I'D LIKE TO
WELCOME THE MEMBERS OF THE
NATIONAL CANCER ADVISORY BOARD,
EX-OFFICIO MEMBERS, STAFF AND
GUESTS.
SPECIAL WELCOME TO DR. RATHMELL
SINCE THIS IS HER FIRST NCAB
MEETING AS THE NEW NCI DIRECTOR.
SO WELCOME, KIM.
LOOKING FORWARD TO WORKING WITH
YOU.
MEMBERS OF THE PUBLIC WHO MAY
WISH TO DISCUSS THEIR VIEWS, MAY
DO SO BY WRITING TO THE
EXECUTIVE SECRETARY OF THE BOARD
WITHIN 10-DAYS FOLLOWING THE
MEETING.
ANY WRITTEN STATEMENTS OR
QUESTIONS SUBMITTED BY MEMBERS
OF THE PUBLIC WILL RECEIVE
CAREFUL CONSIDERATION.
AS BOARD MEMBERS, I WANT TO
REMIND YOU THAT YOU MUST ABSENT
YOURSELF VIRTUALLY DURING
SPECIFIC DISCUSSIONS WHENEVER
YOUR PARTICIPATION AND
DELIBERATIONS ON A PARTICULAR
PRODUCT, PROGRAM OR OTHER
SPECIFIC MATTER WOULD CONSTITUTE
A CONFLICT OF INTEREST OR EVEN
CREATE THE APPEARANCE OR
PERCEPTION OF ONE.
IT IS INCUMBENT UPON YOU OR US
TO ADVISE THE EXECUTIVE
SECRETARY, DR. GRAY, AND ABSTAIN
FROM ANY PARTICIPATION AND
DISCUSSION OR ACTION REGARDING
THAT MATTER.
IN LIGHT OF THE CURRENT POLICIES
GOVERNING CONFLICT OF INTEREST
BASED ON FINANCIAL HOLDINGS OF
SPECIAL GOVERNMENT EMPLOYEES,
WHICH INCLUDES ALL OF THE
MEMBERS OF THE BOARD, WE MUST
DEPEND ON YOU AND OURSELVES TO
VOLUNTARILY ABSENT DURING ANY
AND ALL DISCUSSIONS OR MATTERS
THAT COULD CONCEIVABLY IMPACT
THE STATUS OF THESE HOLDINGS OR
THOSE HOLDINGS.
WE TRUST YOUR JUDGMENT IN THESE
INSTANCES.
DURING ANY CLOSED SESSIONS, ANY
MATERIALS OR DISCUSSIONS OF A
CONFIDENTIAL NATURE DELIBERATED
ON TODAY ARE PRIVILEGED
INFORMATION AND ARE MADE
AVAILABLE TO US ON A NEED-TO
KNOW-BASIS.
SUCH ARE PRIVATE AND THEIR
CONTENTS SHOULD NOT BE DIVULGED.
FUTURE MEETING DATES HAVE BEEN
PROVIDED AND LISTED ON THE
AGENDA.
FIRST WE NEED TO APPROVE THE
NOVEMBER 29-30, 2023 JOINT
BSANCAB VIRTUAL MEETING SUMMARY.
SO WE NEED TO CALLOY MENTION TO
APPROVE THE MEETING SUMMARY.
DO WE HAVE A MOTION?
>> SO MOVED.
>> SECOND?
>> SECOND.
>> ANY FURTHER DISCUSSION?
SO WE NEED TO VOTE TO APPROVE
THE MEETING SUMMARY.
ARE THERE ANY NEIGHS?
ANY ABSTENTIONS?
-- ANY NAYs?
PAULETTE?
BY LAW, A QUORUM OF BOARD
MEMBERS IS REQUIRED FOR EACH
INSTANCE IN WHICH A VOTE MAY
OCCUR, WHETHER IN OPEN OR CLOSE
SESSION.
DURING THIS MEETING A MINIMUM OF
10 APPOINTED MEMBERS MUST BE
PRESENT TO VOICE THEIR VOTES
SINCE WE CAN'T PREDICT THE TIME
OR OCCURRENCE OF ANY MOTION OUR
PRESENCE IN THE VIRTUAL ROOM FOR
ALL SEGMENTS OF THE MEETING IS A
REQUIREMENT.
PAULETTE, DO WE HAVE A QUORUM?
>> YES WE DO.
>> GREAT.
TO ENSURE THAT WE DON'T HAVE ANY
INTERRUPTIONS, PLEASE ENSURE
THAT YOUR MIC IS MUTED AND
REMAINS SO UNTIL RECOGNIZED BY
EITHER ME, PAULETTE, KIM OR THE
SPEAKER AT THAT GIVEN TIME OF
THE MEETING OR AGENDA.
SO WE'LL NOW MOVE INTO THE FIRST
AGENDA ITEM, WHICH WILL BE THE
DIRECTOR'S REPORT GIVEN TO US BY
DR. RATHMELL.
KIM?
>> GREAT.
THANK YOU VERY MUCH.
REALLY GLAD TO BE HERE AND
EXCITING TO BE ON THIS SIDE OF
THINGS.
I HAVE BEEN A BSA MEMBER SO I
HAVE GOTTEN TO SEE PART OF YOUR
WORK IN ACTION AND EXCITING TO
SEE WHAT THIS MEETING HOLDS.
I WANT TO SAY FIRST, IT HAS BEEN
AN EXCITING SIX WEEKS THAT I
HAVE BEEN IN THE JOB AND SO I'M
REALLY STILL LEARNING AND
LISTENING AND SO, PART OF THIS
MEETING IS REALLY STILL ME
WANTING TO HEAR FROM YOU.
THAT WILL BE A THEME THROUGHOUT
MY TENURE BUT ESPECIALLY SO
CURRENTLY.
I ALSO HAVE TO SAY THAT MONICA
BERTAGNOLLI HAS BEEN FANTASTIC
IN HER NEW ROLE IN GIVING ME
SOME POINTERS.
I'M SO GLAD SHE'S IN HER ROLE
AND I'M IN MINE AND SHE'S DOING
A GREAT JOB.
AND ANGEL LOAND A DOUG LOWY HASN
FANTASTIC.
THE NEXT SLIDE WILL TELL US WHAT
WE'RE GOING TO DO.
SOME OF YOU KNOW ME BUT MAYBE
SOME NOT.
SO SOME DISCUSSION ABOUT SOME
NEWS AND EVENTS AND FOCUS WILL
BE ON THE BUDGET AND THEN I DO
WANT TO END ON A POSITIVE NOTE,
WHICH IS THAT THE RESEARCH
CONTINUES TO BE FANTASTIC.
SO WE HAVE HIGHLIGHTS TO SHARE.
SO FIRST OFF, IN MOVING INTO
THIS ROLE, I SPENT TIME AS WELL
AS GETTING TO KNOW THE NCI AND
THE HISTORY OF THE NCI.
AS YOU KNOW, IT DATES TO A
LANDMARK EVENT IN 1971 WITH THE
SIGNING OF THE NATIONAL CANCER
ACT THE INTENT OF HOW WE UTILIZE
NATIONAL RESOURCES TO CHANGE
CANCER IS AS A PARTNERSHIP, SO I
WANT TO EMPHASIZE HOW IMPORTANT
IT IS I GET TO KNOW THIS
COMMITTEE AND HEAR FROM ALL OF
YOU.
I ALSO WANT TO JUST MAKE MENTION
BECAUSE WE JUST LOST A LUMINAIRE
IN THE FIELD.
MANY OF YOU PROBABLY KNEW
DR. EDITH MITCHELL.
SHE WAS AN NCI BLUE RIBBON PANEL
MEMBER AND NATIONAL CANCER PANEL
MEMBER OF THE WHITE HOUSE AND
SHE WAS TRAGICALLY LOST TO US
JUST A COUPLE OF WEEKS AGO.
SO A BIG LOSS TO OUR FIELD.
SO A LITTLE BIT ABOUT ME.
SO FOR THOSE WHO DON'T KNOW ME
AT ALL, I'M A PHYSICIAN
SCIENTIST.
I CAME MOST RECENTLY FROM
VANDERBILT UNIVERSITY MEDICAL
CENTER.
MY BACKGROUND IS TRAINING IN
BIOPHYSICS AND REALLY AN
INTEREST IN MOLECULES AND HOW
PATHWAYS GO WRONG IN CANCER.
I RUN A LABORATORY FOR OVER 20
YEARS WITH TRANSLATIONAL
ELEMENTS ALL AROUND QUESTIONS
RELEVANT TO KIDNEY CANCER.
I'M A MEDICAL ONCOLOGIST AND I
TREATED AND SEEN PATIENTS WITH
KIDNEY CANCER FOR THE LAST 20
PLUS YEARS, PARTICULARLY
INTERESTED IN RARE TUMORS OF THE
KIDNEY AND HEREDITARY TUMORS.
WITH THAT BACKGROUND, I ALSO
SPENT A GOOD AMOUNT OF TIME
TRAINING STUDENTS IN MY LAB AND
OTHER SPACES.
FOUND MYSELF INTERESTED IN
TRAINING PROGRAMS.
I BRIEFLY HELPED TO RUN THE
M.D., PH.D. PROGRAM AT UNC
CHAPEL HILL AND THAT COMBINED
EXPERIENCE WAS WHAT LED ME TO
MOVE OVER TO VANDERBILT ABOUT
NOW ALMOST NINE YEARS AGO WHERE
I WAS THE DIVISION CHIEF WHERE I
COULD PUT TOGETHER ALL OF THOSE
COMPONENTS, RESEARCH, CLINICAL
COMPONENTS AND THE EDUCATION.
I ENJOY ADMINISTRATION SO MUCH
SO THAT IN 2021, I WENT BACK AND
GOT MY MASTER'S DEGREE FROM THE
OWEN SCHOOL OF BUSINESS AT
VANDERBILT TO REALLY BE ABLE TO
UNDERSTAND SOME OF THE BUSINESS
OF HEALTH CARE.
MY JOURNEY HAS REALLY MADE ME
WELL PREPARED TO BE IN THIS
ROLE.
SO THAT'S MY CV, ESSENTIALLY.
A LITTLE BIT MORE ABOUT ME IS
THAT I DO REALLY VALUE LISTENING
AND WANT TO HEAR FROM YOU.
I SAID THAT FIVE TIMES TODAY.
I WANT TO DEMONSTRATE THAT IN A
COUPLE OF DIFFERENT WAYS.
FIRST, YOU WILL PROBABLY NOTICE
THERE WILL BE SOME SUBTLE
CHANGES IN THE WAY THIS MEETING
IS ORGANIZED.
SO DR. GRAY AND I WORKED
TOGETHER TO CHANGE SOMETHING SO
THERE IS MORE TIME FOR QUESTION
AND ANSWER PERIODS.
I WILL KEEP MY REMARKS ON THE
BRIEF SIDE SO WE HAVE TIME.
WE ARE ALSO DOING THAT WITH THE
OTHER TALKS AND IN PARTICULAR
WITH THE SPECIAL PRESENTATIONS
THAT WE HAVE.
WE ARE ASKING THEM TO GIVE TIME
FOR THAT THERE IS USUALLY TWO
PRESENTATIONS OF PROGRAMS OF
INTEREST OR PARTICULAR NCI
INVESTIGATORS THAT WE REALLY
WANT YOU TO HEAR FROM.
I HAVE INTENTIONALLY SELECTED
THIS TIME, ONE INTRAMURAL
INVESTIGATOR AT THE MID CAREER
STAGE AND ONE EXTRAMURAL
INVESTIGATOR AT THE MID CAREER
STAGE.
BOTH DOING PHENOMENAL VERY
DIFFERENT WORK.
JUST TO HIGHLIGHT THAT BREADTH
OF WHAT THE NCI REALLY IS.
AND THEN YOU WILL ALSO SEE OTHER
PLACES WHERE I'M LOOKING FOR
SOLICITING INPUT.
I HAVE BEEN PRETTY ACTIVE ON
SOCIAL MEDIA AND I ASKED PEOPLE,
INCLUDING ON TWITTER, TO TELL ME
WHAT THEY THOUGHT AND I GOT
INCREDIBLY VALUABLE FEEDBACK.
IT'S UNSCIENTIFIC, I KNOW THAT,
BUT IT WAS REALLY TERRIFIC.
SO WE'LL CONTINUE TO KEEP TRYING
TO GET INPUT FROM EVERY PLACE WE
CAN.
I LOVE BASKETBALL SO I LIKE TO
USE BASKETBALL ANALOGIES BUT I
LOVE TEAM WORK AND THE CONCEPT
OF HOW VERY DIVERSE A TEAM IS
NECESSARY TO BE TO BE SUCCESSFUL
AND HOW MUCH WE HAVE TO CONSIDER
HOW THE INDIVIDUAL PLAYERS WORK
TOGETHER TO BE ABLE TO MAKE A
TEAM THAT WINS.
SO, THAT'S COLLABORATION, THAT'S
PRACTICE.
THAT'S ROLE DEFINITION AND I
LEARNED MORE THAN MY MANY YEARS
OF PLAYING BASKETBALL OR
WATCHING BASKETBALL ABOUT TEAM
WORK FROM WORKING ON THE CANCER
GENOME ATLAS.
THERE YOU HAVE 300 PEOPLE WITH
ALL VARYING DIFFERENT EXPERTISE
WHO ARE WORKING TOGETHER TO COME
UP WITH A FINAL PRODUCT.
AND THE PICTURE OF THE TANGLED
UP WIRES IS TO SHARE THAT I
REALLY DO LIKE UNTANGLING A GOOD
TANGLE.
NOTHING MAKES ME MORE EXCITED
THAN TO PUT A PATHWAY TOGETHER
AND KNOW WHO TALKS TO WHO IN
WHAT SEQUENCE.
THAT ALSO EXTENDS TO
ORGANIZATIONS WHEN I WAS DOING
THAT MASTER'S DEGREE, MY
FAVORITE CLASS WAS SOMETHING I
DIDN'T EACH KNOW EXISTED,
OPERATIONS.
WITH THAT, THAT'S ME AND THE
DESIRE TO HEAR FROM YOU AND ALSO
TO UNTANGLE SOME GOOD TANGLES --
NEXT SLIDE.
WE'RE GOING TO TALK ABOUT
BUDGET.
SO WE JUST CAME OUT OF THE
BUDGET SUBCOMMITTEE MEETING SO
THOSE OF YOU WHO ARE ON THE
SUBCOMMITTEE, THIS IS GOING TO
BE A HIGHER LEVEL.
YOU WERE DOWN IN THE WEEDS A
LITTLE BIT MORE, BUT NEXT SLIDE.
I THINK IT IS IMPORTANT THAT WE
ALL KNOW WHERE WE ARE AND WHAT
IS GOING ON IN MAKING SOME OF
THE DECISIONS THAT ARE NECESSARY
HERE AT THE NCI.
SO FIRST OF ALL, YOU ALL KNOW
THAT WE STILL DON'T HAVE A
BUDGET BUT HAVE NOT -- HAD A
GOVERNMENT SHUTDOWN THIS YEAR.
SO THREE TIMES SO FAR,
SEPTEMBER, NOVEMBER AND IN
FEBRUARY WE AVERTED HAVING A
SHUTDOWN.
THE NEXT DATE ON OUR CALENDAR IS
MARCH 8, WHICH WILL BE A FULL
HALFWAY THROUGH OUR FISCAL YEAR.
OUR FISCAL YEAR BEGINS OCTOBER 1
AND SO WE ARE WATCHING VERY
CLOSELY TO SEE WHAT HAPPENS IN
MARCH.
I HAVE ANOTHER SLIDE IN A MINUTE
THAT WILL GET TO THAT.
BUT, RUNNING A BUSINESS, WHERE
YOU DON'T KNOW YOUR BUDGET, AS
YOU CAN IMAGINE, IS PRETTY
CHALLENGING.
WE HAVE MADE SOME ASSUMPTIONS
BASED ON WHAT ARE NOT OVERLY
CONSERVATIVE BUT ARE HOPEFULLY
CONSERVATIVE ENOUGH TO BE ABLE
TO CONTINUE TO WAIT ON THE
BUDGET.
WE CAN TALK ABOUT THAT MORE
LATER IF YOU WANT BUT WE ARE
BASICALLY OPERATING UNDER AN
ASSUMPTION THAT THINGS WILL BE
PRETTY MUCH LIKE THEY WERE LAST
YEAR.
NEXT SLIDE.
SO, WHEN AND HOW DOES THIS
DECISION GET MADE?
WE LIVE IN A VERY COMPLICATED
ECOSYSTEM.
THE APPROPRIATIONS FROM CONGRESS
HAVE TO COVER A HUGE PART OF THE
NATIONAL LANDSCAPE, NOT
SURPRISING.
WE THINK THAT CANCER IS A VERY
IMPORTANT PART BUT IT ALSO
INTERCONNECTS WITH OTHER
COMPONENTS.
AT THE LAST CONTINUING
RESOLUTION, ACTUALLY TWO BEFORE,
IT WAS SPLIT SO WE HAVE NOW
SEPARATE APPROPRIATIONS BILLS.
SO ON MARCH 1, THE FIRST SET
WILL BE UP FOR, HOPEFULLY,
GETTING A BILL PASSED.
AND WE ARE IN THE SECOND SET.
YOU CAN SEE WHO THEY ARE IN
WITH.
WE ARE IN WITH COMMERCE,
DEFENSE, HOMELAND SECURITY, THE
OFFICE OF THE INTERIOR, THE
LEGISLATIVE BRANCH, ET CETERA.
SO THAT IS OUR TRAUNCH OF
APPROPRIATIONS THAT WILL ALL BE
CONSIDERED IN BULK.
SO HOPEFULLY, ON MARCH 8, WE'LL
GET A BUDGET.
NEXT SLIDE.
HOW DO WE SPEND OUR BUDGET?
THIS IS A CONSISTENT BREAKDOWN
OF WHAT WE DO OVERALL.
WE USUALLY SPEND ROUGHLY
THREE-QUARTERS ON EXTRAMURAL
GRANTS.
SO THE MAJORITY IS RESEARCH
PROJECT GRANTS, TRADITIONALLY
RO1s.
ABOUT 8% OF OUR BUDGET GOES TO
CENTERS AND SPORES.
SO THE CANCER CENTER PROGRAM IS
A MAJOR VERY IMPORTANT PART OF
OUR OVERALL PORTFOLIO 1/4 GOES
TO INTRAMURAL RESEARCH, RESEARCH
MANAGEMENT AND SUPPORT AND
BUILDINGS AND FACILITIES.
NEXT SLIDE.
THERE ARE A COUPLE OF NUMBERS
FOR YOU TO HAVE IN MIND.
LAST YEAR'S BUDGET, FY23, WAS
ROUGHLY 7.3 BILLION DOLLARS.
SO IF WE LOOK AT FY24, THE WAY
THE PROCESS WORKS IS THE NCI,
BECAUSE OF THE 1971 NATIONAL
CANCER ACT, HAS THE ABILITY TO
PUT FORWARD A PROFESSIONAL
JUDGMENT PROPOSAL.
SO FIRST INCREASING AT LESS THAN
THE OVERALL COST OF INFLATION,
FOR MANY, MANY YEARS, SO WE ARE
ALREADY BEHIND, AND WE'RE BEING
ASKED TO DO A LOT OF NEW THINGS.
