” said Sharpless, who assumed the agency's helm in October. “I don't think that with an organization this big that you can come from the outside and say, ‘Here are the three things we need to do to fix this place.’” Instead, he began a 6-month listening tour, “talking to patients, to advocates, to scientists, to doctors, to cancer center directors … to pretty much anybody I could find about what the NCI does well and what it doesn't do well,” he said. Through those conversations, he found that many of the organization's challenges fell into those four broad categories.

“One of the most important jobs of the National Cancer Institute, arguably the most important job of the National Cancer Institute, is to train the scientists, the physicians, and health services researchers that lead and prosecute the war on cancer,” Sharpless said. “We have to assure that our best and brightest don't get discouraged by the cumbersome process of NCI funding and vagaries of science. We really have to make it a good career path.”

To that end, Sharpless said that the NCI will work to ensure a diverse and representative workforce and make sure that scientists have the best training for cancer research and that researchers have incentives to train in growing areas, such as “big data.”

In addition, Sharpless pledged to set aside 25% more funding for RO1 grants for early-stage investigators, who are often at a disadvantage in obtaining funding compared with more seasoned scientists. He also said that early-career researchers could look to R37 MERIT grants, which provide 7 years of funding instead of the standard 5 years.

“Abraham Lincoln said, ‘Give me 6 hours to chop down a tree and I'll spend the first four sharpening my axe,’” Sharpless told meeting attendees. “That's what basic science is. It's our axe. It needs to be really sharp to make progress against a problem like intractable cancers.”

Among efforts on this front, Sharpless said that financial support needs to increase for investigator-initiated research, funded though research project grants (RPG). “We will be putting another $100 million or so into the RPG pool for basic science,” he announced, adding that “this is the largest increase in the RPG awards in over 15 years.”

Having written countless grant applications himself, Sharpless said he was keenly aware of how much time they take to complete. Rather than spending so much time on paperwork, scientists should be doing more science. Noting that he's open to suggestions on how to reduce administrative burdens, Sharpless said one solution is to stretch the terms of grants, reducing the need to apply for funding renewals.

The NCI can also play a role in providing the infrastructure researchers need to advance basic science, Sharpless said, creating facilities for cryo-electron microscopy and tools for “big data” projects.

In recent years, scientists have generated tremendous amounts of data, Sharpless said, but many upload data and forget about it, adding it to what he called “data lakes.” “We need aggregated data sets we can actually use,” he argued. “We need to understand what's in the data lakes.”

To better care for patients, Sharpless called for various data sets to be linked, by tying genomic data to pathologic data, to radiologic data, and to patient electronic health records. The NCI could then play a role in setting standards for data collection and aggregation, and finding new ways to use existing data repositories, such as SEER, the Surveillance, Epidemiology, and End Results Program database. “The costs of not doing [all of] this are too significant,” he said.

Finally, Sharpless noted that multiple problems have plagued clinical trials, such as slow, and low, enrollment and the high cost of conducting trials. Further, patients often cannot determine which trials they might be eligible for.

“We need clinical trials to work for our patients,” Sharpless said, noting that central institutional review boards and simplified trial consent and enrollment forms would streamline trial conduct. He also called for greater investment in clinical trials in community settings, given that most patients aren't treated at large research institutions or academic medical centers.

“To be sure,” Sharpless concluded, “we have already made tremendous progress since those bad old days when we didn't understand the biology of cancer and we had drugs that were not very effective. I believe that by applied focus in these areas now, we can further accelerate the pace of that progress. This will allow us to honor every patient … we owe it to them to work together and to see this potential realized.” –Suzanne Rose