NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term...
Transcript of NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term...
![Page 1: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/1.jpg)
NCI, Prevention, and Screening
AACR Cancer Prevention Summit
February 3, 2016
Doug Lowy, M.D.
Acting Director, National Cancer Institute, NIH
![Page 2: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/2.jpg)
Outline of
Presentation
Cancer mortality trends
NCI budget trends &
the cancer moonshot
Precision
medicine/oncology in
prevention & screening
![Page 3: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/3.jpg)
Long-Term Mortality Trends 2002-2011, by Cancer Site
Percent Change 2002–2011
Men Women
3
Increasing Increasing
Decreasing Decreasing
Based on Kohler et al, Annual report to the nation on the status of cancer 1975-2011. JNCI, 2015
![Page 4: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/4.jpg)
4
Competing RPG & NCI Total Obligations
FY 2012 FY 2013 FY 2014 FY 2015 Est.
Competing RPGs - Obligations 414,003,721 403,944,814 450,476,095 -
Competing RPGs - Count 1,085 1,095 1,207 -
NCI Total Obligations 5,067,341,795 4,789,014,389 4,932,368,225 4,953,028,000
-
1,000,000,000
2,000,000,000
3,000,000,000
4,000,000,000
5,000,000,000
6,000,000,000
-
100,000,000
200,000,000
300,000,000
400,000,000
500,000,000
600,000,000
700,000,000
800,000,000
Competing RPGs - Obligations NCI Total Obligations
Competing RPG Obligations NCI Total Obligations
508,126,000
1,236
![Page 5: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/5.jpg)
Outlook for
Cancer
Research
Funding
Strong bipartisan support
in congress for NCI/NIH
Potential for continuing
increases in Federal
cancer research funding
Coordination with other
research efforts
![Page 6: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/6.jpg)
The 2016 NCI Budget: A Substantial Increase After Many Years
of Flat Budgets & Decreasing Purchasing Power
6
![Page 7: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/7.jpg)
NCI FY16
Appropriation
• ~$265 million total increase
• $70 million for the President’s
Precision Medicine Initiative in
Oncology (PMI-O)
• $195 million (must take
mandatory increases from this
number)
![Page 8: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/8.jpg)
The Vice
President’s
Cancer Initiative
To accelerate progress in
cancer, including
prevention & screening
From cutting edge to
wider uptake of
standard of care
To encourage greater
cooperation and breaking
down silos
Within and between
academia,
government, and
private sector
Importance of data
sharing
![Page 9: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/9.jpg)
Cancer Moonshot Federal Task Force: Feb 1, 2016
![Page 10: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/10.jpg)
Cancer Moonshot Federal Task Force: Feb 1, 2016
Doug
![Page 11: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/11.jpg)
![Page 12: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/12.jpg)
Doug
![Page 13: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/13.jpg)
![Page 14: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/14.jpg)
14
Doug’s Definition of Precision Oncology
Interventions to prevent, diagnose, or treat cancer, based on a molecular and/or mechanistic understanding of the causes, pathogenesis, and/or pathology of the disease.
Where the individual characteristics of the patient are sufficiently distinct, interventions can be concentrated on those who will benefit, sparing expense and side effects for those who will not.
![Page 15: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/15.jpg)
Oncogenic Microbial Agents are
Molecular Targets
Genes and proteins of oncogenic
microbial agents (such as HBV, HCV,
HPV, and EBV) are as much molecular
targets as B-raf, EGFR, etc.
![Page 16: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/16.jpg)
Precision Oncology in Primary and
Secondary Prevention
The genetic and epigenetic changes in normal and premalignant tissues are less complex than in cancer
the driver changes may predominate in a higher proportion of premalignant lesions than of progressed lesions
Resistance is less likely to develop against interventions that target early changes
Premalignant cells are more stable genetically and less heterogeneous than cancer cells
Therefore, if you like targeted interventions for the treatment of cancer, you will love targeted interventions for prevention and screening of cancer
![Page 17: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/17.jpg)
![Page 18: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/18.jpg)
Cancer Screening: From Pattern
Recognition to Molecular Diagnosis
Precision oncology and its related technology have the potential to improve cancer screening
Primary screening tests for cervical cancer have gone from empiric pattern recognition (pap smear) to etiology-based (HPV) testing
![Page 19: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/19.jpg)
Adegoke et al, J Womens Health 21:1031-37, 2012
Squamous cell: blacks
Squamous cell: whites
Adenocarcinoma: whites
Adenocarcinoma: blacks
Cervical cancer rates (USA): Decreasing
squamous cell cancer, stable
adenocarcinoma
Adenosquamous: blacks & whites
![Page 20: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/20.jpg)
HPV testing can prevent more cervical cancers,
especially adenocarcinomas, than cytology
Ronco et al, Lancet 383: 524-33, 2014
Pooled cervical cancer incidence from 4 randomized controlled trials of
cytology (control arm) vs. HPV testing (experimental arm)
*Ratio of incidence with HPV testing vs. incidence with cytology
20
![Page 21: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/21.jpg)
HPV testing: Ancillary molecular testing to
increase specificity (CIN2/3+)
HPV testing has high sensitivity but sub-optimal specificity (CIN2/3+)
Candidate ancillary molecular testing based on HPV-induced pathogenesis, to increase specificity
HPV induces p16INK4A and Ki-67 expression
Progression to CIN3+ is associated with methylation of silenced HPV genes
![Page 22: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/22.jpg)
HPV Methylation for Triage of HPV-
positive women
0%
2%
10%
40%
100% Risk of precancer
Mirabello et al. JNCI 2012; Wentzensen et al. JNCI 2012; Clarke, Wentzensen et al. CEBP 2012
o HPV methylation can achieve risk stratification that alters clinical management
o Methylation testing can be done from the HPV DNA sample, is alos applicable for self-sampling
Methylation +
Methylation -
HPV +
HPV -
Population
Risk
Refer for culposcopy
![Page 23: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/23.jpg)
23
Summary
An improved outlook for NCI/NIH appropriations
Precision oncology – broadly defined - represents a rational approach to cancer prevention, screening, and treatment
Precision oncology has the potential to improve outcomes in cancer prevention, screening, and treatment
![Page 24: NCI, Prevention, and Screeningcollaboration.aacr.org/sites/CPS/Shared Documents...Long-Term Mortality Trends 2002-2011, by Cancer Site Percent Change 2002–2011 Men Women 3 Increasing](https://reader033.fdocuments.in/reader033/viewer/2022050415/5f8bc7f053e84874430eba2b/html5/thumbnails/24.jpg)
www.cancer.gov www.cancer.gov/espanol