THINGS WE REALLY WANT TO DO TO
IMPROVE HEALTH CARE IN THE
CANCER ARENA.
THE WHOLE PROCESS HAPPENS AGAIN
FOR THIS YEAR, WE ARE PLANNING
FOR NEXT YEAR FOR FY25, STARTING
OCTOBER 1 OF' 24.
AND THE PROFESSIONAL JUDGMENT
BUDGET BASED ON INFLATION AND
COSTS THAT ARE INCURRED AND I
HAVE A LITTLE BIT OF INFORMATION
ON THE NEXT SLIDE.
ESTIMATES THAT IT WILL CONTINUE
TO INCREASE, NOT SURPRISING.
SO THE CURRENT REFLECTION OF THE
PROFESSIONAL JUDGMENT BUDGET IS
11 BILLION DOLLARS.
WE ARE WAITING TO SEE WHAT THE
PRESIDENT'S PROPOSAL WILL BE,
THAT WILL COME LATER THIS SPRING
AND THEN SOME TIME A WAYS FROM
NOW BEFORE WE FIND OUT WHAT OUR
BUDGET WILL BE FOR FISCAL YEAR
'25.
NEXT SLIDE.
SO, THOSE NUMBERS, THE 9 BILLION
AND 11 BILLION, PROFESSIONAL
JUDGMENT BUDGET PROPOSAL, I
WOULD ENCOURAGE YOU TO TAKE A
LOOK AT WHAT GOES INTO THAT,
THIS WEBSITE ON THE BOTTOM LEFT
IS A DESCRIPTION OF WHY THOSE
NUMBERS CAME TO BE AND WHERE
THEY COME FROM.
THERE ARE MANY THINGS THAT WE
WOULD DO IF WE HAD ENOUGH MONEY,
PARTICULARLY AROUND CLINICAL
TRIALS AND PARTICULARLY AROUND
CANCER DATA AND USING DATA TO
BEST SERVE OUR COMMUNITIES.
NEXT SLIDE.
I WANT TO ASSURE YOU, IN SPITE
OF ALL OF THESE HEADWINDS AND
THIS IS NOT COMPLETELY NEW,
ALTHOUGH IT FEELS TITER THAN IN
PRIOR YEARS, THAT THE NCI HAS
BEEN FUNDING EFFECTIVELY FOR
EXTRAMURAL AWARDS.
THIS SHOWS OUR FUNDING HISTORY
TO FY23.
ON THE LEFT IS IN DOLLARS.
SO YOU CAN SEE THAT ENACTED
AWARDS THAT WERE GOING OUT,
INCLUDING MOONSHOT MONEY SHOWN
IN YELLOW, BUT IS INCREASING
YEAR-OVER-YEAR.
SO WE ARE SENDING MORE MONEY OUT
THE DOOR.
IN A SLIDE IN A MINUTE, SOME
GRANTS ARE GETTING BIGGER IN
SIZE.
BUT THE TOTAL NUMBER OF AWARDS
IS ALSO GOING UP.
YOU CAN SEE THAT ON THE RIGHT IN
THE BLUE BARS IS THE EASIEST ONE
TO LOOK AT.
ALL NCI AWARDS, BUT TRUE FOR THE
OTHERS AS WELL, ARE INCREASING.
WE KNOW THERE ARE INVESTIGATORS
IN THE COMMUNITY WHO NEED TO DO
WORK THAT IS VITAL TO THE WHOLE
NATIONAL EFFORT OF THE NCI.
SO, THE DIRECTORS BEFORE ME HAVE
ALSO HAD A REAL MANDATE TO
CONTINUE TO GROW THIS
ENTERPRISE.
NEXT SLIDE.
SO, MORE GRANTS GOING OUT THE
DOOR BUT THEY ARE BIGGER.
THIS IS JUST TO GIVE YOU SOME
PERSPECTIVE ABOUT HOW MUCH
BIGGER THE GRANTS ARE STARTING
TO BECOME.
WE COULD LOOK AT IT IN LOTS OF
DIFFERENT MECHANISMS BUT OUR
BULK MECHANISM, 25-30% OF OUR
GRANTS BEING IN THE RO1 POOL,
THE RO1 MODULAR GRANT THAT WE
ALL PROBABLY STARTED OUT WITH A
LONG TIME AGO, USED TO BE THE
NORM.
250,000 DOLLAR DIRECT COST.
IN 2012, 63% OF GRANTS WERE
COMING IN AS MODULAR.
THAT HAS BECOME REALLY NOT A
SUSTAINABLE NUMBER FOR FOLKS AND
ONLY 17% OF GRANTS ARE COMING IN
MODULAR.
83% ARE NON-MODULAR.
AND THEY ARE NOT COMING IN AT
260,000 DOLLARS.
THEY ARE COMING IN AT 450 AND
490.
BECAUSE 500,000 IS THE CAP.
SO, IN PUTTING OUT MORE AWARDS,
IT COSTS MORE BECAUSE EACH GRANT
IS A BIGGER CHUNK.
NEXT SLIDE.
SO AS WE TRY TO GUESS WHAT OUR
BUDGET MIGHT LOOK LIKE, IF OUR
BUDGET COMES IN FLAT T WILL BE
VERY, VERY HARD TO MAINTAIN THE
THINGS THAT WE'RE DOING HERE
TODAY.
FIRST OF ALL, A FLAT BUDGET
ISN'T FLAT.
WE KNOW ABOUT INFLATION.
WE ALL KNOW ABOUT THE INCREASE
COSTS POSTDOC SALARIES AND OTHER
STAFF SALARIES.
WE ALL KNOW THAT THERE ARE ARE
EXPENSES THAT WILL JUST GO UP.
OUR AVERAGE NCI INCREASE OF
MANDATED EXPENSES, THINGS AROUND
CYBERSECURITY AND BASIC
INFRASTRUCTURE, IS 100 MILLION
DOLLARS.
JUST TO MAINTAIN THE FUNDING AT
THE CURRENT LEVEL FOR RO1s AND
TO PAY OUT EXISTING AWARDS AT
100%, WOULD ADD 250 MILLION
DOLLARS TO OUR BUDGET.
SO, EVEN MODEST INCREASES ARE
ESSENTIALLY FLAT.
IF WE COME IN AT FLAT, THIS IS
WHAT I JUST HAVE TO HAVE YOU
KNOW.
I DON'T WANT TO DO ANY OF THESE
THINGS.
BUT, THE CUTS THAT YOU MAY BE
FEELING AT YOUR INSTITUTIONS
ALREADY THAT ARE ANTICIPATORY,
WE WILL HOPEFULLY NOT HAVE TO
BUT MIGHT HAVE TO DECREASE THE
PAY LINE FOR NEW AWARDS OR NOT
FUND NONCOMPETING AWARDS AT
THEIR FULL BUDGET 100%.
THE CANCER CENTER SUPPORT GRANTS
HAVE NOT BEEN TOUCHED
HISTORICALLY, USUALLY, BUT WE
MAY HAVE TO CHANGE PLANS TO
INCREASE THE NUMBERS OR DECREASE
THE AMOUNT IN 91 COMPETING CCSG
AWARDS.
I'M JUST TELLING YOU WHAT LEVERS
I HAVE TO PULL.
I'M NOT TRY TO FRIGHTEN PEOPLE,
JUST LET YOU ALL KNOW WHAT WE
CAN DO IF WE HAVE TO.
THIS ONE WOULD HURT ME THE MOST.
CANCER TRAINING AWARDS.
THOSE ARE NOT RENEWABLE.
INDIVIDUAL CANCER TRAINING AWARD
IS FIVE YEARS AND THAT'S ALL.
SO IT'S EASIER PLACE TO MAKE A
CUT.
BELIEVE ME, THAT ONE WOULD HURT
MY SOUL.
BUT SPORES ARE SIMILAR TO
CCSGs, OTHER BIG PROGRAMS
WHERE WE MAY JUST HAVE TO MAKE
HARDER CHOICES.
AND I WANT TO LET YOU KNOW THAT
OUR PHILOSOPHY HERE, AND I
MAINTAIN, IS THAT WHEN WE MAKE
CUTS THAT HIT THE EXTRAMURAL
PROGRAM, THEY ARE COMMENSURATELY
TAKEN ON THE INTRAMURAL PROGRAM.
SO IT'S ACROSS-THE-BOARD.
SO, THIS IS MY WORST SLIDE.
NEXT SLIDE.
SO, IF YOU WANT MORE
INFORMATION, WE HAVE LOTS OF IT.
AND IF YOU WANT TO TAKE A LOOK
AT DETAILS ABOUT PAY LINES AND
BUDGETS AND HOW WE COME TO SOME
OF THESE NUMBERS, WE HAVE LOTS
OF RESOURCES AND YOU HAVE SHOULD
ALL THESE SLIDES.
NEXT SLIDE.
OKAY, SO, I JUST GOT HERE AND
MIGHT BE SAYING OH, MY GOSH, WHY
IS SHE STILL HERE SIX WEEKS IN
AND THIS IS THE JOB.
SO, LET ME JUST TELL YOU -- I
CAME TO VANDERBILT TO RUN THE
HEMATOLOGY AND ONCOLOGY
DIVISION.
I NEVER EXPECTED I MIGHT BECOME
A DEPARTMENT OF MEDICINE CHAIR.
IN JANUARY OF 2020, AND IN
FEBRUARY OF 2020, I WAS VERY
INTERESTED IN TRYING TO HELP
MOVE SOME THINGS BUT IT WAS
HARD.
AND IT GOT A WHOLE LOT EASIER IN
MARCH OF 2020.
NOW, THE DEPARTMENT OF MEDICINE,
THIS IS COVID.
THE DEPARTMENT OF MEDICINE
COVERS URGENT CARE CLINICS,
WALK-IN CLINICS, WE HAD A
WALGREENS GROUP.
WE HAD EXTERNAL HOSPITALS.
WE HAD PRIMARY CARE.
WE HAD HOSPITAL MEDICINE.
WE HAD INTENSIVE CARE AND
PALLIATIVE CARE WITH ALL THE
SPECIALTIES, PULMONARY AND ID.
SO COVID WAS OUR DISEASE.
IT WAS THE MOST INTENSE PERIOD
OF MY ENTIRE PROFESSIONAL
EXPERIENCE TO DATE.
AND THE ABILITY TO CHANGE ON A
DIME AND TO HAVE PEOPLE BE
ALIGNED WITH A MISSION AND TO DO
WHAT IT TOOK IN NASHVILLE
TENNESSEE, WAS INCREDIBLE.
IT WAS BREATH TAKING AND IT WAS
SO EXCITING.
AND IN THE END, WHEN IT'S NEVER
QUITE ENDED, BUT WHEN COVID
STARTED TO RECEDE, WE HAD THE
OPPORTUNITY TO STOP AND SAY,
WHAT THINGS HAVE WE DONE HERE WE
WANT TO KEEP?
AND WE LEARNED THAT THERE WERE
LOTS OF OPPORTUNITIES TO KEEP.
AND IN THE END, OUR ABILITY TO
DELIVER CARE, PARTICULARLY TO
THE BROAD AREA AROUND NASHVILLE
WAS ENORMOUSLY PRESERVED AND
EXPANDED.
AND WE LEARNED THAT WE WERE ABLE
TO DELIVER CARE MUCH MORE
EFFICIENTLY IN SOME OF OUR
COMPONENTS OF THE MAIN CAMPUS
AND WE WERE ABLE TO COLLABORATE
WITH TEAMS THAT PREVIOUSLY HAD
NEVER HAD ANY OPPORTUNITY TO
INTERACT WITH EACH OTHER.
AND THE WHOLE PROGRESS WAS
IMPROVED DRAMATICALLY BECAUSE OF
THIS REALLY INTENSE CRISIS.
AND YOU ALL LIVED THIS
EXPERIENCE AS WELL AND PROBABLY
HAVE SOME OUTCOMES.
THIS FEELS THE SAME.
AND PEOPLE ARE ALSO LINING UP
AND WILLING TO REALLY THINK
CAREFULLY ABOUT WHAT WE ARE
DOING, HOW WE ARE GOING TO
MANAGE, AND WE WILL HAVE A
BUDGET SOME DAY AND WE WILL BE
ABLE TO CARRY ON THE MISSION OF
THE NCI WITH THAT BUDGET AND IN
SOME THINGS WE DO, WE WILL DO
BETTER.
AND SO, I'M EXCITED TO SEE HOW
THIS GOES.
NEXT SLIDE.
SO, TO DO THAT, WE NEED A
ROADMAP.
I'M A BIG FAN OF THE NATIONAL
CANCER PLAN THAT DR. MONICA
BERTAGNOLLI PUT OUT THIS TIME
LAST YEAR.
THIS ENCOMPASSES WORK WE HAVE
ALWAYS DONE.
THE EIGHT GOALS OF THE NATIONAL
CANCER PLAN ENCOMPASS THE
EXPERIENCE OF CANCER, PREVENTS
CANCER, DETECT CANCERS EARLY,
DELIVER OPTIMAL CARE AND THEN AN
ECOSYSTEM AROUND IT ELIMINATING
EQUALITIES, UTILIZING THE DATA
THAT IS AVAILABLE IN ALL OF
THESE DIFFERENT SPACES AND
COLLABORATING WELL TO USE DATA.
OPTIMIZING THE WORKFORCE SO WE
CAN BEST MEET THE NEEDS OF
PATIENTS AND PROVIDE THE
SCIENTIFIC POWER BEHIND THE
ADVANCES WE MAKE AT THE NCI AND
MOST IMPORTANTLY, MY FAVORITE
PART OF THE NATIONAL CANCER PLAN
IS THE POINT TO ENGAGE EVERY
PERSON, THAT THE WORK THAT WE DO
AT THE NCI IS EVERYONE'S WORK
AND WE REALLY WILL CHANGE CANCER
AND END CANCER AS WE KNOW IT,
WHEN EVERY PERSON IS ENGAGED
FULLY IN THIS OVERALL MISSION.
SO, WITH THAT ROADMAP, NEXT
SLIDE.
WE ALSO NEED A SET OF GOALS.
THOSE GOALS WERE PUT IN PLACE BY
OUR WHITE HOUSE, PRESIDENT BIDEN
REIGNITED THE CANCER MOONSHOT
WITH THE TWO-YEAR ANNIVERSARY
BEING JUST LAST WEEK.
SETTING REALLY BOLD BUT
ACHIEVABLE GOALS.
TO CUT THE CANCER DEATH RATE IN
HALF BY 2027 AND END CANCER AS
WE KNOW IT.
IT'S GOING TO INVOLVE ALL OF OUR
WORK.
THIS IS GOING TO BE
UNDERSTANDING CANCER BETTER.
ALLOWING PEOPLE TO APPROACH A
CANCER DIAGNOSIS WITHOUT AS MUCH
FEAR PREVENTING A LOT OF CANCERS
AND BEING ABLE TO REACH
COMMUNITIES THAT PREVIOUSLY HAVE
NOT HAD THE KINDS OF ACCESS WE
NEED TO DO.
WE CAN USE DATA AND SCIENCE AND
GOOD INVESTIGATIVE SKILLS TO BE
ABLE TO TACKLE WELL.
SO THERE CAN'T EVER BE A BETTER
TIME TO BE ENGAGED IN CANCER
RESEARCH THAN TODAY WHEN WE HAVE
A PRESIDENT AND A WHITE HOUSE
THAT IS THIS BEHIND THE WORK
THAT WE WANT TO DO AND NIH
DIRECTOR, WE KNOW IS PASSIONATE
ABOUT CANCER AS WELL.
AND AN AMAZING NUMBER OF TOOLS
TOGETHER TO BE ABLE TO ADDRESS
THIS MAJOR PROBLEM.
NEXT SLIDE.
SO HOW DO WE BE WE ARE MAKING
IMPROVEMENTS?
WHEN FEWER PEOPLE DIE FROM
CANCER.
I WANT TO PUT A SLIDE UP FROM
THE SEER DATABASE THAT SHOWS
DECLINE IN LUNG CANCER.
YOU CAN SEE DECLINES IN BREAST
CANCER.
A RECENT PUBLICATION I DIDN'T
HAVE TIME TO PUT IN MY TALK
TODAY, SHOWS IMPROVEMENTS IN
MORTALITY THAT COME NOT ONLY
FROM PREVENTION AND EARLY
DETECTION BUT ALSO FROM
MANAGEMENT OF METASTATIC DISEASE
AND PEOPLE ARE ALSO LIVING
LONGER, INCLUDING IMPROVEMENTS
IN COLORECTAL MORTALITY AS WELL.
I'M JUST GOING TO GIVE YOU A
COUPLE OF GOOD WINS.
NEXT SLIDE.
SO WE JUST ANNOUNCED A COUPLE OF
WEEKS AGO, THE NETWORK.
THIS IS IN THE NATIONAL CANCER
PLAN THEME OF EARLY DETECTION.
SOCIAL EARLY DETECTION CAN ONLY
HAPPEN WHEN PEOPLE HAVE ACCESS
TO THE TOOLS TO BE DOING THE
EARLY DETECTION TESTING
NECESSARY.
SO THIS IS A SELF COLLECTION FOR
HPB TESTING TO IMPROVE SERVING
CALL CANCER PREVENTION.
THAT'S THE SHIP TRIAL NETWORK.
IT'S INTENTIONALLY DEVELOPED
WITH COLLABORATION FROM FEDERAL
AND PRIVATE SECTOR PARTNERS WITH
PATIENT ADVOCACY GROUPS AS WELL
ADDRESSING DISPARITIES.
THE GROUPS THAT WERE SELECTED TO
PILOT THE NETWORK ALL HAVE
POPULATIONS WHO NEED TO HAVE
ACCESS TO TESTING FOR HPV SO
THEY CAN BE RISK ASSESSED AND
MANAGED EFFECTIVELY BEYOND THAT.
AND THIS IS A TRIAL THAT I'M
REALLY EXCITED ABOUT BECAUSE IT
ENGAGES THE COMMUNITY DIRECTLY.
THE OTHER COMPONENT IS ENGAGE
EVERY PERSON, IS RIGHT HERE.
THERE ARE SO MANY BIG WINS.
I COULD SPEND MY WHOLE TALK
TELLING YOU ABOUT NEW ADVANCES
SINCE THE LAST MEETING.
I'M NOT GOING TO GO THROUGH ANY
OF THESE.
I WANT TO POINT OUT THAT WE DO
TRY TO KEEP UP WITH SOME OF THE
HIGHER LEVEL THINGS ON A
CANCER.GOV BLOG.
SO IF YOU'RE INTERESTED OR WANT
SOME GOOD STORIES TO TELL,
THAT'S A GOOD PLACE TO GO.
NEXT SLIDE.
ANOTHER COUPLE OF THINGS THAT I
JUST WANT TO SHARE.
THIS ONE IS DATA THAT JUST COMES
FROM TAKING A LOOK AT OUR FUNDED
NCI CANCER EPIDEMIOLOGY COHORTS.
SO, THIS IS JUST COMPARING THE
PATIENTS OR INDIVIDUALS WHO ARE
A PART OF THE COHORTS FROM
HISTORICAL COHORTS TO MORE
RECENT COHORTS.
AND WHEN WE THINK ABOUT THE
NATIONAL CANCER PLAN AND ITS
GOAL TO ELIMINATE INEQUITIES, WE
CAN SEE THAT MODERN NCI FUNDED
CANCER EPIDEMIOLOGY COHORTS HAVE
A MUCH BROADER DISTRIBUTION OF
PATIENTS.
