FDA guidance helps facilitate drug co-development

Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine ( Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute’s Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph ( Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.

Since its release of Version 1.0 in 1998, Joinpoint software developed for cancer trend analysis by a team at the US National Cancer Institute has received a considerable attention in the trend analysis community and it became one of most widely used software for trend analysis. The paper published in Statistics in Medicine in 2000 (a previous study) describes the permutation test procedure to select the number of joinpoints, and Joinpoint Version 1.0 implemented the permutation procedure as the default model selection method and employed parametric methods for the asymptotic inference of the model parameters. Since then, various updates and extensions have been made in Joinpoint software. In this paper, we review basic features of Joinpoint, summarize important updates of Joinpoint software since its first release in 1998, and provide more information on two major enhancements. More specifically, these enhancements overcome prior limitations in both the accuracy and computational efficiency of previously used methods. The enhancements include: (i) data driven model selection methods which are generally more accurate under a broad range of data settings and more computationally efficient than the permutation test and (ii) the use of the empirical quantile method for construction of confidence intervals for the slope parameters and the location of the joinpoints, which generally provides more accurate coverage than the prior parametric methods used. We show the impact of these changes in cancer trend analysis published by the US National Cancer Institute.

Natural products remain a significant source of anticancer chemotherapeutics. The search for targeted drugs for cancer treatment includes consideration of natural products, which may provide new opportunities for antitumor cytotoxicity as single agents or in combination therapy. We examined the association of molecular genomic features in the well-characterized NCI-60 cancer cell line panel with invitro response to treatment with 1302 small molecules which included natural products, semisynthetic natural product derivatives, and synthetic compounds based on a natural product pharmacophore from the Developmental Therapeutics Program of the US National Cancer Institute's database. These compounds were obtained from a variety of plant, marine, and microbial species. Molecular information utilized for the analysis included expression measures for 23059 annotated transcripts, lncRNAs, and miRNAs, and data on protein-changing single nucleotide variants in 211 cancer-related genes. We found associations of expression of multiple genes including SLFN11, CYP2J2, EPHX1, GPC1, ELF3, and MGMT involved in DNA damage repair, NOTCH family members, ABC and SLC transporters, and both mutations in tyrosine kinases and BRAF V600E with NCI-60 responses to specific categories of natural products. Hierarchical clustering identified groups of natural products, which correlated with a specific mechanism of action. Specifically, several natural product clusters were associated with SLFN11 gene expression, suggesting that potential action of these compounds may involve DNA damage. The associations between gene expression or genome alterations of functionally relevant genes with the response of cancer cells to natural products provide new information about potential mechanisms of action of these identified clusters of compounds with potentially similar biological effects. This information will assist in future drug discovery and in design of new targeted cancer chemotherapy agents.

Since 2007, the US National Cancer Institute (NCI) Office of Cancer Complementary and Alternative Medicine (OCCAM), together with the Cancer Institute of the China Academy of Chinese Medical Sciences (CICACMS), institutes at China Academy of Sciences and Chinese Academy of Medical Sciences, have engaged in collaborations on Chinese medicine (CM) and cancer research. Through these collaborations, CM drugs and compounds have been studied at NCI labs. This paper summarizes the discoveries and progress on these research projects, exploring the aspects of cancer prevention, botanical drug mechanisms of action and component analysis/quality control (QC), and anticancer activity screening. These and other related projects have been presented in various jointly convened workshops and have provided the backdrop for establishing a new organization, the International Consortium for CM and Cancer, to promote international collaborations in this field.