YOU CAN SEE THE SHIFT FROM
PREVIOUSLY 63% WHITE AND VERY
FEW RACIAL OR ETHNIC MINORITIES,
TO NOW BEING NICELY DIVERSE
GROUP THAT HAS OCCURRED PARTLY
INTENTIONS AND PARTLY
ORGANICALLY.
SO WE WILL HAVE BETTER DATA AND
BETTER ABLE TO SERVE ALL OF OUR
POPULATIONS.
ANOTHER EPIDEMIOLOGY STUDY TOOK
A LOOK AT CIGARETTE SMOKING.
THIS WAS AN INTERESTING
PARTNERSHIP BETWEEN THE NCI AND
THE U.S. CENSUS BUREAU TO TAKE A
LOOK AT CIGARETTE SMOKING AMONG
TEENAGERS.
IN THE ARENA OF PREVENTION, AND
ALSO MAXIMIZING DATA UTILITY,
YOU CAN SEE THAT ONE OF THE
MAJOR DRIVERS OF CANCER IS
UNDERGOING A GENERATIONAL
CHANGE.
AND WITH TEENAGERS NOT SMOKING,
WE KNOW THAT THEY ARE LESS
LIKELY TO TAKE UP CIGARETTE
SMOKING LATER IN LIFE.
WE CAN EXPECT THAT IN THE NOT
THAT DISTANT FUTURE, OUR
DEMOGRAPHICS OF CANCERS ARE
GOING TO SHIFT BECAUSE OF THIS
CHANGE.
NOW, YOU CAN ALSO SEE A REALLY
INTERESTING LINE, GOLD AND
YELLOW LINES ARE THE DOWNWARD
CIGARETTE SMOKING BUT AT THE END
IN THE TEAL AND BLUE IS VAPING.
SO THERE IS A WHOLE SHIFT IN
WHAT PEOPLE ARE DOING IN TERMS
OF THEIR EXPOSURES.
AND WE WILL HAVE TO FOLLOW WHAT
IT DOES AND WE WILL BE THERE TO
KEEP UP WITH IT.
NEXT SLIDE.
SO, WITH THAT, I'M GOING TO
CLOSE.
THE TAKEAWAYS ARE THE BUDGET
OUTLOOK IS TIGHT.
THIS IS A AI-GENERATED IMAGE OF
A PRESSURE COOKER TO POINT OUT
THAT WE HAVE SOME HEADWINDS.
WE HAVE SOME CHALLENGING
SITUATIONS AND THAT IS WHERE IT
WILL FORCE US TO THINK
CREATIVELY AND THOSE CREATIVE
SOLUTIONS ARE GOING TO BE THE
FUTURE OF WHAT WE DO HERE AT THE
NCI.
IT WILL INVOLVE COLLABORATION.
IT WILL INVOLVE EFFICIENTLY
STEWARDING RESOURCES AND REALLY
THINKING ABOUT WHAT WE CAN DO.
OUR WORK WILL BENEFIT PEOPLE,
PATIENTS AND FAMILIES THAT ARE
TOUCHED BY CANCER.
AND WE USE THE NATIONAL CANCER
PLAN AS OUR ROADMAP.
THE MOONSHOT AS OUR GOALPOST AND
WITH THAT, WE CAN END CANCER AS
WE KNOW IT.
AND EVERYONE HAS A ROLE.
SO I WANT TO THANK YOU AND I
HOPE I SAVED TIME FOR QUESTIONS
AND I'D LOVE IT HEAR FROM YOU.
>> THAT WAS FANTASTIC,.
THAT WAS A GREAT INAUGURAL NCAB
DIRECTOR'S REPORT.
VERY GOOD.
ANY QUESTIONS FROM THE
COMMITTEE?
I CAN START WITH - YOU CAPTURED
MY THOUGHTS AND IMAGINATION WITH
YOUR COMMENTS RELATED TO
CLINICAL TRIALS AND DATA.
AND BUT YOU KNOW, WE WANT TO
SORT OF INTEGRATE THAT WITH
ACCESS, RIGHT?
SO I'D LOVE TO GET YOUR THOUGHTS
ON SORT OF THE NCI'S DIRECTION
AND EXPANDING AND EXTENDING
CLINICAL TRIALS.
>> ABSOLUTELY.
SO, I WAS LOOKING TO SEE WHERE
IT LANDED ON THE COMMITTEE.
WE ARE GOING TO TALK ABOUT THAT
A LITTLE BIT LATER, LATE IN THE
AFTERNOON.
SO, THERE IS A LOT -- THAT IS A
BIG QUESTION WITH LOTS OF
DIFFERENT ANSWERS TO GIVE.
BUT, ONE OF THE THINGS THAT
WE'LL TALK ABOUT IS TRYING TO
GET MORE INFORMATION ABOUT WHERE
THE REAL NEEDS ARE AND WHERE THE
NCI HAS OPPORTUNITIES FOR
PARTNERSHIP AND WHERE USING NCOR
OR WORKING WITH THE V.A. OR
WORKING ACROSS VASE SPACES TO
TRY TO MAKE SURE WE CAN MAKE
ACCESS REAL SO WE CAN -- THE
FUNDAMENTAL PROBLEM WE ARE
TRYING TO ADDRESS IS THAT
OUTCOMES ARE POORER IN CERTAIN
REGIONS, RURAL, URBAN CORE,
OTHER COMPONENTS OF AMERICAN
LIFE.
SO, WHAT IS THE PROBLEM WE CAN
ADDRESS AND WHAT IS THE BEST WAY
TO ADDRESS THAT AS A COMMITTEE
I'M PLANNING TO CHARGE?
>> SO THANKS.
AND YOU'RE RIGHT.
I KNOW WE'RE GOING IT HAVE SOME
ADDITIONAL TIME TO CHAT ABOUT
THAT LATER IN THE DAY.
I DO HAVE ONE OTHER QUESTION.
I THINK WE ALL HAVE SEEN ALL OF
THE ACTIVITY AROUND AI AND
MACHINE LEARNING AND LARGE
LANGUAGE MODELS.
OF COURSE IN THE PRIVATE SECTOR
THERE IS JUST TREMENDOUS
ACTIVITY.
SO I WANTED TO GET YOUR THOUGHTS
ON WHAT DO YOU THINK THE ROLE OF
ACADEMIC RESEARCH AND HOW THAT
WILL BE BROUGHT TO BEAR?
I THINK ONE OF THE CHALLENGES
WITH AI, LOOK TAT LIKE A CHILD.
YOU TEACH IT, IT WILL LEARN ONLY
WHAT INFORMATION THAT ITS FED
AND IF IT'S NOT FED ALL OF THE
INFORMATION, THEN THE MODELS MAY
NOT NECESSARILY BE OPTIMAL.
SO I WANTED TO GET YOUR
THOUGHTS.
AND THE WHAT ACTIVITIES ARE
ONGOING INSIDE OF NCI TO HELP
ADDRESS SOME OF THESE ISSUES
WITH THE -- IT'S NOT IN THE
FUTURE.
WE'RE HERE.
>> I AGREE WITH YOU 100%.
IT'S HERE.
I EXPECT IT WILL HAVE THE SAME
IMPACT ON OUR LIVES THAT THE
TRANSITION BEFORE THERE WAS
INTERNET AND THEN AFTER
INTERNET.
AND I CAN'T EVEN QUITE IMAGINE
WHAT IT'S GOING TO BE LIKE 10
YEARS FROM NOW WHEN WE'RE USING
IT WELL.
WHAT I WORRY ABOUT IS THAT THE
HEALTH CARE FIELDS WILL BE SLOW
TO UPTAKE AND BUT THERE IS SO
MUCH ENERGY IN THIS SPACE, I
DON'T THINK THAT THAT WILL BE
THE CASE.
SO, THE NCI HAS SEVERAL WORKING
GROUPS THAT WORK WITHIN IT,
WITHIN OUR CURRENT IT
STRUCTURES, AND BIOINFORMATIC
STRUCTURES WHO ARE WORKING ON
OPPORTUNITIES IN THE AI SPACE.
THIS IS NOT MY ZONE SO I DON'T
HAVE QUITE ALL THE WORDS FOR IT,
BUT THERE ARE THINK TANKS
HAPPENING AROUND THE COUNTRY AND
WE ARE MAKING SURE THAT WE ARE
REPRESENTATIVE OF THOSE THINK
TANKS AND WE HAVE PEOPLE WHO CAN
SHARE WHAT WE ARE DOING AT THE
NCI AND BRINGING THINGS BACK AS
WELL.
CERTAINLY THERE IS A LOT OF
FUNDED RESEARCH GOING ON IN THIS
SPACE, AND A LOT OF EXCITEMENT
AROUND SIMPER THINGS THAT IT CAN
DO IN IMAGE ANALYSIS.
BUT ALSO GETTING INTO NATURAL
LANGUAGE PROCESSING AND BEING
ABLE TO UTILIZE THESE LARGE
DATASETS.
AND THEN THE OTHER THING I'LL
SAY IS, THIS IS NOT AN
NCI-UNIQUE THING.
IT WILL BE PARTNERSHIPS WITH THE
GREATER NIH, WHICH I'M REALLY
EXCITED ABOUT.
MONICA IS A HUGE CHAMPION OF
DATA UTILIZATION DATA ACCESS.
AND USING BIG DATA TO ANSWER
QUESTIONS.
AND SO SHE, I'M SURE, WILL BE A
CHAMPION FOR BRINGING THESE
KINDS OF DATASETS TOGETHER.
>> MAYBE A TOPIC FOR FUTURE
MEETING FOR SURE.
SORT OF INTERNAL INITIATIVES.
FOR ME, I'M NOT AS AFRAID OF
SLOW UPTAKE.
I'M AFRAID THERE WILL BE SWIFT
UPTAKE OF SUBOPTIMAL APPROACHES.
THAT'S WHAT SCARES ME THE MOST.
ISABEL?
MAKE SURE YOU'RE UNMUTED.
>> I APPRECIATE YOU BRINGING UP
THIS TOPIC BECAUSE THIS IS
ALREADY A HUGE SUBJECT WITH
PATIENT ADVOCATES WHO ARE EVEN
NOW AS WE SPEAK, CRAFTING AN AI
PATIENT BILL OF RIGHTS BECAUSE
THEY ARE REALLY CONCERNED ABOUT
LOSING CONTROL OF THEIR DATA, OF
IT BEING USED, ABUSED,
ET CETERA.
SO WHAT I ENCOURAGE YOU TO DO,
EVEN WITH INTERNAL COMMITTEES,
TO PLEASE BRING THOSE VOICES TO
THE TABLE BECAUSE THAT'S WHAT
THEY WANT.
THEY WANT A VOICE AT EVERY TABLE
THAT IS GOING TO BE UTILIZING
THEIR DATA AND THEY WANT IT TO
BE DONE FOR THE GREATER GOOD AND
FOR THEIR OWN GOOD HEALTH.
AND THEY FEAR THAT WITHOUT BEING
THERE, PEOPLE ARE GOING TO MISS
SOME VERY IMPORTANT ISSUES THAT
NEED TO BE ADDRESSED.
SO, I INVITE YOU, I'LL SEND YOU
MY GROUP.
>> OKAY.
>> THANK YOU.
BECAUSE THOSE OF US OUTSIDE ARE
VERY CONCERNED ABOUT THIS ISSUE.
>> OKAY.
UNDERSTOOD.
>> I GUESS ONE OTHER QUESTION, I
DON'T SEE HANDS ON THE FIRST
PAGE.
I'M TRYING TO MAKE SURE I SCAN
THE ENTIRE.
>> I THINK THERE IS SOME CHATS.
>> -- VIRTUAL TABLE.
THERE IS A LOT OF ACTIVITY IN
THE CHAT.
JUST ONE OTHER QUESTION.
WHAT ARE YOUR THOUGHTS ABOUT
SORT OF THE INTEGRATIONS AND
DISCUSSIONS WITH CMS AND TRYING
TO UNDERSTAND PAY AND
REIMBURSEMENT AND ACCESS?
>> I WORRIED ABOUT THAT A LOT
WHEN I WAS A DEPARTMENT OF
MEDICINE CHAIR SO I WORRY ABOUT
IT A LOT HERE AS WELL.
DO I HAVE MORE INTEL ON THAT?
THAT ANSWER IS NO.
NOT YET.
I'LL GO WITH NOT YET BECAUSE
IT'S STILL EARLY.
I THINK THAT WHEN WE LOOK AT
WHAT THE END GOAL OF THIS IS,
WE'RE GOING TO MAKE REALLY BIG
END ROADS WITH RESEARCH, BASIC
SCIENCE AND TRANSLATION AND
DISCOVERY ABOUT YOU THE BIGGEST
ONES WILL BE WITH ACCESS TO
CARE.
AND WITH A HEALTH CARE SYSTEM
THAT ALLOWS OUR PATIENTS TO GET
THE CARE THEY NEED WHEN THEY
NEED IT, WHERE THEY NEED IT.
SO, WE WANT TO BE PARTNERS IN
THAT TO EVERY BIT WE CAN.
>> SO WITH MOONSHOT AND THE
CANCER CABINET, PERHAPS
OPPORTUNITIES ARE THERE TO
ENGAGE WITH THE WHITE HOUSE AND
BRING NCI CLOSER TO THE TABLE IN
THOSE DISCUSSIONS.
ADDITIONAL QUESTIONS?
>> YOU CAN TAKE A COUPLE FROM
THE CHAT.
>> I CAN DO THAT.
SO, CAN WE TALK ABOUT -- HOWARD
FINGER HAD A COMMENT ABOUT BEING
IMPRESSED WITH THE FUNDING
ANNOUNCEMENT ABOUT PRAGMATIC
CLINICAL TRIALS AS NCAB
UNDERSTANDS THIS EXEMPLIFIES OUR
GOALS TO INNOVATIVE THOUGHT
MECHANISMS TO EXPAND ACCESS AND
OPPORTUNITY TO CONDUCT RESEARCH
ABOUT RESEARCH.
HOWARD, DO YOU WANT TO EXPAND ON
THAT?
>> I MEAN, AS I READ THAT
ANNOUNCEMENT LAST YEAR, IT
REALLY IMPRESSED ME.
IT WAS KIND OF AN INNOVATIVE
BECAUSE SOMETIMES WE KNOWLEDGE
ABOUT PRAGMATIC IN TERMS OF
COSTS AND MONEY AND THIS AND
THAT.
THE WAY THEY DESCRIBED IT IN THE
ANNOUNCEMENT, IT REALLY WAS
TRYING TO FOCUS ON PRAGMATIC TO
ACHIEVE AND HELP UNDERSERVED
POPULATIONS.
AND -- I JUST WANTED TO SORT OF
CLARIFY THAT AND WHEN WE ARE
GOING TO GET MORE LEARNINGS
ABOUT THE APPROACH TO USE THE
CLINICAL TRIAL ENTERPRISE IN A
WAY THAT IS INNOVATIVE AND
INVITES MORE, EVEN GRANT SUPPORT
FOR IT IF NEEDED.
>> YES, I THINK THAT --
PRAGMATIC TRIALS CAN MEAN A LOT
OF DIFFERENT THINGS.
I LOVE THEM BEST WHEN IT IS LIKE
COMMON SENSE CLINICAL TRIALS.
AND TRIALS THAT MEAN SOMETHING
TO PEOPLE IMMEDIATELY.
SO I THINK THAT IS WHAT THE
CURRENT ROUND SPEAKS TO ME WITH.
HERE AGAIN IT IS INTERESTING
COMING FROM SPENDING FOUR YEARS
A LITTLE BIT OUTSIDE OF CANCER
IN THE DEPARTMENT OF MEDICINE
WHERE A LOT OF OTHER ARENAS USE
PRAGMATIC TRIALS A LOT MORE
OFTEN TO MAKE SORT OF MEANINGFUL
DISCOVERIES THAT WILL CHANGE
PATIENT CARE FOR THE BETTER.
SOMETIMES THEY CAN SEEM ALMOST
LIKE MUNDANE QUESTIONS BUT IF
NOBODY KNOWS THE ANSWER, NOBODY
IS DOING THE RIGHT THING.
I THINK THOSE KINDS OF RESEARCH
AND THEN I THINK THE RESEARCH
ABOUT RESEARCH TO ME, I DON'T
KNOW IF YOU MEAN IMPLEMENTATION
RESEARCH OR RESEARCHING HOW WE
BEST ASK SOME OF THESE
QUESTIONS, THOSE ARE ALL SUPER
IMPORTANT.
>> AND I THINK STAYING WITH THE
THEME OF CLINICAL TRIALS, I
THINK ANOTHER THING THAT WOULD
BE GREAT IS TO MAYBE AN UPCOMING
MEETING, GET UPDATES ON NCOR.
WE ALL KNOW IT'S AN AMAZING
PROGRAM AND IT WOULD BE GREAT TO
SEE WHERE THINGS ARE NOW AND
WHAT THE PLANS ARE FOR THE
FUTURE.
THAT MIGHT BE A GOOD FUTURE
TOPIC.
>> SOUNDS GOOD.
>> SO WE'LL MOVE ON TO THE NEXT
AGENDA ITEM.
THAT IS LEGISLATIVE REPORT.
>> I WANT TO REMIND EVERYONE
THERE IS A DETAILED LEGISLATIVE
UPDATE IN YOUR MEETING
MATERIALS.
WE ARE GOING TO FOCUS ON THE
HIGHLIGHTS TODAY.
I'D LIKE TO FOCUS ON WHAT IS
HAPPENING IN CONGRESS RIGHT NOW,
THE DEADLINES AND LEGISLATIVE
COMPLICATIONS.
IT IS A TENSE TIME ON CAPITOL
HILL.
CONGRESS IS FEEL CAN THE
PRESSURE OF A LOT OF DEADLINES
CONVERGING AT ONCE AND SOME
PRETTY SPECTACULAR IMPLOSIONS OF
LEGISLATION.
IT'S NOT AN EASY WEEK IN
CONGRESS.
POTENTIAL OUTCOMES OF FY24
APPROPRIATIONS IS ON EVERYONE'S
MIND.
I WANT TO WALK THROUGH SOME OF
THE POSSIBILITIES.
AND THEN REALLY TALK ABOUT
CONGRESSIONAL ENGAGEMENT AND WHY
IT'S SO IMPORTANT THAT THE
CANCER RESEARCH COMMUNITY BE
HEARD.
NEXT SLIDE.
SO I HAVE SHOWN THE BOARD THIS
SLIDE BEFORE.
UNFORTUNATELY, WE ARE STILL IN
THE EXACT SAME SPOT WITH, WE ARE
HERE BETWEEN STEPS TWO AND 3.
THE APPROPRIATIONS SUBCOMMITTEES
ARE STILL WORKING ON TRYING TO
GET APPROPRIATIONS BILLS READY
TO GO AND CONFERENCE BETWEEN THE
HOUSE AND SENATE.
UNFORTUNATELY, IT'S 131 DAYS
INTO THE FISCAL YEAR.
OUR SUBCOMMITTEES GOT THEIR
ALLOCATIONS.
12 SUBCOMMITTEES, A TOP LINE
SPENDING NUMBER, THE 12
SUBCOMMITTEES GET AN ALLOCATION.
THEY GOT THEIR ALLOCATION ABOUT
TWO WEEKS AGO.
SO WHY IS EVERYTHING SO LATE?
AS YOU MAY REMEMBER, THERE WAS A
FISCAL RESPONSIBILITY ACT
PASSED.
CAN WE HAVE THE NEXT SLIDE?
THE FISCAL RESPONSIBILITY ACT,
THERE WAS A LOT OF DISAGREEMENT
ABOUT WHETHER IT SUSPENDED THE
DEBT LIMIT AND SET BUDGET CAPS
FOR FY24 AND 25.
THE ISSUE OF DISAGREEMENT WAS
WHETHER THOSE CAPS WERE THE
AGREED UPON NUMBERS, WHICH
THREE-FOURTHS OF THE DECIDING
AUTHORITY FIGURES IN THE HOUSE
AND SENATE AGREED THAT THAT WAS
THE DEAL.
THE HOUSE GOP DECIDED THOSE WERE
CEILINGS AND NOT FLOORS.
SO THEY CHOSE TO MARK THEIRS UP
TO A LOWER LEVEL, WHICH CREATED
A LACK OF SYNCHRONIZATION WITH
THE HOUSE AND SENATE
APPROPRIATIONS COMMITTEES.
AND SO EVEN THOUGH THAT HAS BEEN
RESOLVED NOW, AT LEAST THE TOP
LINE, THE DIVIDE LINGERED FOR
6-7 MONTHS AND IT WAS A REAL
SLOW DOWN.
WHAT WE ARE SEEING HERE IN TERMS
OF LEGISLATIVE COMPLICATIONS,
THERE WERE PROCEDURAL VOTES WITH
HOUSE SPEAKER MIKE JOHNSON HAD A
REALLY ROUGH WEEK.
HE HAS A TWO-VOTE MAJORITY NOW.
SEVERAL MEMBERS WHO ARE NOT ABLE
TO BE IN CONGRESS RIGHT NOW.
STEVE SKA LEASE, THE MAJORITY
LEADER IS ON MEDICAL LEAVE, AND
CAUSING A TIGHT SQUEEZE FOR
HOUSE REPUBLICANS.
THERE WAS A VOTE FOR AN
IMPEACHMENT OF HOMELAND
SECRETARY THIS WEEK THAT WAS
EXPECTED TO BE A WIN.
IT WAS NOT.
AND THEN A STAND ALONE ISRAEL 8
BILL WAS ALSO DEFEATED.
THE HOUSE GOS GOING TO HAVE TO
RELY ON DEMOCRATS TO PASS THE
FY24 SPENDING BILLS, WHICH IS
GOING TO CREATE A LOT OF
CHALLENGES.
DEMOCRATS ARE NOT GOING TO
ACCEPT POLICY WRITERS AND NOT
ACCEPT GUTTING PROGRAMS THAT ARE
IMPORTANT TO THEM.
SO THERE WILL BE PUSH AND PULL
TO GET THOSE DONE.
WE ARE ALL CONCERNED ABOUT WHERE
THAT IS GOING TO LAND.
THE IMMIGRATION FOREIGN AID
SUPPLEMENTAL BILL FAILED AFTER
MONTHS OF BIPART SUDDEN
NEGOTIATION.
SENATE REPUBLICANS SAID WE WILL
ONLY VOTE FOR UKRAINE AID IF
THERE IS BORDER SECURITY
ATTACHED.
THEY WORKED ON THAT BILL.
THE SENATE FROM OKLAHOMA
REPRESENTED THE REPUBLICANS IN
THE SENATE.
ARIZONA WHO IS AN INDEPENDENT
NOW BUT CAUCASUS WITH THE
DEMOCRATS NOW, OBVIOUSLY A STATE
WHERE IMMIGRATION POLICY IS ON
TOP OF MIND FOR A LOT OF VOTERS.
AND ALSO SENATOR CHRIS MURPHY
FROM CONNECTICUT REPRESENTED THE
DEMOCRATS.
THEY WORKED FOR MONTHS ON THIS
LEGISLATION.
IT WAS -- THEY REVEALED THE DEAL
ON SUNDAY, SATURDAY OR SUNDAY OF
THIS PAST WEEKEND AND IT WAS
DEAD BY MONDAY.
ESSENTIALLY.
UNFORTUNATELY, THERE WAS A LOT,
THEY LOST GOP SUPPORT.
THERE WERE IMPLICATIONS FOR FY24
FUNDING BECAUSE THAT BILL WOULD
HAVE ALSO PROVIDED SUPPLEMENTAL
AID TO THE HOMELAND SECURITY
ACCOUNT.
THAT'S ONE OF THE 12 BILLS THAT
SHOWED WHICH ONES EXPIRED ON
MARCH 1 AND MARCH 8.
THAT IS ONE OF THOSE 12.
IF HOMELAND HAD GOTTEN SOME
FUNDING FROM THIS SUPPLEMENTAL
BILL, THERE WOULD BE A LITTLE
BIT MORE TO GO AROUND FOR THE
OTHER 11 BILLS.
UNFORTUNATELY, THAT BILL IS --
NO ONE THINKS THAT'S GOING TO BE
REVIVED AT THIS POINT.
THERE IS ALSO A TAX BILL THAT
PASSED THE HOUSE WITH LARGE
MARGINS.
WHAT IS IMPORTANT THERE REALLY
FOR OUR COMMUNITY IS THAT IT
INCLUDES A IMPORTANT FIX IN THE
TAX CODE FOR SBIR COMPANIES THAT
THEY WILL BE ABLE TO WRITE OFF
R&D COSTS.
THERE WAS A CHANGE IN A 2017 LAW
THAT MADE THAT DIFFICULT AND A
LOT OF SMALL COMPANIES ARE
FACING LARGE TAX BILLS.
THAT'S BEEN FIXED.
NEXT SLIDE.
FISCAL RESPONSIBILITY ACT.
SO, AS I SAID, THIS IS THE DEBT
LIMIT, THAT WAS GREAT.
BUDGET CUTS FOR 24 AND 25.
FOR FY24, THE DEAL WAS FOR FLAT
BUDGETS EXCEPT FOR A 3% INCREASE
FOR DEFENSE, WHICH IS WHAT
PRESIDENT BIDEN REQUESTED IN HIS
BUDGET.
AND THEN FOR FY25, A 1%
INCREASE.
IT ALSO INCLUDED A STICK, A
PENALTY TO INCENTIVIZE CONGRESS
TO COMPLETE ALL 12 SPENDING
BILLS.
IF ANY OF 12 BILLS ARE NOT
COMPLETED BY APRIL 30, THERE
WILL BE A SEQUESTRATION, A
BUDGET CUT, OF 1% TO ALL DEFENSE
AND NON-DEFENSE DISCRETIONARY
FUNDING.
EXCEPT FOR AGENCIES OR PROGRAMS
THAT ARE EXEMPT FROM
SEQUESTRATION, FOR EXAMPLE, THE
V.A. IS EXEMPT.
SO THAT IS GOING TO PUT MORE
PRESSURE ON ALL OF THE OTHER
DISCRETIONARY PROGRAMS.
OMB HAS SOLE RESPONSIBILITY FOR
IMPLEMENTING SEQUESTRATION.
SO WE HOPE WE DON'T FIND OUT HOW
THAT WILL BE DONE AND IT DOESN'T
HAPPEN AND THE BILLS ARE ALL
DONE BY THIS DATE, BUT IT IS
COMING PRETTY SOON.
SO, CONGRESS IS REALLY VERY
BEHIND IN TERMS OF TIME THEY
HAVE TO GET THESE DONE.
NEXT SLIDE, PLEASE.
I WANTED TO JUST REMIND YOU OF
THE NUMBERS OF -- AND
DR. RATHMELL SHOWED YOU THESE
DATA THAT IN THE SENATE, WE ARE
LOOKING AT -- IF THE SENATE
NUMBERS PREVAIL AND WE GET AN
APPROPRIATION FOR FY24, THAT IS
CLOSER TO WHAT THE SENATE MARKED
UP, THAT WOULD CLOSE THE GAP OF
THE FUNDING CLIFF FOR MOONSHOT
FUNDING BECAUSE THE MANDATORY
FUNDING STREAM FOR THE CANCER
MOONSHOT THAT WAS PROCURED
BECAUSE OF THE CURES AUTHORIZING
LAW, THE 21ST CENTURY CURES LAW,
THAT ENDED IN FY23.
AND SO WE WILL BE 216 MILLION
DOLLARS LESS IF WE WERE TO GET A
FULL YEAR CR OR IF THE
APPROPRIATORS DO NOT RESCUE US
FROM THAT CLIFF, THE PHRASE THAT
IS USED COMMONLY.
IT WAS NOT PART OF OUR BASE
BUDGET AND THE HOUSE DID NOT
INCLUDE ANY OF THE SUPPLEMENTAL
FUNDS FOR THE INNOVATIONS
ACCOUNTS.
NOT JUST US, IT'S ALSO ALL OF
US.
THAT PROGRAM.
IT'S ALSO THE BRAIN INITIATIVE.
THIEVES WERE ALL IN 21ST CENTURY
CURES AND THE FUNDING IS NOT IN
THE BASE BUDGET OF THE
INSTITUTES ADMINISTERING THOSE
PROGRAMS.
SO WE ARE HOPEFUL THAT WE GET A
NUMBER CLOSER TO THE SENATE.
BUT WE HAVE TO WAIT AND SEE.
AND THIS IS JUST SOMETHING THAT
IS IMPORTANT FOR US TO KEEP
REMINDING APPROPRIATIONS STAFF
AND MEMBERS OF CONGRESS WHO ASK
US SORT OF WHAT THE CONCERNS ARE
THAT THIS IS SOMETHING THAT
MIGHT NOT BE TOP OF MIND TO
THEM.
IT'S NOT A LARGE AMOUNT OF MONEY
IN THE CONTEXT OF THE WHOLE
FEDERAL BUDGET BUT IT IS
SIGNIFICANT FOR NCI AND THESE
PROGRAMS.
NEXT SLIDE, PLEASE.
I WANTED TO POINT OUT THAT
DR. RATHMELL IS, SHE WAS 42 DAYS
INTO THE JOB WHEN SHE HAD
ALREADY COMPLETED MEETINGS WITH
SEVERAL SENATORS WHO ARE ON OUR
APPROPRIATIONS SUBCOMMITTEE WITH
ALSO AT A RECEPTION SHE WAS ABLE
TO TALK WITH CONGRESSWOMAN ROSA
DELOREIO, THE RANKING MEMBER OF
THE APPROPRIATIONS COMMITTEE.
THESE MEMBERS, RANKING MEMBER ON
THE SUBCOMMITTEE IN THE SENATE
THAT DECIDES THE NIH BUDGET.
JERRY MORAN, LONG TIME ADVOCATE
FOR NIH AND NCI.
VERY PROUD OF THE CANCER CENTER
AT KU AND ALSO SENATOR BOSMAN
FROM ARKANSAS AND R DR. ELAINE
FLORES: D FROM RHODE ISLAND.
THESE MEETINGS WERE VERY
POSITIVE.
IT WOULD BE VERY HARD TO GET
MEETINGS BUT THESE WERE ALL --
CONGRESS REALLY CARES ABOUT WHAT
THE INVESTMENTS THAT THEY ARE
MAKING IN BIOMEDICAL RESEARCH
WHAT IT IS YIELDING.
A LOT OF THESE MEMBERS, IT'S
PERSONAL TO THEM AND WHAT WE
FIND IS THAT THEY ARE REALLY
INTERESTED TO KNOW WHAT WE NEED,
HOW THEY CAN HELP AND THEN THEY
OFTEN HAVE QUESTIONS ABOUT
SPECIFIC AREAS OF RESEARCH,
SOMETIMES IT'S GEOGRAPHIC,
SOMETIMES IT'S A PARTICULAR TYPE
OF DISEASE.
BUT THESE MEETINGS WERE REALLY
SUCCESSFUL AND THIS IS SOMETHING
WE TRIEDED TO DO AS MUCH AS
POSSIBLE.
NEXT SLIDE.
HERE ARE CONGRESSIONAL BRIEF
ACCIDENT WHERE NCI HAS BEEN
ASKED TO COME TO AN EVENT
WHETHER HOSTED BY A DISEASE
GROUP OR PROFESSIONAL SOCIETY.
AND THESE WERE JUST VERY RECENT
EXAMPLES.
ONE OF OUR INTRAMURAL
RESEARCHERS SPOKE AT A
NEUROFIBROMATOSIS BRIEFING, HE
IS FROM OUR PEDIATRIC ONCOLOGY
BRANCH AND INTRAMURAL PROGRAM
AND THEN ANOTHER ONE OF OUR
EXTRAMURAL PROGRAM STAFF,
DR. VICK, WHO WORKS IN THE
DIVISION OF CANCER PREVENTION AT
NCI, WAS INVITED TO GIVE A TALK
ABOUT CANCER PREVENTION.
THIS PICTURE SHOWS HIM WITH
CONGRESSWOMAN DEBI DINGELL OF
MICHIGAN WHO IS A SUPPORTER OF
BIOMEDICAL RESEARCH AND VERY
INTERESTED IN CANCER RESEARCH IN
GENERAL.
THESE TYPES OF OPPORTUNITIES
REALLY ARE EDUCATIONAL
OPPORTUNITIES.
IT IS VERY OFTEN THE CASE THAT
MEMBERS ARE SURPRISED TO FIND
OUT THEY MAY TELL US ABOUT
RESEARCHERS THEY KNOW AT
INSTITUTIONS IN THEIR STATE OR
DISTRICT.
SOMETIMES THEY ARE REALLY
SURPRISED TO KNOW THAT WE HAVE
SUPPORTED THAT RESEARCHER FROM
THE TIME THEY WERE A TRAINEE TO
THE TIME THEY ARE RUNNING A
SPORE OR CANCER CENTER DIRECTOR
AND THOSE ARE REALLY GREAT
OPPORTUNITIES TO SORT OF BRING
THIS FULL CIRCLE FOR SOME OF
THESE MEMBERS.
NEXT SLIDE, PLEASE.
WE OF COURSE ALWAYS SAY YES WHEN
WE ARE INVITED TO VISIT A MEMBER
OF CONGRESS.
CERTAINLY ATTEND A HEARING.
WE HOPE YOU WILL SAY YES WHEN
YOU'RE INVITED TO BE PART OF
PROFESSIONAL ASSOCIATION
MEETINGS AND MANY OF YOU DO THIS
AS A OF COURSE.
ONE THING THAT IS HELPFUL FOR,
IN TERMS OF EDUCATING STAFFERS
AND HELPING MEMBERS GET
OPPORTUNITIES TO MEET WITH
CONSTITUENTS AND MEET WITH
RESPECT I WAS, THEY GET A SENSE
OF HOW IMPORTANT CANCER RESEARCH
IS WITHIN THESE COMMUNITIES AND
THERE ARE EASTERLY CAREER
GROUPS, TRAINEES AND WORKFORCE
DEVELOPMENT IS A VERY -- IT'S A
PRIORITY FOR A LOT OF CONGRESS
AND THOSE WHO SUPPORT BIOMEDICAL
RESEARCH.
ONE THING I WANTED TO HIGHLIGHT,
DR. JULIE GRAY LOW OF ASCO WAS
TESTIFYING -- TESTIFIED AT A
HOUSE WEIGHS AND MEANS COMMITTEE
ABOUT DRUG SHORTAGES THIS WEEK.
THIS SORT OF PRESENCE FROM THIS
ROBUST CANCER RESEARCH AND
CANCER CARE COMMUNITY IS
INCREDIBLY HELPFUL.
ONE OF THE GROUPS THAT I
HIGHLIGHTED HERE IS OVAC, ONE
VOICE AGAINST CANCER GROUP, A
GROUP OF MANY DIFFERENT TYPES OF
CANCER ORGANIZATIONS WHO COME
TOGETHER WITH ONE VOICE TO ASK
FOR REALLY FUNDING INCREASES.
AND THAT'S SOMETHING WE CAN'T
DO.
WE HAVE SPECIFIC WAYS TO TALK
ABOUT BUDGET, BYPASS BUDGET AND
OUR CONGRESSIONAL BUDGET PART OF
THE PRESIDENT'S BUDGET, BUT
THESE GROUPS ARE ABLE TO BRING
PATIENTS.
THEY ARE ABLE TO HAVE LOCAL
EMPHASIS WHEN THEY TALK TO
MEMBERS AND IT HAS A LOT OF
IMPACT.
I THINK A LOT OF MEMBERS, THIS
ONE PICTURE ON THE UPPER LEFT
CORNER IS DR. JONATHANLICATE
FROM THE UNIVERSITY OF FLORIDA,
THE CANCER CENTER DIRECTOR THERE
MEETING WITH DEBI WASSERMAN
SHULTZ AND THE EXECUTIVE
DIRECTOR OF AACI.
THESE ARE REALLY GREAT
OPPORTUNITIES FOR MEMBERS TO
ENGAGE IN WAYS THAT ARE
MEANINGFUL TO THEM.
SOMETIMES BECAUSE OF THE CANCER
HISTORY FOR THEMSELVES OR THEIR
FAMILY BUT SOMETIMES REALLY JUST
BECAUSE OF THE REGIONAL LOCAL
CONNECTION TO THEIR DISTRICT.
SO WE ALWAYS SAY YES.
WE HOPE YOU SAY YES WHEN YOU'RE
ASKED.
THERE IS NO BETTER MESSENGER
ABOUT THE IMPORTANCE OF CANCER
RESEARCH THAN RESEARCHERS FROM
BASIC TO CLINICIANS WHO ARE
TAKING CARE OF PATIENTS.
THOSE HAVE A LOT OF IMPACT AND
PLEASE TALK ABOUT YOUR NCI
SUPPORT IF YOU GET THOSE
OPPORTUNITIES AS WELL.
I'M GOING TO STOP HERE AND TAKE
QUESTIONS IF WE HAVE TIME FOR
THAT.
COULD WE HAVE THE NEXT SLIDE?
I WANT TO ENCOURAGE YOU TO
PLEASE REACH OUT TO ME WITH
E-MAIL WITH ANY QUESTIONS YOU
HAVE.
I'M HAPPY TO TALK TO ANY BOARD
MEMBERS THAT WOULD LIKE TO HAVE
ANY QUESTIONS.
>> THANK YOU.
WE HAVE TIME FOR A FEW QUESTI
QUESTIONS.
ANY QUESTIONS FROM THE BOARD?
>> I RAISED MY HAND BUT I DON'T
KNOW IF YOU CAN SEE ME.
>> YES.
>> THE CAMERA IS NOT WORKING
TODAY SO I APOLOGIZE FOR THAT.
ONE THING THAT IS A LITTLE --
THANK YOU VERY MUCH FOR THE
GREAT PRESENTATION.
THERE ARE TIMES WHERE WE ARE
ASKED TO GO AND DO ADVOCACY BUT
IN OUR ROLE, AND MAYBE THIS IS
MORE A QUESTION FOR PAULETTE,
BUT IN OUR ROLE AS NCAB MEMBERS,
I KNOW THERE ARE A LOT OF
RESTRICTIONS AROUND WHAT WE CAN
AND CAN'T DO, ESPECIALLY IN
TERMS OF LIKE ONE AGENCY
LOBBYING ANOTHER.