Dichloroacetic acid and its derivatives exhibit the properties of metabolic cytoprotectors and apoptosis inducers. Nowadays evaluation of these derivatives is being conducted regarding the induction of immunogenic cell death. Therefore, the search for new derivatives of dichloroacetic acid as potential antitumor agents has a certain perspective and may be successful for the molecular design of «drug-like» structures. The aim of the work was the development of synthetic approaches to the obtaining of dichloroacetic acid amides and the primary screening of the antitumor activity of the synthesized compounds. Synthetic studies were conducted using reagents from the companies «Merck» (Darmstadt, Germany) and «Sigma-Aldrich» (Missouri, USA). 1H NMR spectra were measured on a Varian VXR-400 instrument, and LC-MS spectra on an Agilent 1100 Series LCMS instrument. The anticancer activity of the synthesized compounds was studied according to the international scientific program of the US National Cancer Institute – DTP (Developmental Therapeutic Program). Amides were synthesized based on acylation reactions of the corresponding substituted ethylamines and aminobenzoic acids with methyldichloroacetate and dichloroacetyl chloride. The use of two methods of acylation of amines allows obtaining the target compounds with sufficient purity and satisfactory yields (44–98%). The structure and purity of the synthesized compounds were confirmed by the methods of elemental analysis, LCMS spectrometry and 1H NMR spectroscopy. It was shown that dichloroacetyl chloride and methyl dichloroacetate are effective acylating agents, which was confirmed by the synthesis of a series of amides based on substituted ethylamines and aromatic amino acids. Moderate antitumor activity of dichloroacetamides was established on some melanoma, leukemia, and renal cancer cell lines. The highest activity was observed for 4-(2,2-dichloroacetylamino)-2-hydroxybenzoic acid, against which the mitotic activity of the LOX IMV melanoma line was 45.83%. Preliminary data on the antitumor activity indicate certain prospects for the search for anticancer agents in the group of dichloroarylacetamides in comparison with alkyl amides.

Purpose: Persons living with HIV have elevated risks of HPV-related cervical, anogenital, and oropharyngeal cancers. Yet, research on optimization and implementation of prevention interventions (prophylactic HPV vaccination, cervical and anogenital cancer screening and triage, and precancer therapeutics) for HPV-related cancers among persons living with HIV has been limited. With a goal to expand this evidence, and building on strong academic research partnerships developed for HIV research between institutions in the US and the Latin American and the Caribbean (LAC) region, the US National Cancer Institute (NCI) initiated ULACNet, a new Cooperative Agreement clinical trials network in 2019. Methods: ULACNet comprises of three Partnership Centers each led by US-based institutions (University of California San Francisco, Weill Medical College of Cornell University, and Fred Hutchinson Cancer Research Center), working collaboratively with US and LAC institutions and with the NCI to develop and conduct multicenter prevention clinical trials focused on filling key scientific gaps and evaluating novel interventions. Results: ULACNet encompasses six countries (US, Mexico, Puerto Rico, Brazil, Peru, and Dominican Republic), twenty partner institutions, and over 100 collaborating scientific investigators, clinical and public health practitioners, research staff, and patient advocates. ULACNet will collaboratively conduct nine prevention clinical trials (two prophylactic HPV vaccine trials in adults and perinatally-HIV infected adolescents, three trials for clinical validation of molecular biomarkers and imaging technologies for screening and triage, two candidate HPV therapeutic vaccine trials, and two trials of topical therapeutic agents). Facilitation across network partners is achieved via a Coordinating Committee and three Working Groups (focused on HPV testing and screening, precancer treatment, and recruitment and retention activities). Conclusion: ULACNet seeks to leverage established academic global health partnerships to conduct high quality collaborative clinical trials to inform clinical practice and ultimately reduce the burden of highly preventable HPV-related cancers in persons living with HIV worldwide. Citation Format: Emma Brofsky, Margaret House, Brandy Heckman-Stoddard, Mostafa Nokta, Satish Gopal, Vikrant Sahasrabuddhe. Development of International Cancer Research Partnerships Through the NCI US-Latin American-Caribbean HIV/HPV-Cancer Prevention Clinical Trials Network (ULACNet) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 20.

The English version of the online encyclopedia, Wikipedia, has been recently reported to be the prominent source of online health information. However, there is little information concerning the quality of information found in Wikipedia. Therefore, we created a questionnaire asking for scope, completeness, and accuracy of information found on osteosarcoma. Three independent observers tested the English version of Wikipedia, as well as the patient version and the health professional version of the US National Cancer Institute (NCI) website. Answers were verified with authoritative resources and international guidelines. The results of our study demonstrate that the quality of osteosarcoma-related information found in the English Wikipedia is good but inferior to the patient information provided by the NCI. Therefore, non-peer-reviewed commonly used websites offering health information, such as Wikipedia, should include links to more definitive sources, such as those maintained by the NCI and professional international organizations on healthcare treatments. Furthermore, frequent checks should make sure such external links are to the highest quality and to the best-maintained aggregate sites on a given healthcare topic.