SO I HAD A RECENT REQUEST TO
JOIN THE MYELOMA RESEARCH
FOUNDATION ON THE HILL FOR
ADVOCACY DAY.
I RAN THE REQUEST THROUGH JOY
AND SHALA AND THEY SAID,
PROBABLY NOT SOMETHING YOU
SHOULD BE INVOLVED IN.
SO HOW DO WE KNOW WHAT WE CAN
AND CAN'T BE INVOLVED IN?
BECAUSE YOU JUST ENCOURAGED US
ALL TO DO THIS KIND OF THING BUT
I'M ALWAYS VERY WARY THAT I'M
GOING TO BE IN SOME FORM OF
CONFLICT IF I DO DO SOMETHING.
>> I WILL SIMPLY SAY, AS LONG AS
YOU DO IT AS A PRIVATE CITIZEN,
THERE ARE NO ISSUES.
BUT YOU CAN NOT DO IT ON THE
PART OF THE GOVERNMENT OR AS A
REPRESENTATIVE OR A MEMBER OF
THE NATIONAL CANCER ADVISORY
BOARD.
AND YOU DID THE RIGHT THING IN
REACHING OUT TO JOY AND TO
OTHERS.
>> OKAY, THANK YOU.
>> -- AUTHORITY ON THAT ISSUE, I
WOULD SAY IF YOU ARE ASKED TO
TALK, TO GIVE A TALK WITH A
DISEASE GROUP OR A PROFESSIONAL
ASSOCIATION THAT RELATES TOTS
YOUR PROFESSIONAL EXPERTISE AND
YOUR RESEARCH EXPERTISE,
CERTAINLY YOU CAN ALWAYS RUN IT
THROUGH OUR COMMITTEE MANAGEMENT
TEAM, BUT I THINK THAT'S REALLY
DIFFERENT THAN BEING ASKED TO
COME IN AS A NATIONAL CANCER
ADVISORY CHAIR.
AND IT'S THE SCIENTIFIC
EXPERTISE THAT IS SO -- FOR
EXAMPLE, I'VE BEEN IN HEARINGS
WITH JAFFEE WHEN SHE WAS THE
NCAB CHAIR AND SHE BROUGHT A
PATIENT AND TALKED ABOUT
RESEARCH AND TALKED ABOUT THIS
PATIENT WHO HAD BENEFITED FROM A
TARGETED THERAPY.
AND SO THAT WAS A VERY POWERFUL
DISCUSSION OF BENCH TO BEDSIDE
RESEARCH AND THE MEANING OF IT.
I THINK IT REALLY DOES DEPEND
WHY THE ORGANIZATION IS ASKING
YOU.
AND I THINK THAT IS SOMETHING
DR. GRAY WOULD PROBABLY WANT TO
UNDERSTAND BEFORE -- SO SHE CAN
HAVE ALL THE INFORMATION.
>> YES, WE DO NEED INFORMATION
AHEAD OF TIME AND WE CAN
INDICATE TO YOU WHETHER YOU CAN
DO IT AS A PRIVATE CITIZEN,
REPRESENTING YOUR INSTITUTION
AND WHETHER IT SHOULD OR SHOULD
NOT BE AS AN NCAB MEMBER
REPRESENTATIVE.
SO YOU DID THE RIGHT THING.
SO KEEPING WITH TIME, I'M GOING
TO MOVE ON.
AND I WILL FLY THROUGH THIS AS I
NORMALLY DO.
AND I DON'T HAVE SLIDES, BUT WE
HAVE TO DO THE ANNUAL
DELEGATIONS OF AUTHORITY.
SO ANNUALLY AT THE FIRST NCAB
MEETING, THE BOARD MUST APPROVE
SPECIFIC DELEGATIONS OF
AUTHORITIES SO THAT THE DIRECTOR
AND NCI STAFF CAN FUNCTION
WITHOUT HAVING TO COME TO AN --
FOR CERTAIN ACTION AS,
SPECIFICALLY DELEGATION A STATES
THE NCAB DELEGATES TO THE
DIRECTOR OF THE NATIONAL CANCER
INSTITUTE PERMISSION TO OBTAIN
AS STATED IN SECTION 413B5 OF
THE PUBLIC HEALTH -- AND IN
ACCORDANCE WITH SECTION 3109
TITLE V IN THE UNITED STATES
CODE, THE OPPORTUNITY TO REQUEST
THE SERVICES OF NOT MORE THAN
151 SPECIAL EXPERTS OR
CONSULTANTS WHO HAVE SCIENTIFIC
OR PROFESSIONAL QUALIFICATIONS
TO ASSESS AND ACCOMPLISH THE
MISSION OF THE INSTITUTE.
DELEGATION B, THE NCAB DELEGATES
TO THE DIRECTOR, NCI, PER
MISSION TO EXERCISE AUTHORITY AS
STATED IN SECTION 413B7 OF THE
PUBLIC HEALTH SERVICE ACT, THE
OPPORTUNITY TO ESTABLISH ONE OR
MORE ADVISORY COMMITTEES
COMPOSED OF PRIVATE CITIZENS AND
OFFICIALS OF FEDERAL, STATE AND
LOCAL GOVERNMENTS TO ADVISE
HIM/HER WITH RESPECT TO HIS/HER
FUNCTIONS.
NEXT IS THE STATEMENT OF
UNDERSTANDING WHAT NCI STAFF ON
OPERATING PRINCIPLES AND MAKING
EXTRAMURAL AWARDS WITHIN
ACCORDANCE WITH MANAGEMENT AND
REVIEW PROCEDURES SET FORTH IN
THE NIH MANUAL ISSUANCE 4513.
THAT IS, NCAB COMPARES WITH
RECOMMENDATIONS OF INITIAL
REVIEW GROUPS WILL BE REQUIRED
TO ALL GRANTS, THAT IS EXCEPT
FOR TRAINING GRANTS, FELLOWSHIPS
AND OTHER NON-RESEARCH GRANT
APPLICATIONS.
THESE GRANTS MAY BE AWARDED
WITHOUT PRESENTATION TO THE
NCAB.
THAT IS WITH THE EXCEPTION OF
THE RUTH L KIRSTEN NATIONAL
RESEARCH SERVICE AWARD.
APPLICATIONS OF THE 20 ERSENTILE
WILL NOT HAVE THE SUMMARY
STATEMENTS PRESENTED TO THE NCAB
UNLESS THE INSTITUTE IS THE
CONSIDERING THEIR AWARD OF SUCH
AN APPLICATION FOR SPECIAL
CONSIDERATION BY AN APPOINTED
MEMBER OF THE BOARD.
APPLICATIONS ASSIGNED NOT -- THE
CUT OFF WILL BE AN IMPACT SCORE
OF 45 FOR ALL MECHANISMS, EXCEPT
R41, 42, 43 AND 44 AWARDS.
THE LATTER AWARDS ALL SCORED
APPLICATIONS WILL BE INCLUDED.
EXPEDITED -- WILL BE USED FOR
L21 APPLICATIONS.
EXCLUDING THOSE FROM FOREIGN
ORGANIZATIONS.
PERCENTILE SCORES THAT FALL
WITHIN THE NCI PAY LINES, AND
THAT HAVE NO CONCERNS NOTED THAT
WOULD REPRESENT AN
ADMINISTRATIVE AWARD, FOR
EXAMPLE, HUMAN SUBJECTS, ANIMAL
WELFARE, BIOHAZARDS FOR
INCLUSION OF WOMEN, CHILDREN AND
APPROPRIATE MINORITY
DISTRIBUTION.
EXPEDITED -- WILL BE DELEGATED
BY THE CHAIR TO SPECIFICALLY
DESIGNATE MEMBERS OF THE BOARD
AND ON BEHALF OF THE BOARD AS A
WHOLE.
THE REVIEWERS WILL CONSIST OF
THE CHAIR OF THE SUBCOMMITTEE ON
SPECIAL ACTIONS AND THREE,
ADDITIONAL NCAB MEMBERS
APPOINTED BY THE CHAIR OF THE
NCAB.
IN CASES OF EMERGENT NEED AS
DETERMINED BY THE DIRECTOR OF
NCI, WITH THE CONCURRENCE OF
NCAB CHAIR, EXPEDITED
CONCURRENCE MAY BE UTILIZED FOR
SINGLE-CASE DEVIATIONS.
EXPEDITED -- ENOUGH VOTES FOR
FINAL ACTION WILL BE PRESENTED
TO THE FULL NCAB AT ITS REGULAR
MEETING.
ADMINISTRATIVE ADJUSTMENTS.
THE NCAB DELEGATES TO THE
DIRECTOR OF NCI PERMISSION TO
ALLOW STAFF TO NEGOTIATE THE
APPROPRIATE ADJUSTMENTS IN
DOLLARS AND OTHER TERMS AND
CONDITIONS OF GRANTS AND
COOPERATIVE AGREEMENT AWARDS
RECOMMENDED BY THE BOARD.
IN DOING SO, ALLOWS THE
INSTITUTE TO MAINTAIN A SMOOTH
AND EFFECTIVE OPERATION OF THE
ADMINISTRATION OF GRANTS BY THE
INSTITUTER.
STAFF WILL NEGOTIATE APPROPRIATE
ADJUSTMENTS AND WHEN APPLICABLE,
WILL MAKE ADJUSTMENTS TO
RECONCILE INCONSISTENCIES
BETWEEN RECK HENDED BUDGET AND
RECOMMENDED ACTIVITIES --
RECOMMENDED -- ADMINISTRATIVE
REQUESTS FOR INCREASE IN DIRECT
COSTS, WHICH ARE THE RESULT
OF -- FOR SIGNIFICANT CHANGE IN
SCIENTIFIC CONTENT OF A PROGRAM
AFTER FORMAL PEER REVIEW, WILL
BE REFERRED TO THE BOARD FOR
ADVICE AND RECOMMENDATION.
IF THERE IS AN ISSUE, THAT IS IN
TERMS OF SCOPE ANDUREIGENCEY,
THE DIRECTOR OF NCI WILL CONSULT
WITH THE NCAB CHAIR PRIOR TO A
FINAL DETERMINATION THAT NCAB
CHAIR WILL ACT ON BEHALF OF THE
BOARD AS A WHOLE.
IN TERMS OF ACTIONS NOT
REQUIRED, THE BOARD REVIEW OR
ADVICE, THOSE INCLUDE ACTIONS
SUCH AS CHANGE OF INSTITUTION,
CHANGE OF PRINCIPAL
INVESTIGATOR, PHASE OUT OR
INTERIM SUPPORT OR ADDITIONAL
SUPPORT EITHER TO MEET THE
INCREASED COST OF MAINTAINING
THE LEVEL OR RESEARCH
RECOMMENDED OR TO ACCOMMODATE
ACTIVITIES JUDGED BY STAFF TO BE
WITHIN THE SCOPE OF THE
PREVIOUSLY PEER-REVIEWED
RESEARCH.
THESE ACTIONS WILL NOT BE
REPORTED TO THE BOARD.
IN ADDITION, NCI STAFF MAY
RESTORY QUESTS IN TIMES TO
SUPPORT WHICH WERE DELETED BY
THE INITIAL REVIEW GROUP WHEN
THE PRINCIPAL INVESTIGATOR HAS
PROVIDED JUSTIFICATION IN AN
APPEAL LETTER.
THE RESTORATION IS IN THE BEST
INTEREST OF THE NCI AND THE
PROJECT IS OF HIGH PROGRAMMATIC
RELEVANCE.
THERE IS SPECIAL COUNSEL REVIEW
OF PRINCIPAL INVESTIGATORS WITH
TWO MILLION TOTAL COST OR MORE
IN RPG AWARDS.
IN AN EFFORT TO CONTINUE
RESPONSIBLE STEWARDSHIP OF
PUBLIC FUNDS AND TO SUPPORT
MERITORIOUS AND INNOVATIVE
RESEARCH, NIH HAS INSTITUTED A
POLICY OF SPECIAL CANCER REVIEW
FROM WELL-FUNDED INVESTIGATORS.
PENDING GRANTS GOING TO THE
BOARD FROM PRINCIPAL
INVESTIGATORS THAT HAVE MORE
THAN TWO MILLION OR MORE DIRECT
COSTS FROM ACTIVE NIH RESEARCH
GRANTS THAT IS RPGs, MUST BE
GIVEN ADDITIONAL CONSIDERATION T
IS IMPORTANT TO RECOGNIZE THAT
THIS IS A THRESHOLD ONLY.
INVESTIGATORS WHO HAVE MORE
RESEARCH SUPPORT MAY STILL
RECEIVE ADDITIONAL AWARDS AS
WARRANTED.
SO, ARE THERE QUESTIONS?
OR IS FURTHER CLARIFICATION
NEEDED?
IF NOT, THEN JOHN WILL CALL FOR
A VOTE OF APPROVAL, DISAPPROVAL
OR EXTENSION.
THAT IS, HE CAN INDICATION OF
THE DELEGATIONS OF AUTHORITY.
-- HE CAN EXTEND THE DELEGATIONS
OF AUTHORITY.
>> THANK YOU, PAULETTE.
AS PAULETTE SAID, WE NEED TO
CALL FOR A MOTION TO EITHER
APPROVE, DISPROVE OR FOR
EXTENSION.
IS THERE A MOTION?
>> MOVE TO AAPPROVE.
>> IS THERE A SECOND?
>> SECOND.
>> PROPERLY MOVED AND SECONDED.
IS THERE ANY FURTHER DISCUSSION
OR QUESTIONS?
IF NOT, WE'LL GO AHEAD AND VOTE.
I'M GOING TO ASK IF THERE ARE
ANY NEIGHS.
ANY ABSTENTIONS?
PAULETTE?
>> IT'S UNANIMOUS.
AND I GAVE YOU BACK TWO MINUTES.
>> SO FOR OUR PRESENTERS, NEXT
UP WE HAVE TWO SCIENTIFIC
PRESENTATIONS AND THESE ARE BY
MID CAREERS AND SELECTED IN
INTRAMURAL AND EXTRAMURAL.
SO THE FIRST WILL BE BROUGHT TO
US BY DR. MACHIELA, AN
INVESTIGATOR INTEGRATIVE TUMOR
EPIDEMIOLOGY BRANCH IN THE
BRANCH OF CANCER EPIDEMIOLOGY
AND GENETICS, WHO WILL BE
PRESENTING A TALK ENTITLED,
INTEGRATIVE POPULATION BASED
CHARACTERIZATION OF MOSAIC
CHROMOSOMAL ALTERATIONS UNCOVERS
ETIOLOGIC INSIGHTS FOR
HEMATOLOGIC MALIGNANCIES.
>> LET ME PULL UP THE SLIDES
HERE REAL QUICK.
THANK YOU FOR THE OPPORTUNITY TO
PRESENT MY WORK HERE IN FRONT OF
THE NCAB.
I'M DELIGHTED TO PRESENT
FINDINGS FROM INTEGRATIVE
POPULATION BASED ANALYSIS
UNDERSTANDING SOMATIC
ALTERATIONS AND HOW THE
ENVIRONMENTAL EXPOSURES INTERACT
AND INFLUENCE CANCER RISK.
GENETIC ETIOLOGY OF CANCER, I
STUDY NORMAL TISSUES BEFORE
TUMOR FORMATION.
CHARACTERIZED CHANGES THAT COULD
PROMOTE CLONAL EXPANSION TO
MUTATED CELLS.
BIOBANKS HAVE EXISTING
COLLECTIONS OF BLOOD SAMPLES.
BLOOD IS AN IDEAL TISSUE TO
STUDY.
MY RESEARCH CAPITALIZES ON
DECADES OF INTRAMURAL AND DCCPS
EXTRAMURAL INVESTMENTS TO
CHARACTERIZE AGE RELATED
MUTATIONS AND EXISTING SAMPLES
WITHIN SHEDDING LIGHT ON
FREQUENCY AS WELL AS BIOLOGIC
IMPORTANCE OF THESE OBSERVAT
OBSERVATIONS.
THE MUTATIONS IN THE LEUKOCYTES
OF CANCER-FREE INDIVIDUALS IS
CH.
CH IS ACQUIRED WHEN NORMAL CELLS
ARE MUTATED AND THE MUTATION
CONFERS A SURVIVAL ADVANTAGE OF
MUTATED CELLS TO EXPAND.
ANY SUCH EXPANDING MUTATION
COULD HAVE RELEVANCE FOR FUTURE
CANCER RISK.
AS SUCH, CH COULD PROVIDE
INSIGHT INTO THE GENETIC
ETIOLOGY OF HEMATOLOGIC
MALIGNANCIES.
MOST INDIVIDUALS CH DO NOT
DEVELOP MALIGNANCY HIGHLIGHTING
THE NEEDS TO IDENTIFY HIGH-RISK
SUBTYPES.
THERE A BROAD SPECTRUM OF CH.
MY RESEARCH FOCUSES ON
CHROMOSOMAL ALTERATIONS WHICH
ARE LARGE STRUCTURAL CHROMOSOMAL
ALTERATIONS.
THEY ARE USUALLY DETECTED WITH
PHENOTYPE ARRAY DATA.
AS DESCRIBED IN EARLY POPULATION
BASED STUDIES BY MY MENTOR.
THE OTHER END OF THE SPECTRUM,
CHIP WAS CARTED RIDES LATER AS
POPULATION BASED SEQUENCING
STUDIES BECAME AVAILABLE.
CHIP IS CHARACTERIZED BY
VARIANCE WHICH IMPACT ON THE
GENES.
SIMILAR TO CYTOLOGY BASED
METHODS, MORE.
CAs ATTACK USING VIRTUAL
KARYOTYPES.
SPECIALIZED ALGORITHMS CAN SCAN
THE GENOME FOR IMBALANCES
MEASURED BY ALLELE FREQUENCY.
AND DEVIATIONS MEASURED BY LOG 2
RATIOS ARE HALLMARK SIGNATURES
OF MCAs.
CONTINUOUS CHROMOSOMAL STRETCHES
AND DEVIATIONS SEEN HERE ARE
EVIDENCE OF CHROMOSOMAL
ALLERRATIONS.
DETECTED EVENTS ARE
CHARACTERIZED INTO COPY NEUTRAL
HETEROZYGOSITY.
ENSURING BALANCES MEASURED BY
THE B LEGAL FREQUENCY ARE
PROPORTIONAL TO EXPECTED
DEVIATIONS AND SIGNAL INTENSITY
MEASURED BY LRR.
THIS HAS BEEN VALIDATED BY BOTH
CYTOGENETIC AS WELL AS MONTH
ELECTULAR TECHNIQUES.
AS A LOT OF SAMPLE SIZES ARE
NEEDED TO STUDY MCAs, WE HAVE
CHARACTERIZED OVER ONE MILLION
STUDY PARTICIPANTS TO GAIN
IMPORTANT INSIGHTS ON THE
FREQUENCY AND DISTRIBUTION.
INITIAL STUDIES IDENTIFIED
HIGHER THAN ANTICIPATED
FREQUENCIES OF MORE.
CAs.
STUDIES DETECTED FREQUENCY OF
3-5% WITH INCREASES WITH
INCREASING AGE, NOTABLE
ENRICHMENT IN REGIONS KNOWN TO
BE ALTERED IN MALIGNANCIES.
-- MOSAIC Y LOSS AS MOST
FREQUENTLY OCCURRING AGE RELATED
MCA WITH FREQUENCIES IN ACCESS
OF 20% IN ELDERLY POPULATIONS.