The possibility of developing small molecule cancer chemotherapeutics using mechanism-based drug design has only recently been considered. The anti-cancer drugs presently available to the clinic were initially discovered as substances that inhibit the proliferation of tumors in animal models and/or of cultured cells (see 1,2 for reviews). The field of cancer chemotherapy started with the serendipitous discovery that mustard gas agents used in chemical warfare induced lymphoid hypoplasia, leading the way to their use in the treatment of Hodgkin’s and lymphocytic lymphoma. The availability of transplantable tumor models in laboratory animals was also of utmost importance to allow testing of novel chemical agents. The establishment of a mass screening effort at the US National Cancer Institute (NCI) to identify substances that inhibit the proliferation of cultured tumor cells, then led to the discovery of agents that have been useful to treat and cure certain tumors, including leukemias and lymphomas. The NCI approach has primarily focused on the identification of chemical entities that inhibit the proliferation of one or the other histological cell type. With the discovery of the multiple drug resistance (MDR-1) gene and its amplification in tumors, some cell lines that show MDR-1 amplification in addition to their parental lines were introduced into the screen, but still, to this date most of the NCI screening efforts have focused on the identification of novel compounds that inhibit cell proliferation with a distinctive pattern. The identification of the molecular targets of the available anti-cancer drugs, together with the explosion in the discovery of genetic and biochemical abnormalities in cancer cells have suggested the possibility of taking a molecular mechanism-based approach for the development of cancer therapeutics (see3, for review).

BackgroundCervical cancer is caused by persistent infection with carcinogenic human papillomavirus (HPV) genotypes. Prophylactic HPV vaccines are highly efficacious in preventing the acquisition of HPV infection. HPV vaccine trials and epidemiologic studies based on virologic endpoints rely on valid and reproducible measurements of HPV. We evaluated the second version of TypeSeq (TS2), a next-generation, sequencing-based assay that detects 46 HPV genotypes, in a historical phase 3 clinical trial.MethodsWe used 1214 stored cervical samples from women enrolled in the Costa Rica HPV Vaccine Trial with available HPV results from Short PCR Fragment 10- Line Probe Assay 25 (SPF10-LiPA25). TS2 was first validated at the National Cancer Institute (NCI) and transferred to the laboratory in Costa Rica, where we conducted a second validation study. We compared TS2 results generated at each laboratory to the SPF10-LiPA25 results.ResultsOverall, each laboratory demonstrated high positive agreement for most carcinogenic and noncarcinogenic genotypes between TS2 and SPF10-LiPA25. Intralaboratory comparisons revealed very high agreement in repeated testing. Interlaboratory comparisons showed high agreement for most carcinogenic and noncarcinogenic types. Overall, there were no statistically significant differences in vaccine efficacy in the according-to-protocol cohort using TS2 (either in NCI or Costa Rica) or SPF10-LiPA25 (McNemar P values >.05). Costa Rica produced similar vaccine efficacy estimates as NCI for HPV16/18, HPV31/33/45, and HPV35/39/51/52/56/58/59 as NCI (P values ≥.36).ConclusionsCompared to SPF10-LiPA25, a well-established standard for HPV genotyping, TS2 demonstrated high accuracy. Inter- and intralaboratory comparisons demonstrated that TS2 is valid and reproducible. TS2 can accurately classify the presence of HPV, which is essential in HPV vaccine trials evaluating virological endpoints.Clinical Trials RegistrationNCT00128661.

Quality of life assessment using patient-reported outcome (PRO) measures: still a Cinderella outcome?