LIKEWISE X LOSS IS THE MOST
COMMONLY OCCURRING IN FEMALES
WITH X CHROMOSOME BEING PRESENT
AND 10-12% OF WOMEN.
OUR INVESTIGATIONS OBSERVED
HIGHER FREQUENCIES AMONG
INACTIVATED X CHROMOSOME IN
AGREEMENT WITH HIGH MUTATION
FREQUENCIES IN CANCER GENOMES AS
INACTIVE X CHROMOSOME IS
REPLICATING AND SUSCEPTIBLE TO
REPLICATION ERRORS.
FINALLY OUR STUDY OF X MOSAICS
IN MEN IDENTIFIED LOW
FREQUENCIES OF .006% WITH NO
OBSERVATIONS OF MALE X
CHROMOSOMAL LOSS DEMONSTRATING
IMPORTANCE OF ONE COPY OF X
CHROMOSOME FOR LEUCOCYTE
FUNCTION.
THESE INDICATE MCAs ARE COMMON
IN THE ADULT POPULATIONS BUT
VERY INFREQUENT BY THE
CHROMOSOME EFFECTED.
-- POPULATION BASED STUDIES
UTILIZING EXPOSURE POPULATIONS
WITHIN DCG AND EXTRAMURAL
IDENTIFIED RISK FACTORS.
ACROSS ALL TYPES OF MCAs,
AGING IS THE STRONGEST RISK
FACTORS WITH FREQUENCY
INCREASING WITH AGE.
GENERALLY POPULATIONS UNDER 40
YEARS OF AGE HAVE LOW
FREQUENCIES OF MCAs,
EXPONENTIAL INCREASES OBSERVED
IN THE 50s.
SEX IS OTHER WELL-CHARACTERIZED
RISK FACTOR WITH MALES HAVING
HIGHER FREQUENCIES OF AUTOSOMAL
MCAs RELATIVE TO FEMALES.
WHEN FACTORING IN SEX, MALES
HAVE FURTHER ELEVATED
FREQUENCIES.
ANCESTRY IS ASSOCIATED WITH MCA
RISK WITH INDIVIDUALS OF AFRICAN
ANCESTRY HAVING LOWER
FREQUENCIES OF MCAs THAN
INDIVIDUALS WITH THE EUROPEAN OR
ASIAN ANCESTRY.
THERE ARE ALSO DIFFERENCES MCA
FREQUENCY BY GEOGRAPHY.
IN SUB-SAHARAN AFRICA WE
IDENTIFIED CHILDREN WITH RATES
COMPARABLE TO MIDDLE AGED
POPULATION IN DEVELOPED NATIONS.
SUGGESTING ENVIRONMENTAL FACTORS
SUCHA MALARIA INFECTION MAKE MCA
RISK.
MODIFIABLE RISK FACTORS, SUCH AS
SMOKING ARE ASSOCIATED WITH
MCAs WITH STRONGEST
ASSOCIATIONS FOR LOSS OF Y
CHROMOSOME IN MEN.
SMOKERS SUGGESTS THAT Y LOSS
DECREASE AS YEARS OF CESSATION
INCREASE.
STUDIES ALSO IDENTIFIED
RELATIONSHIP WITH INHERITY TEAL
MERLENGTH.
INDIVIDUALS WITH LONGER INHERITY
TELOMERE LENGTH HAVE INCREASE
SUSCEPTIBILITY.
AS MCAs -- ALL DATA NECESSARY
TO PERFORM GWAS TO IDENTIFY
GERMLINE SUSCEPTIBILITY IS
AVAILABLE.
IDENTIFIED 156 AUTOSOMAL LOCI
ASSOCIATED WITH MOSAIC Y LOSS.
I HAVE RECENTY CALLED A GWAS OF
LOSS OF X CHROMOSOME IN FEMALES
THAT IDENTIFIED AN ADDITIONAL 56
LOCI AND RARE VARIANT
ASSOCIATION.
X LOSS LOCI ARE SHARED WITH LOSS
OF Y MANY OF GENES ASSOCIATED
WITH BLOOD CELL COUNTS AND
IMMUNE FUNCTION AND CANCER PRE
DISPOSITION.
INTERESTINGLY, LOOKING AT ONLY
THE X CHROMOSOME, WE IDENTIFIED
44 LOCI RETAINED ON THE
REMAINING X CHROMOSOME USING
DIFFERENTIAL SCORES OF LOCI FOR
EACH COPY OF X, WE CAN INFER
THAT RETAINED X CHROMOSOME UP TO
8% OF LOSS OF X CASES.
TO INVESTIGATE DOWNSTREAM
CONSEQUENCES OF MCAs, STUDIES
OF DIVERSE OUTCOMES RELEVANT FOR
DISEASE AND CANCER RISK.
MCAs ARE STRONGLY ASSOCIATED
WITH INCREASED LEUKEMIA RISK
WITH ESTIMATED HAZARD RATIOS IN
EXCESS OF 15.
ASSOCIATIONS ARE STRONGEST FOR
LYMPHOID LEUKEMIA AND ALSO
MYELOID.
SPECIFIC EVENTS SUCH AS
DELETIONS ARE ASSOCIATED WITH
HAZARD RATIOS WITH OVER 100 FOR
CLL RISK.
MCAs ARE ASSOCIATED WITH
SELECT SOLID TUMOR RISK
INCLUDING LONG, SKIN AND
PROSTATE CANCER, TOGETHERRING
THOSE IN BLOOD COULD SERVE AS
ABA ROM TORE FOR MUTATIONAL
PROCESS AND OTHER TISSUES.
RISK ESTIMATES ARE MUCH LOWER.
LONGER TELOMERE LENGTH IS
INCREASED MCAs.
THIS SUGGESTS THAT DYNAMIC
RELATIONSHIPS SUCH CELLS
HARBORING MCAs MEET MECHANISMS
THAT MAINTAIN LONGER TELOMERES.
THE CLONE EXPANSION RESULTS IN
TELOMERE LENGTH ATTRITION.
MCAs ARE ASSOCIATED WITH
ALTERATIONS IN BLOOD CELL COUNTS
SPECIFICALLY ELEVATED LEUCOCYTE
COUNTS.
THE COVID-19 PANDEMIC MOTIVATED
ME TO INVESTIGATION
RELATIONSHIPS BETWEEN MCAs AND
INFECTIOUS DISEASE RISK.
WE IDENTIFIED RELATIONSHIPS WITH
EXPANDED MCAs AND RISK OF
SEPSIS AND PNEUMONIA WITH
STRONGER EFFECTS OBSERVED IN
CANCER PATIENTS.
WE ALSO NOTED EVIDENCE DURING
PRE SUSCEPTIBILITY TO SEVERE
COVID-19.
MY RESEARCH PROGRAMS ALSO
DEVELOPING MODELS TO IMPROVE
CANCER RISK STRATIFICATION USING
CLL AS AN EXAMPLE, WE AIM TO SEE
HOW THE INCORPORATION OF GENETIC
KNOWLEDGE CAN IMPROVE RISK
STRATIFICATION OVER CLINICAL
RISK FACTOR INFORMATION.
USING UK BIOBANK DAY DATA AND A
MODEL ONE CONTAIN CLASSICAL RISK
FACTORS, WE OBSERVED 0.84, HIGH
VALUE TO START WITH ATTRIBUTABLE
TO THE UTILITY OF BLOOD CELL
COUNTS.
INCREASES IN A1C ADDING DATA
DERIVED FROM GENOME-WIDE
ASSOCIATION STUDIES.
FINALLY MODEL 3 SHOWS PREDICTED
UTILITY OF A FINAL COMBINED
MODEL THAT INCLUDES INFORMATION
ON MCAs AND CHIP.
THIS EXAMPLE DEMONSTRATES THAT
EVEN FOR HEMATOLOGIC
MALIGNANCIES FOR WHICH CLINICAL
RISK FACTORS PERFORM WELL,
ADDITION OF GERMLINE AND SOMATIC
INFORMATION NUTS NOTICEABLE
IMPROVEMENTS IN RISK.
MCAs ARE UNDER SELECTIVE
PRESSURE, THEIR CLONAL
TRAJECTORIES ARE DYNAMIC AND
PERIOD OF RAPID CLONAL EXPANSION
OR REVERTING BACK TO NORMAL
STATES.
WHILE THE DELETIONS ARE PRESENT
IN CIRCULATING BLOOD UP TO 15
YEARS PRIOR TO CLL DIAGNOSIS,
OUR ANALYSIS SUGGESTS CLL IS
BEST PREDICTED WITHIN 5-10 YEARS
OF SAMPLE COLLECTION AND
ADDITIONAL ASSESSMENTS MIGHT BE
NECESSARY WHEN PREDICTING FOR
LONGER TIME INTERVALS.
SO A QUICK SUMMARY OF KEY
FINDINGS FROM MY INVESTIGATIONS
OF MCAs.
FIRST MCAs IS DETECTABLE IN
THE BLOOD OF CANCER FREE
INDIVIDUALS INDICATING
EORGANIZATION WITH AGE AND
HEMATOPOIETIC COMPARTMENT TO
TOLERATE MUTATED CLONES.
THE DISTRIBUTION OF MCAs
DIFFERS BY CHROMOSOME WITH
REEGENCE MUTAT MUTATED IN LEUKES
ALTHOUGH MOST INDIVIDUALS OF MCA
CLONES DO NOT EQUIP PEOPLE TA
LOGIC CANCERS.
RISK FACTORS HAVE A HIGH DEGREE
OF SIMILARITY WITH HEMATOLOGIC
CANCER RISK FACTORS.
ON AGE AS WELL AS SMOKING.
INDICATING THE POTENTIAL TIME TO
UNCOVER NOVEL ETIOLOGIC
INSIGHTS.
FINALLY MCAs ARE ASSOCIATED
WITH MULTIPLE OUTCOMES AND CAN
BE IMPORTANT FOR HEMATOLOGIC
CANCERS SUGGESTING POSSIBLY
UTILITY FOR A MARKER FOR DISEASE
RISK.
WITH THAT, I WANT TO THANK MY
AMAZING RESEARCH GROUP AS WELL
AS MANY EXCEPTIONAL
COLLABORATORS AND RESOURCES
WITHIN NCI AND EXTRAMURALLY.
AND IF YOU ARE LOOKING FOR A
FELLOWSHIP, WE HAVE TERRIFIC
OPPORTUNITIES.
THANK YOU FOR YOUR ATTENTION AND
I WOULD WELCOME ANY QUESTIONS.
>> THANK YOU.
EXCEPTIONAL WORK.
ANY QUESTIONS FROM THE BOARD
MEMBERS I CAN START WITH ONE
WHILE WAITING FOR HANDS.
SO YOU MENTIONED ONE POTENTIAL
RISK FACTOR BEING AGING.
HAVE YOU LOOKED AT ASPECTS
RELATED TO EPIGENETIC AGING OR
FASTER AGING?
AND EARLIER ONSET OF THESE
ALTERATIONS AND INCREASED RISK
OF THESE TYPES OF CANCERS?
>> YES, THAT'S A TERRIFIC
QUESTION.
TO DATE, WE HAVE NOT.
BUT WE HAVE A STUDY UNDERWAY
LOOKING AT METHYLATION AGE AND A
LOT OF THESE OTHER METHYLATION
CLOCKS AND SEEING HOW THAT
BIOLOGIC AGE DIFFERS FROM THE
CHRONOLOGIC AGE AND SEEING IF
THERE ARE CERTAIN MECHANISMS
THAT MIGHT BE MORE CLOSELY
RELATED TO MCA RISK RELATIVE TO
THE CHRONOLOGIC AGE.
SO STAY TUNED.
THE ASSAYS ARE UNDER WAYITE NOW
AND HOPEFULLY IN THE NEXT FEW
MONTHS WE HAVE THE BEGINNINGS
OF --
>> INCREDIBLE EPIDEMIOLOGY YOU
GUYS HAVE TO SORT OF ASSOCIATE
THAT WITH THE EPIGENETIC AGING
WITH EXPOSURES OR OTHER
EPIDEMIOLOGICAL RISK FACTORS.
SO THIS IS GREAT.
SO I SEE ANN AND KIM'S HANDS.
>> THANK YOU.
THAT WAS REALLY INTERESTING AND
EXCITING.
THE THING ABOUT MCAs THEY SEEM
TO BE INCREASINGLY BE ASSOCIATED
WITH ALMOST EVERYTHING,
CARDIOVASCULAR DISEASE AND
ET CETERA.
AND JOHN JUST TOUCHED ON A POINT
THAT IS CRITICAL AND THAT IS,
THE AGE FACTOR, I THINK, IS
GOING TO BE INCREDIBLY IMPORTANT
IN TERMS OF UNDERSTANDING THE
ROLE IN CANCER.
SO I'M WONDERING HOW PREDICTIVE
DO YOU THINK MCAs WILL BE?
YOU'RE LOOKING AT LEUKEMIAS BUT
BEYOND LEUKEMIAS, IS THIS A
BETTER PREDICTIVE TOOL THAN SOME
OF THE OTHER THINGS WE ARE
SEEING, IN MULTIPLE CANCER EARLY
DETECTION ASSAYS?
>> THAT'S A REALLY GOOD
QUESTION.
I THINK PART OF THE REASON THAT
WE'RE DOING A LOT OF THESE
REALLY INTEGRATIVE MODELS, IS WE
THINK IT HAS VALUABLE
INFORMATION TO ADD ALONG WITH
OTHER CLINICAL RISK FACTOR
INFORMATION ALONG THE OTHER GERM
LINES AND SUSCEPTIBILITY
INFORMATION.
I DON'T THINK MCAs IN AND OF
THEMSELVES WILL BE INCREDIBLY
PREDICTIVE, BUT I THINK IT DOES
ADD ADDITIONAL INFORMATION TO
THESE MODELS.
TING JUST IMPROVES OUR KNOWLEDGE
OF HOW THE GENOME WITH AGE
BEGINS TO DETERIORATE.
I ALSO LIKE AT THE BEGINNING OF
YOUR QUESTION, MENTION THE FACT
THAT WE SEE A LOT OF THESE
ASSOCIATIONS OUT THERE WITH
MCAs AND A LOT OF CHRONIC
DISEASES.
AND I THINK A LOT OF STUDIES
NEED TO BE CAREFUL IN THIS AREA.
MCAs ARE RELATED TO AGING AND
SMOKING AND THESE ARE LIKE TWO
REALLY STRONG RISK FACTORS FOR A
LOT OF OTHER DISEASES.
WE REALLY TRIED TO, AS CAREFULLY
AS WE CAN, MODEL THAT
RELATIONSHIP WITH AGE WHERE IT'S
NOT THIS LIN AREA RELATIONSHIP,
BUT EXPONENTIAL INCREASE WITH
AGE.
IF YOU INCORRECTLY SPECIFY THAT,
YOU DO HAVE POTENTIAL BIAS
CREEPING IN THERE AS WELL AS
THINGS LIKE SMOKING.
SMOKING IS DIFFICULT TO MEASURE
AND IF YOU HAVE POOR ADJUSTMENT
FOR THAT, OTHER ASSERTIONS ARE
IN THERE AS WELL.
>> IS THERE ANY DATA ON THE
SUPER AGERS, THOSE LIVING OVER
100?
DO THEY HAVE FEWER OF THESE
KINDS OF STRUCTURAL CHANGES?
>> THAT'S A TERRIFIC QUESTION.
WE HAVE LIMITED EVIDENCE FOR
OLDER AGE GROUPS AND THE CURRENT
STUDIES WE ARE ASSESSING.
IT'S POSSIBLE THAT THERE IS AT
THE HIGHEST AGE RANGE, A SLIGHT
DIP IN FREQUENCY OF MCAs.
SO IT'S MAYBE SOMETHING THESE
INDIVIDUALS THAT DO HAVE THESE
REALLY LONG LIFESPANS HAVE SOME
TYPE OF MECHANISMS THAT HELP
PROTECT AGAINST THAT.
WE JUST DON'T HAVE SUFFICIENT
DATA AT THIS MOMENT IN OUR
SAMPLE SIZE TO CONFIRM THAT AT
THIS POINT.
>> JUST WANT TO JUMP IN.
NICE TALK AND GOOD TO SEE YOUR
WORK CONTINUING TO PROGRESS.
I WONDER IF YOU CAN SPEAK,
BEFORE I ASK THE QUESTION, I
THINK IT'S A GREAT EXAMPLE OF
WHERE WE CAN LEARN SO MUCH FROM
DATA THAT IS THERE.
LIKE THESE MUTATIONS ARE SORT OF
HIDING UNDER OUR IF I WANTS AND
WE DIDN'T NOTICE THEM UNTIL WE
START LOOKING -- FINGERTIPS.
CAN YOU SPEAK TO WHY YOU CHOSEN
TO KEEP YOUR CAREER AT NCI?
LIKE WHAT RESOURCES ARE UNIQUE
HERE IN THE KIND OF WORK THAT
YOU DO?
>> YES, GREAT QUESTION.
THANKS FOR ASKING.
MOST OF MY WORK ACTUALLY BEGAN
IN DOING GENOME-WIDE ASSOCIATION
STUDIES LOOKING AT GERMLINE
SUSCEPTIBILITY TO DISEASE RISK.
IT'S A TERRIFIC COLLECTION OF
GENOME-WIDE ASSOCIATION STUDY
DATA.
AND DOING THESE GENOTYPING
EFFORTS WE NOTICED THAT KEY
FAILING QC OVER AND OVER AGAIN
WITH DIFFERENT HETEROZYGOSITY
RATES AND THAT'S HOW WE BEGAN
USING THESE MEASUREMENTS TO
DETECT THESE EVENTS USING THE
VIRTUAL KARYOTYPING.
THAT REALLY OPENED UP A WHOLE
NEW WINDOW OF NOT ONLY BEING
ABLE TO USE THAT INFORMATION TO
STUDY GERMLINE VARIATION IN
INDIVIDUALS, BUT WE ALSO GET A
GLIMPSE OF THE SOMATIC VARIATION
BEGINNING TO HAPPEN IN THE FORM
OF REALLY LARGE STRUCTURAL COPY
NUMBER EVENTS.
TO BE HONEST, I WAS REALLY
SURPRISED HOW FREQUENT THESE
WERE IN THE POPULATION AND AS WE
HAVE BEGUN TO CHARACTERIZE THESE
OVER THE YEARS, REALLY TRYING TO
FIND OUT THE UTILITY OF THESE
EVENTS WHERE WE CAN LEARN FROM
THEM ABOUT THE DISEASE PROCESS
AS WELL AS HOW THEY CAN BE USED
TO PREDICT DISEASE.
>> I'LL ASK ONE MORE QUESTION.
I'LL GO AHEAD AND LET KARIN ASK.
>> GREAT TALK, THANK YOU VERY
MUCH, JOHN FOR ALLOWING ME TO
ASK THIS QUESTION.
IT'S RELATEDDED TO WHAT YOU HAD
JUST MENTIONED AS WELL.
AND I DO WONDER IF YOU HAVE
THOUGHT A LITTLE BIT ABOUT THE
IMPACT OF CHRONIC INFLAMMATION
ON THE MCA DEVELOPMENT.
BECAUSE THAT'S ONE OF THE THINGS
FOR COMMUNITIES OF COLOR, THOSE
WITH OTHER DISENFRANCHISED
COMMUNITIES, IT'S A CONSTANT
STRESSOR.
IT MAY BE HARDER TO LOOK AT
SINCE YOU HAVE PRO INFLAMMATORY
CYTOKINE RESPONSE, BUT I DON'T
KNOW IF THAT'S SOMETHING YOU
THOUGHT ABOUT LOOKING AT, IS
THIS CHRONIC RESPONSE TO
INFLAMMATORY INFLAMMATION.
>> TERRIFIC QUESTION.
AS I PRESENTED EARLIER IN THE
TALK, THERE IS A BIT OF A
SPECTRUM TO HEMATOPOIESIS.
I'M STUDYING LARGER EVENTS IN
THE SPECTRUM AND THERE ARE
SMALLER POINT MUTATIONS AT THE
OTHER END.
FOR THE POINT MUTATIONS, I THINK
THERE IS SOME INITIAL EVIDENCE
OF INFLAMMATION BEING A ROLE IN
DEVELOPMENT AND PROGRESSION
THERE.
FOR THE LARGER EVENTS, STUDIES
WE LOOKED AT SO FAR IN THE U.K.
BIOBANK THAT HAS SOME MEASURE OF
C RAV PROTEIN, WHICH AGAIN MIGHT
NOT BE THE BEST MEASURE OF
INFLAMMATION, WE DO NOT SEE ANY
ASSOCIATIONS BETWEEN THOSE
MEASUREMENTS AND MCAs.
MAYBE THERE IS OTHER BETTER
INFLAMMATION MEASUREMENTS WE
COULD LOOK AT BUT AT LEAST WE
DON'T HAVE INFORMATION RIGHT NOW
FROM LARGE ENOUGH SAMPLE SIZES
TO REALLY THROUGHLY ASSESS THAT.
>> THAT WAS A GREAT QUESTION.
WE KNOW THAT SOME HEME TA LODGE
CACK MALIGNANCIES SHOWS
DISPARITIES, MYELOMA, ALL, AND
SO I GUESS THE QUESTION IS, HOW
DIVERSE IS THE DATASET THAT YOU
HAVE BEEN MINING AND DO YOU
THINK THAT THERE COULD BE ANY
INSIGHTS THAT COULD BE GLEANED
ABOUT THE DIFFERENCES AND
PREVALENCE OR RISKS FOR THESE
DISEASES IN CERTAIN GROUPS?
>> THANK YOU.
THAT'S A REALLY TERRIFIC
QUESTION.
MOST OF THE RESEARCH I'M WORKING
ON RIGHT NOW IS USING EXISTING
GENOME-WIDE ASSOCIATION STUDY
DATA.
SO WE ARE REALLY LIMITED TO THE
GEE NO TYPING SETS THAT EXIST
AND UNFORTUNATELY, MOST OF THEM
TEND TO BE ON EUROPEAN
POPULATIONS.
REALLY LIMITING WHAT WE CAN DO
AS FAR AS LOOKING AT SAMPLE SIZE
WISE IN OTHER POPULATIONS.
LIKE I MENTIONED IN MY TALK, WE
DO HAVE EVIDENCE THAT
INDIVIDUALS WITH AFRICAN
ANCESTRY HAVE REDUCED RATES OF
MCAs WHICH WE FOUND
INTERESTING I'M WORKING IN
SUB-SAHARAN AFRICA FROM UGANDA
LOOKING AT POPULATIONS THERE AND
THIS IS A CONTINUATION ON WHAT
WE FOUND WITH THIS MALARIAL RISK
FACTOR FOR MCA RISK.
THIS IS A LARGER POPULATION OUT
THERE.
SO THAT IS ONE OPPORTUNITY TO
LOOK AT A DIFFERENT POPULATION
BEYOND EUROPEANS THAT WILL BE
SIZEABLE TO INVESTIGATE.
AND AS GWAS ARE BECOMING MORE
MULTI-ANCESTRY FOCUSED, WE WILL
HAVE MORE AND MORE DATA COMING
IN TO ASSESS THIS.
BUT MY PROGRAM IN AND OF ITSELF
JUST DOESN'T HAVE THE BANDWIDTH
OR RESOURCES TO REALLY ACQUIRE
THESE VERY LARGE SAMPLE SIZES
NEEDED TO INVESTIGATE THOSE
POPULATIONS.
>> THANKS.
GREAT ANSWER.
AND WE'LL KEEP WORKING TOWARDS
THAT.
FANTASTIC WORK.
THANK YOU VERY MUCH FOR THAT
PRESENTATION.
NEXT ON OUR AGENDA IS OUR BREAK.
AND IT WAS ORIGINALLY SET FOR
2:55-3:10.
LOOKS LIKE WE MAY GAIN ANOTHER 5
MINUTES HERE.
SO CAN EVERYONE PLEASE RETURN
ROUGHLY EIGHT MINUTES AFTER THE
HOUR SO WE CAN BEGIN PROMPTLY AT
10 MINUTES AFTER THE HOUR.
SO IT WOULD BE 3:10 EASTERN FOR
OUR NEXT PRESENTATION.
SO JUST MUTE AND TURN YOUR
CAMERAS OFF AND LOG BACK IN AROUND EIGHT AFTER.
>> THANK YOU ALL.
SO WE HAVE OUR FINAL
PRESENTATION FOR TODAY.
AND THE TITLE IS DECIPHERING THE
COMPLEXITY OF GENOMIC
ALTERATIONS IN HUMAN BREAST
CANCER FOR PRECISION ONCOLOGY BY
DR. A GUTTE GUTTE, AN ASSOCIATE,
UNIVERSITY OF NORTH CAROLINA,
CHAPEL HILL.
>> THANK YOU VERY MUCH FOR THE
INTRODUCTION AND IT'S A REAL
PLEASURE TO BE INVITED TO SPEAK
TODAY BY DR. RATHMELL AND A
PLEASURE TO BE HERE AND SHARE
SOME, UPDATES AND OPPORTUNITIES
IN THIS REALM OF DECIPHERING THE
COMPLEX CANCER GENOMES.
SO GENOME REARRANGEMENTS ARE A
HALLMARK OF CANCER AS MANY OF
YOU KNOW, BUT THEY ARE DISTINCT
FROM SINGLE NUCLEOTIDE
VARIATIONS THAT ARISE FROM
DAMAGE TO A SINGLE STRAND OF THE
DOUBLE-STRANDED DNA, SUCH AS
SHOWN HERE.
IN CONTRAST, GENOME
REARRANGEMENTS ARISE FROM A
BREAK TO BOTH STRANDS OF THE DNA
THAT WE CALL A DOUBLE STRAND
BREAK.
AND DURING THE POTENTIAL MISERY
PAIR OF THESE LESIONS THAT CAN
LEAD TO GENOME REARRANGEMENT.
ANOTHER INTERESTING DIFFERENCE
BETWEEN THESE TWO IS THAT WHILE
SINGLE NUCLEOTIDE VARIATIONS
SEEM TO INCREASE SOMEWHAT
LINEARLY ACROSS THE LIFETIME OF
A NORMAL TISSUE THAT PROGRESSES
TO PRE CANCER AND EVENTUALLY TO
INVASIVE CANCER, GENOME
REARRANGEMENTS ARE QUITE
INFREQUENT IN PRE CANCERS BUT
ARISE AT A MUCH HIGHER RATE IN
OVERT CANCER.
AND SO, THE PROCESSES THAT GIVE
RISE TO THESE GENOME REARRANGEMS
SUCH AS WHOLE GENOME
DUPLICATIONS AND p53
IMPAIRMENT, MAY BE PARTICULARLY
RELEVANT TO THIS PROCESS OF PRE
CANCER TO CANCER TRANSITION THAT
WE KNOW IS IMPORTANT FOR CANCER
ETIOLOGY.
ADDITIONALLY, DIFFERENT CANCERS
EVEN FROM THE SAME HISTOLOGICAL
SITE SUCH AS BREAST CANCER, CAN
SHOW VASTLY DIFFERENT AMOUNTS
AND PATTERNS OF GENOME
REARRANGEMENTS.
AND THE CAUSES AND THE CLINICAL
IMPLICATIONS OF THESE DIFFERENT
PATTERNS REMAINS TO BE
UNDERSTOOD IN MUCH GREATER
DETAIL.
NOW WHOLE GENOME SEQUENCING
PROVIDES A MUCH MORE COMPLETE
PICTURE OF CANCER GENOME
REARRANGEMENTS BUT IS MORE
COMPLEX.
NOW THANKFULLY, THERE IS 100,000
GENOMES PROJECT THAT IS ACTIVE
LEON GOING IN THE U.K. AND THEY
RECENTLY PUBLISHED THEIR INITIAL
EXPERIENCE BEFORE PERFORMING
WHOLE GENOME SEQUENCING IN
13,000 CANCERS THAT ARE BEING
DIAGNOSED.
POTENTIALLY CREATING A PATHWAY
TO EVALUATING ITS USE MORE
BROADLY IN CLINICAL SCENARIOS.
IN TERMS OF DECIPHERING THE
COMPLEXITY OF GENOMES, WE MADE A
LOT OF PROGRESS AND HERE I'M
REFERRING TO THE PAN CANCER
ANALYSIS OF WHOLE GENOMES
EFFORT, REALLY AN INTERNATIONAL
COLLABORATION BETWEEN THE TCAGA
GROUP IN THE U.S. AND
INTERNATIONAL COLLABORATORS THAT
HAVE BEGUN TO DISSECT THIS
COMPLEX PATTERN AND FOUND
RECURRENT SIGNATURES OF
CHROMOSOMAL INSTABILITY THAT ARE
BEING SEEN ACROSS DIFFERENT
TYPES OF CANCERS AND REALLY
INCORPORATING VAST AMOUNTS OF
DATA COMING NOT JUST FROM DNA
SEQUENCING BUT ALSO RNA
SEQUENCING AND FUNCTIONAL
GENOMICS.
AND WHILE WE HAVE MADE THIS
SIGNIFICANT PROGRESS, I THINK
THERE IS STILL IMPORTANT GAPS IN
OUR KNOWLEDGE THAT I WANT TO GO
OVER IN THE NEXT FEW SLIDES.
THE FIRST GAP IS HOW WE CAN
OPTIMALLY CAPTURE THE COMPLEXITY
OF CANCER GENOMES.
AND IN THIS STUDY PUBLISHED BY
THE LABS JUST LAST YEAR, IT
DEMONSTRATED USING LINKED READ
TECHNOLOGY OF NEXT GENERATION
SEQUENCING.
THEY FOUND THAT THE SAME PATTERN
OF COPY NUMBER ABERRATION AND
REARRANGEMENTS THAT WAS OBSERVED
COULD ACTUALLY ARISE FROM THREE
VERY DIFFERENT STRUCTURAL
REARRANGEMENTS IN THE GENOME
THAT COULD ONLY BE OBSERVED WHEN
THEY USED LINK READ SEQUENCING
METHOD.
WHY DOES THIS MATTER?
THEY FOUND THAT A SPECIFIC
PATTERN OF REARRANGEMENT THEY
CALLED RECIPROCAL PAIR
REARRANGEMENT, IS PARTICULARLY
PREVALENT IN BRCA DEFICIENT
CANCERS.
AND IT WAS ONLY REALLY BEING
IDENTIFIED USING THIS LINKED
READ METHOD.
BUT THERE IS GOOD NEWS HERE AS
IF YOU KNOW WHAT PATTERN YOU'RE
LOOKING FOR, YOU CAN SOMETIMES
FILL IN THE GAPS WITH SHORT READ
SEQUENCING AND THEY SHOWED THAT
HAVING THIS KNOWLEDGE OF THIS
UNDERLYING STRUCTURE, THEY COULD
PROX MADE THESE SIGNALS FROM THE
LUMINA SEQUENCING AND IMPROVE
THEIR ABILITY TO IDENTIFY HR
DEFICIENT CANCERS, WHICH MAY
ALLOW US TO BETTER TARGET
TREATMENT SUCH AS PARP
INHIBITORS AND OTHER THERAPIES.
WHAT DNA PROCESSES DRIVE THESE
THAT ARE BEING OBSERVED?
HERE, THERE IS A SPECIFIC
PATTERN OF EXTRACHROMOSOMAL
CIRCULAR DNA WHERE ONCOGENES
THAT ARE HIGHLY AMPLIFIED CAN
EXIST IN THESE CIRCLES THAT ARE
FLOATING AROUND IN THE NUCLEI OF
SOME AGGRESSIVE CANCERS, SUCH AS
GLIOBLASTOMA.
RECENTLY, A STUDY BY THE ZHANG
LAB AT DUKE FOUND A SPECIFIC DNA
REPEER PATHWAY MEDIATED BY DNA
POLYMERASE THETA THAT IS
REQUIRED FOR THE GENERATION OF
EXTRACHROMOSOMAL CIRCLES.
WHAT IS STRIKING IS THEY FOUND
THIS INITIALLY BY STUDYING
DROSOPHILA CELL SYSTEMS AND
VALIDATED IN MAMMALIAN SYSTEMS
AND IT REALLY HIGHLIGHTS THAT
THIS PATHWAY MAY BE -- WE KNOW
IT'S DRUGABLE BECAUSE THERE ARE
INHIBITORS TO THIS ENZYME THAT
ARE IN EARLY-STAGE CLINICAL
TRIALS BUT IT MAY ACTUALLY HELP
IN THE TREATMENT OF CANCERS THAT
HAVE THESE EXTRACHROMOSOMAL DNA
CIRCLES.
A THIRD IMPORTANT KNOWLEDGE GAP
IS HOW CELLS EVADE MITOTIC
CATASTROPHE AND WHAT ARE THE
PATHWAY THAT IS DICTATE THESE
MECHANISMS?
AND THESE TWO STUDIES ALSO
RECENTLY PUBLISHED BY THE
CLEVELAND AND PETER LIE LABS,
IDENTIFIED A NOVEL PATHWAY
INVOLVING TOP BP ONE AND CIP2A.
THAT CLUSTERS BROKEN FRAGMENTS
OF DNA AND THIS CLUSTERING OF
THESE FRAGMENTS ALLOWS THESE
CELLS TO SURVIVE THIS MY TO
THETIC CATASTROPHE MORE
EFFECTIVELY.
CANCER THAT OVEREXPRESS THIS
PROGRAM HAVE A SPECIFIC AND
IDENTIFY PANEL THAT IS OBSERVED
IN A SUBSET OF CANCERS AND THEIR
FUTURE WORK, I'M SURE, WILL
EXPLORE WHETHER THESE PATHWAYS
CAN POTENTIALLY BE TARGETED
THERAPEUTICALLY.
NOW LAST BUT NOT LEAST, I THINK
WE ARE REALIZING MUCH BETTER
THAT THERE IS AN INTERPLAY
BETWEEN GENOME REARRANGEMENT
PROFILES AND IMMUNE SURVEILLANCE
PATHWAYS.
AND IN WORK THAT WAS RECENTLY
PUBLISHED FROM OUR OWN GROUP, WE
WERE ABLE TO DEVELOP AN IN-VIVO
TRIPLE NEGATIVE BREAST CANCER
MOUSE MODEL THAT ALLOWS US TO
REALLY EVALUATE MODULATORS OF
THIS PRE CANCER TO CANCER
TRANSITION USING AN IN-VIVO
CHRIS PER SCREEN.
WHEN WE CHASED THE MECHANISMS,
WE FOUND A SHARED MECHANISM THAT
WAS CENTERED AROUND THE INNATE
IMMUNE SENSING OF DNA DAMAGE IN
THESE PRE CANCERS.
AND THE LOSS OF THAT ABILITY TO
ENGAGE THE INNATE IMMUNE SYSTEM
WAS ABSOLUTELY CRITICAL TO ALLOW
THESE PRE CANCERS TO PROGRESS
INTO OVERT CANCERS WITH HIGH
DEGREES OF GENOME INSTABILITY.
WE BELIEVE THAT THIS IS AN
IMPORTANT FACET OF HOW CANCERS
WITH HIGH DEGREES OF GENOME
ABERRATIONS ARE ABLE TO THRIVE
AND HOW THEY MAY SIMULTANEOUSLY
EVADE IMMUNE DETECTION, WHICH
MAY HAVE IMPLICATIONS FOR BOTH
CANCER PREVENTION AS WELL AS
IMMUNOTHERAPY RESPONSE.
SO JUST IN SUMMARY, I THINK WE
ARE CERTAINLY MAKING PROGRESS IN
SEEING THE PROMISE OF GENOME
REARRANGEMENT ANALYSIS TO HELP
GUIDE PRECISION ONCOLOGY.
BUT THERE IS STILL MORE WORK
THAT NEEDS TO BE DONE.
I THINK WE NEED TO FURTHER
DEVELOP OPTIMIZED METHODS FOR
GENOME CHARACTERIZATION AND
EVALUATE STRATEGIES AND THE
FEASIBILITY OF BRINGING SOME OF
THESE TECHNOLOGIES INTO CLINICAL
APPLICATION.
WE NEED TO CONDUCT MECHANISTIC
STUDIES TO LINK ETIOLOGY TO
THESE DIFFERENT PATTERNS OF
GENOME REARRANGEMENT SIGNATURES
AND EVALUATE THEIR IMPLICATIONS
FOR CANCER PREVENTION AND
POTENTIALLY TREATMENT.
WE NEED TO FURTHER GET INTO THIS
RELATIONSHIP BETWEEN GENOME
REARRANGEMENT MECHANISMS AND
IMMUNE EVASION BECAUSE THIS MAY
HAVE MAJOR IMPLICATIONS FOR HOW
WE CAN LEVERAGE THE IMMUNE SAYS
FOR CANCER PREVENTION AND
POSSIBLY TO IMPROVE OUR ABILITY
TO ENGAGE IN IMMUNE SYSTEM
THERAPEUTIC RESPONSES AND
FINALLY, WHILE WE CAN IDENTIFY
SOME OF THESE REARRANGEMENT
SIGNATURES, WE REALLY NEED TO
LINK THEM TO TARGETABLE
VULNERABILITIES.
AND WHILE I DESCRIBED SOME OF
PROGRESS IN THIS AREA, THERE IS
STILL MUCH WORK TO BE DONE,
PARTICULARLY IN DEVELOPING MODEL
SYSTEMS THAT CAN RECAPITULATE
THESE MECHANISMS AND EVALUATE
FOR POTENTIAL VULNERABILITIES.
SO I'LL STOP THERE.
I HOPE I REMAINED ON TIME AND
I'D BE HAPPY TO TAKE ANY
QUESTIONS.
>> THERE IS PLENTY OF TIME FOR
QUESTIONS.
WE CAN PULL DOWN THE
PRESENTATION AND GO TO
INDIVIDUAL MODE.
ANY QUESTIONS FOR DR. GUPTA?
>> I'LL START WITH A QUESTION.
I SEE SOME HANDS STARTING TO POP
UP.
IT'S NOT GOING TO BE ABOUT YOUR
SCIENCE BUT, I WAS -- SO I KNOW
BRITT BUT I WAS LOOKING AT YOUR
BIOEARLIER TODAY AND DISCOVERED
THAT YOUR ASSOCIATE DIRECTOR FOR
THE M.D., PH.D. PROGRAM FOR MY
OLD JOB, YOU'RE A RADIATION
ONCOLOGY AND CLEARLY DOING
DISCOVERY BASIC SCIENCE.