Late Complications from Chemoradiotherapy for Cervical Cancer: Reflections from Cervical Cancer Survivors 10 Years after the National Cancer Institute Alert

The completion of the human genome project a decade ago opened new avenues to discover cures to diverse diseases. The potential to discover new genes raised high hopes for many discoveries that would make it possible to cure or even prevent human diseases. The outcome has not kept up with the excitement. Of the predicted proteins in the human genome, a vast number are of unknown nature and their relevance remains a mystery [1]. These novel proteins together with the noncoding RNAs constitute the ‘dark matter’ of the genome [2-7]. Hence a problem remains about the path that future genomic research should follow: should institutions and researchers continue on their current course of studying the known genes, or should they take the higher-risk route of working to demystifying the dark matter of the human genome? Currently, researchers face fewer challenges and a higher likelihood of bringing their projects to fruition by continuing to study the known genes. Nonetheless, studying the novel uncharacterized proteins offers numerous advantages. Only through such study can a broad understanding of the complexity of the human genome emerge; this should provide a basis for better pharmaceuticals and diagnostic markers for diverse diseases [8-10]. Further, the mystery surrounding the genome can disappear as more research goes into the dark matter area of the genome. Powerful bioinformatics and proteomics tools, which offer ways to harness the vast amount of genomic information, are increasingly available [6,7]. Genome-wide association databases such as the Genetic Association Database (GAD) [11], the Phenotype-Genotype Integrator (PheGenI) [12], the database of Clinical Variations (ClinVar) [13] and the International HapMap Project (HapMap) [14] allow a user to rapidly establish phenotype-associated traits for a large number of genes in a single experiment. High-throughput gene expression analysis tools for both mRNAs and proteins can provide an initial hint on diverse tissue expression of the genes to be analyzed. Going from the genome to phenome to function and finally to clinical relevance has never before been easier. A key issue resides in convincing researchers of the value of following the unknown genes. Funding agencies and industry have tended to favor projects that offer the highest probability of success; consequently, not much research has delved into the dark matter of the genome. Recently the US National Cancer Institute (NCI) announced a new initiative to address the paucity of attention that has been given to this basic research: “Illuminating the Dark Matter of the Genome for Druggability” [15]. This is a welcome step in the right direction. More funding by so influential an institution as NCI will undoubtedly lead other institutions around the world to foster study of the unknown elements in the human genome.

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

To examine ambient air pollutants, specifically polycyclic aromatic hydrocarbons (PAHs), as a factor in the geographic variation of breast cancer incidence seen in the US, we conducted an ecological study involving counties throughout the US to examine breast cancer incidence in relation to PAH emissions in ambient air. Age-adjusted incidence rates of female breast cancer from the surveillance, epidemiology, and end results (SEER) program of the US National Cancer Institute were collected and analyzed using SEER*Stat 8.3.2. PAH emissions data were obtained from the Environmental Protection Agency. Linear regression analysis was performed using SPSS 23 software for Windows to analyze the association between PAH emissions and breast cancer incidence, adjusting for potential confounders. Age-adjusted incidence rates of female breast cancer were found being significantly higher in more industrialized metropolitan SEER regions over the years of 1973-2013 as compared to less industrialized regions. After adjusting for sex, race, education, socioeconomic status, obesity, and smoking prevalence, PAH emission density was found to be significantly associated with female breast cancer incidence, with the adjusted β of 0.424 (95% CI 0.278, 0.570; p < 0.0001) for emissions from all sources and of 0.552 (95% CI 0.278, 0.826; p < 0.0001) for emissions from traffic source. This study suggests that PAH exposure from ambient air could play a role in the increased breast cancer risk among women living in urban areas of the US. Further research could provide insight into breast cancer etiology and prevention.

The expression “lost at sea” means to be confused or perplexed. By extension, lost at SCLC references the current confusion about how to circumvent the chemoresistance, particularly platinum resistance, which so plagues the treatment of extensive-stage small cell lung cancer (ES-SCLC) that in 2012 the US National Cancer Institute (NCI) designated it a “recalcitrant cancer.” Over a decade later, despite the approval of immune checkpoint inhibitors and the conditional approval of lurbinectedin, the prognosis for ES-SCLC, and especially platinum-resistant ES-SCLC, has scarcely improved. The focus of this review, which briefly summarizes current treatment options for ES-SCLC, is on five clinical-stage therapies with the potential to successfully reverse the platinum resistance that is perhaps the biggest obstacle to better clinical outcomes.