SO, I WONDER IF YOU CAN COMMENT
ON THE -- YOUR EXPERIENCE AS A
PHYSICIAN SCIENTIST AND YOUR
THOUGHTS ON THE ROLE OF
PHYSICIAN-SCIENTISTS IN THIS
SPACE.
>> THANK YOU FOR THAT QUESTION.
IT'S SOMETHING THAT IS NEAR AND
DEAR TO MY HEART AND IT'S A LONG
PATHWAY TO TRAIN AS A PHYSICIAN
SCIENTIST.
AND SOMETIMES YOU FEEL LIKE
THERE IS TWO PARTS OF YOU THAT
YOU'RE DEVELOPING AND
CULTIVATING.
AND IT TAKES SO LONG TO REALLY
SEE THEM COME TOGETHER.
BUT, I OPEN THE DOORS TO MY LAB
AND I WAS STUDYING FUNDAMENTAL
MECHANISMS WHILE I ALSO STARTING
TO TREAT PATIENTS IN THE CLINIC.
BUT YOU KNOW, DUE TO MY ROLE AS
A PHYSICIAN AND A SCIENTIST, I
WAS ALSO ABLE TO BE INVOLVED IN
CLINICAL TRIAL DEVELOPMENT AND
THE GUIDANCE OF THOSE TRIALS TO
MAKE SURE THAT WE COULD ACCESS
BIOSPECIMENS THAT WOULD ALLOW US
TO LEARN FROM THOSE STUDIES.
SO ONE OF THOSE TRIALS IS A
STUDY OF COMBINING IMMUNE
CHECKPOINT BLOCKADE WITH
RADIATION IN BREAST CANCER
PATIENTS.
AND WHAT IS QUITE REMARKABLE IS
THAT NOW THIS TRIAL IS NEARLY
COMPLETE AND WE HAVE THE
SPECIMENS AND WE ARE SEEING
INCREDIBLE AND UNEXPECTED
RESPONSES TO THE COMBINATION AND
WE SEE IT IN SOME PATIENTS AND
NOT IN OTHERS.
AND SO WHILE WE WERE DOING THIS
WORK IN THE PRE-CLINICAL MODELS,
AND WE MAKE THIS DISCOVERY,
ACTUALLY ALREADY IN OUR LAB, WE
ARE LOOKING AT WHETHER THESE
MECHANISMS ARE AT PLAY IN THIS
CLINICAL TRIAL WHERE WE ARE
SEEING THESE NICE RESPONSES.
SO, I THINK IT'S JUST A
TESTAMENT TO OBVIOUSLY THERE IS
SERENDIPITY INVOLVED, BUT I
THINK IT REALLY TOOK THE TWO
SIDES OF MY TRAINING THAT
ALLOWED ME TO HAVE THIS
CULMINATION OF OPPORTUNITY.
AND SO I FEEL VERY FORTUNATE AND
I'M SO HAPPY TO BE ABLE TO BE IN
A ROLE WHERE I CAN CULTIVATE
THIS FOR THE NEXT GENERATION
BECAUSE I THINK IT'S A LONG ROAD
BUT I THINK IT HAS SOME UNIQUE
OPPORTUNITIES.
>> AWESOME, THANK YOU.
AND PATIENTS BENEFIT AS WELL.
I LOVE THAT FULL CIRCLE STORY.
THAT IS GREAT.
>> ANN?
>> SO FIRST OF ALL, OUTSTANDING
PRESENTATION.
SO MUCH TO DO HERE.
SO EARLY ON IN THE CANCER GENOME
ATLAS, ACTUALLY ABOUT A YEAR
INTO IT, WE DID A SIMPLE THING.
WE JUST STACKED UP ALL THE
CHANGES SEEN IN THE TUMORS WE
HAD DONE TO THAT POINT.
AND WHAT FELL OUT OF THAT WAS
THAT THERE ARE THESE TUMORS THAT
ARE VERY, VERY CLEARLY RELATED
TO THESE LARGE STRUCTURAL
CHANGES.
THERE WERE COPY NUMBER, COPY
NUMBER SIGNATURE KIND OF TUMORS,
NO QUESTION.
OVARIAN CANCER IS PROBABLY THE
BEST EXAMPLE.
BUT, AND THE PATTERNS ARE
STARTING TO EMERGE BUT WHAT IS
IT IN THAT ACTUALLY YOU THINK IS
BEHIND OR CAUSED OR
MECHANISTICALLY PRODUCING THIS
KIND OF CHANGE?
AND ARE THESE CANCERS
SUFFICIENTLY DIFFERENT THAT
WE'RE JUST NOT THINKING ABOUT
THEM THE WAY WE SHOULD BE
THINKING ABOUT THEM?
I MEAN I WOULD HAVE PREDICTED
THAT WE WOULD HAVE HAD A MUCH,
MUCH BETTER TRACK RECORD ON
TREATING OVARIAN CANCER BY NOW
THAN WE HAVE.
WHAT DO YOU THINK YOU'RE LOOKING
AT THIS CAREFULLY?
>> SO, I HAVE A BIT OF A SOAPBOX
ON THIS BUT I'LL GIVE YOU THE
SHORT VERSION.
WE HAVE TO BE CAREFUL ABOUT WHAT
SIGNALS WE MAY BE MISSING.
SO, WE ARE LOOKING AT DNA.
WE ARE LOOKING AT RNA AND THE WE
HAVE BEEN REALLY GOOD AT THAT
AND I'M SO GLAD WE MOVED TOWARDS
PROTEIN AND OTHER SIGNALS
BECAUSE WE KNOW THAT THE DNA
DAMAGE RESPONSE IS NOT WELL
CAPTURED BY DNA AND RNA.
p53 IS LOST IN THE MAJORITY OF
THESE HIGHLY-COMPLEX GENOMES.
CANCERS.
BUT p53 IS LOST IN OTHER
CANCERS THAT DON'T HAVE THAT
PHENOTYPE.
WHILE IT MAY BE REQUIRED, WE
KNOW IT'S NOT SUFFICIENT AND I
THINK THIS INTERPLAY WITH THE
IMMUNE SYSTEM MAY BE A CRITICAL
ASPECT OF WHAT MAY BE MISSING
HERE.
AND I SAY THAT BECAUSE WHEN WE
LOOK AT, FOR EXAMPLE, TRIPLE
NEGATIVE BREAST CANCER WHERE WE
GIVE CHEMOTHERAPY BEFORE SURGERY
AND WE KNOW THAT RESPONSE TO
CHEMO IS CRITICALLY LINKED TO
OUTCOME, WE CAN'T PREDICT THAT
RESPONSE BY RNA-SEQ AND DNA SEQ.
BUT, WHEN WE START LOOKING
CAREFULLY, THE SIGNALS THAT
EMERGE THAT ARE MOST PREDICTIVE
OF CHEMOTHERAPY RESPONSE IS
IMMUNE INFILTRATION.
AND THERE IS NO IMMUNE
CHECKPOINT BLOCKADE THERE.
SO THIS CONNECTION BETWEEN DNA
DAMAGE RESPONSE AND IMMUNE
INTERPLAY SEEMS TO BE CRITICAL
AND WE MAY HAVE MISSED THAT
EARLY ON.
AND SO, I THINK WE'RE ON THE
RIGHT PATH BUT WE NEED TO
UNDERSTAND THIS BETTER.
THANK YOU FOR YOUR QUESTION.
>> I ALSO THINK -- ONE OTHER
THING WE ARE MISSING, AND WE ARE
STARTING TO GET ON TOP OF THIS,
SOME OF THE WORK IN THE LAST
MOONSHOT AND NOW THE
MICROENVIRONMENT.
I MEAN IF YOU LOOK AT SOME OF
THESE TUMORS, AND GETTING BACK
TO MY PHYSICS TRAINING, A LOT OF
THESE TUMORS ARE SO DIFFERENT IN
TERMS OF THEIR ENVIRONMENT
COMING BACK TO OVARIAN CANCER.
AND I THINK THAT'S ANOTHER BIG
PART OF THE MISSING PIECES HERE.
>> ABSOLUTELY.
>> SO ONE QUESTION I HAVE FOR
YOU IS, BECAUSE THE WORD
PRECISION ONCOLOGY WAS IN THE
TITLE.
WHAT DOES THIS MEAN AS WE
CONSIDER SORT OF TREATMENT,
INFORMED THERAPEUTICS?
SO I GUESS THE QUESTION IS, DO
YOU THINK WE NEED TO GET WHOLE
GENOME INTO THE CLINIC?
>> I THINK WE DON'T KNOW YET.
YOU KNOW, WE'RE DEVELOPING A LOT
OF THESE VERY COMPLEX TOOLS SUCH
AS SPACIAL TRANSCRIPTOMICS,
SINGLE-CELL ANALYSIS, I DON'T
SEE THAT WE WILL BE ABLE TO
SCALE THAT FOR REALTIME CLINICAL
USE.
BUT, I SHOWED ONE EXAMPLE WHERE
IF YOU APPLY IT IN CERTAIN
SETTINGS, YOU MAY LEARN CERTAIN
INSIGHTS THAT YOU THOUGHT --
THAT YOU DIDN'T REALIZE YOU WERE
MISSING AND THEN YOU CAN COLLECT
A MORE PRAGMATIC ASSAY TO GATHER
THAT INFORMATION.
THAT'S MORE WHAT I'M THINKING
ABOUT, IS THAT THE CANCER
GENOME, THE WHOLE GENOME IS IT A
REFLECTION OF THE UNDERLYING
BIOLOGICAL STATE.
AND WE NEED TO UNDERSTAND THE
BIOLOGICAL UNDERPINNINGS IN A
MORE CONTROLLED SETTING BUT THEN
PERHAPS WE CAN SIMPLIFY THAT AND
CREATE A MORE PRAGMATIC ASSAY TO
CAPTURE THAT AND THEN APPLY THAT
IN THE CLINIC.
SO, IF I WERE TO SUMMARIZE,
THAT'S KIND OF THE WAY I SEE IT
IS THAT THIS IS THE REMBRANDT OF
THE CANCER GENOME AND IT'S
COMPOSED OF MANY COMPONENT PARTS
AND IT'S OUR JOB TO DECIPHER
THAT.
BUT THEN THE APPLICATION DOESN'T
NECESSARILY MEAN WE HAVE TO
APPLY THE MOST COMPLEX ASSAYS TO
EXTRACT THE MEANINGFUL
INFORMATION.
>> I AGREE.
I GUESS WE TALK ABOUT MOLECULAR,
CELLULAR, BIOLOGICAL STATES.
THINK A FOURTH ONE THAT WE MAY
NOT LOOK AT AS MUCH THAT COULD
ALSO BE IMPORTANT IS
PHYSIOLOGICAL STATE.
I THINK IT TIES INTO ANNA'S
COMMENTS ABOUT THE
MICROENVIRONMENT.
THINGS LIKE HYPOXIA.
WE HAVE OXYGEN SPECIES, THE PH
IN CERTAIN REGIONS OF THE CANCER
AND HOW THAT CAN IMPACT THE
TUMOR GROWTH AND ITS EVASION
FROM THE IMMUNE SYSTEM.
SO IT IS REALLY EXCITING WORK.
>> SO CAN I MAKE ONE COMMENT.
I'M IN FAVOR OF WHOLE GENOME
SEQUENCING OF EVERYONE OUT
THERE.
KNOW I FEEL LIKE THAT.
BUT THE 100 DOLLAR GENOME IS OUT
THERE TODAY.
I MEAN WE HAD AN ANNOUNCEMENT
TODAY AND I THINK PEOPLE WHO
LOOKED AT THIS PARTICULAR
INSTRUMENT ARE SAYING GOOD
THINGS ABOUT IT.
SO I THINK THE 100 DOLLAR GENOME
PUTS IT IN THE HANDS OF EVERY
PHYSICIAN VERY SOON.
AND WE TALK ABOUT INEQUITIES IN
CARE, THAT'S WHERE THE
INEQUITIES ARE.
AND WE ARE GOING TO FIX THAT BY
GETTING THESE COSTS DOWN, I
THINK.
I HOPE.
SO LET'S DON'T RULE OUT -- IF
YOU HAVE ALL THAT DIGITAL
INFORMATION, YOU HAVE A LOT OF
INFORMATION AND YOU'RE GOING TO
NEED MOST OF IT TO GO THROUGH
AND PUT THE ENTIRE GENOMIC
PICTURE TOGETHER.
I AGREE WITH THAT.
I THINK YOU NEED THE DNA.
IT'S A GREAT ROADMAP.
>> AGREED.
REALLY UNDERSTAND THESE
STRUCTURAL EVENTS AND THESE
STRUCTURAL REARRANGEMENTS, THE
GENOME IS SO POWERFUL FOR THAT.
ARE THERE ANY ADDITIONAL
COMMENTS OR QUESTIONS?
IF NOT, THANK YOU VERY MUCH FOR
THAT FASCINATING PRESENTATION.
>> THANK YOU VERY MUCH.
GOODBYE.
>> SO NOW THE BOARD WILL
CONSIDER ONGOING AND NEW
BUSINESS RELATIVE TO ONGOING
BUSINESS.
THERE ARE THREE SUBCOMMITTEE --
THERE WERE THREE SUBCOMMITTEE
MEETINGS EARLIER TODAY AND NOW
THE REPORTS WILL BE GIVEN BY THE
SUBCOMMITTEE CHAIRS.
AND WE'LL VOTE ON THE ACCEPTANCE
OF EACH REPORT AFTER THEIR GIVEN
BY THE RESPECTIVE CHAIR.
SO THE FIRST REPORT WILL BE
GIVEN BY DR. A WINK WINK.
KARIN?
>> THANK YOU VERY MUCH.
AND I APPRECIATE THE OPPORTUNITY
TO SHARE A LITTLE BIT ABOUT WHAT
WE DISCUSSED AT OUR AD-HOC
SUBCOMMITTEE MEETING TODAY.
WE ACTUALLY SPENT JUST VERY
BRIEFLY JUST REVIEWING WHAT THE
CHARGE WAS FOR THE SUBCOMMITTEE.
I THINK THAT IS IMPORTANT
BECAUSE WE HAD NEW MEMBERS JOIN.
AND THEN WE WERE VERY PLEASED TO
WELCOME DR. RATHMELL TO COME IN
AND SHE EMPHASIZED THE
IMPORTANCE OF THE WORK OF THE
SUBCOMMITTEE.
AND THE NIH EFFORTS GLOBALLY TO
JUST CHALLENGES RELATED TO
CANCER PREVENTION AND HEALTH
EQUITY.
THERE WERE SEVERAL KEY POINTS
THAT WERE RAISED IN THE MEETING
AND I THINK WE SPENT A VERY LONG
TIME DISCUSSING THE WORK THAT IS
ALREADY ONGOING AT THE NATIONAL
INSTITUTES OF HEALTH.
WE WERE VERY PLEASED TO HAVE
DR. KATRINA G. GODDARD WHO
PRESENTED AN UPDATE ON THE
WORKING GROUP EFFORTS ON SOCIAL
DETERMINANTS OF HEALTH.
SHE PROVIDED THAT UPDATE.
THE SOCIAL DETERMINANTS OF
HEALTH RESEARCH COORDINATING
COMMITTEE OR RCC, THE WORK IS
REALLY VITALLY IMPORTANT BECAUSE
AS DR. GODDARD POINTED OUT,
SOCIAL DETERMINANTS OF HEALTH
ACCOUNT FOR HALF OF THE
VARIATION IN HEALTH OUTCOMES.
IF WE ARE TO REDUCEICANCY
MORTALITY BY 25% IN 25 YEARS
AND -- REALLY UNDERSTANDING
SOCIALITY DETERMINANTS OF HEALTH
AND IDENTIFYING THE APPROPRIATE
WAY TO IMPLEMENT CHANGES WITHIN
THE HEALTH CARE SYSTEM TO
ADDRESS THESE IS REALLY
CRITICAL.
SO THE RCC WAS ESTABLISHED IN
2022.
IT WAS REALLY BORNE OUT OF AN
URGENT NEED TO DEVELOP A
COORDINATED STRATEGY TO PROPEL
DISCOVERIES AND TO IMPROVE
INDIVIDUAL AND POPULATION
HEALTH, TO REDUCE HEALTH
DISPARITIES AND ADVANCE HEALTH
EQUITY.
IT WAS BORNE OUT OF A GRASS ROOT
EFFORT BY STAFF ACROSS THE NIH
WITH THE GOAL OF ACCELERATING
NIH-WIDE SOCIAL DETERMINANTS OF
HEALTH RESEARCH ACROSS DECEASES
AND CONDITIONS.
WE CAN LEARN IN A
MULTIDISCIPLINARY FASHION FROM
ALL THE EFFORTS THAT ARE
HAPPENING AND IT FOCUSED ON
LEVERAGING SOME OF THE SOCIAL
DETERMINANTS OF HEALTH
INVESTMENTS THAT HAVE BEEN MADE,
THE INNOVATIONS AND ACROSS THE
NIH INSTITUTES AND CENTERS.
AND THEN 2023 THE RCC RELEASED A
UNIFIED CONCEPTUAL FRAMEWORK FOR
SOCIAL DETERMINANTS OF HEALTH.
DR. GODDARD REVIEWED THAT.
THESE ARE ON LINE AND AVAILABLE
FOR PUBLIC REVIEW AS IS THE U.S.
PLAY BOOK ON SOCIAL DETERMINANTS
OF HEALTH THAT WAS RELEASED IN
NOVEMBER OF 2023 AND THE PLAY
BOOK OUTLINES AN INITIAL SET OF
STRUCTURAL ACTIONS UNDER THREE
MAIN PILLARS THAT FEDERAL
AGENCIES ARE UNDERTAKING TO
BREAKDOWN SILOS AND SUPPORT
EQUITABLE HEALTH AND OUTCOMES BY
IMPROVING SOCIAL CIRCUMSTANCES
OF INDIVIDUALS AND COMMUNITIES.
DR. GODDARD SHARED SEVERAL OF
THE NCI SUPPORTED SOCIAL
DETERMINANTS OF HEALTH
INITIATIVES INCLUDING THE
ADVANCING CANCER CONTROL EQUITY
RESEARCH THROUGH TRANSFORMATIVE
SOLUTIONS OR ASSERT CONSORTIUM.
AND THE NIH COMMON FUND
COMMUNITY PARTNERSHIPS TO
ADVANCE SCIENCE FOR SOCIETY OR
THE COMPASS PROGRAM.
SHE SHARED THAT THE ADVANCING OR
THE ASSERT, U19 MECHANISM
LAUNCHED IN 2023.
THE EXPECTATION OF THESE FUNDS
WILL SUPPORT INNOVATIVE
STRATEGIES THAT ADDRESS
MULTILEVEL SOCIAL DETERMINANTS
OF HEALTH INTERVENTIONS AND
RESEARCH PROJECTS NOT JUST FORK
USED ON ONE ASPECT OF SOCIAL
DETERMINANTS OF HEALTH BUT
HAVING EXPECTATION AS WELL THAT
THERE WILL BE COMMUNITY
RESPONSIVE PROJECTS INTEGRATED
OVER THE COURSE OF THE GRANT
PERIOD.
PROPOSALS WERE RECEIVED IN
SEPTEMBER AND THE INTENT IS TO
FUND FOUR OF THOSE PROPOSALS.
SHE ALSO REVIEWED HOW THE RCC
HAS CONCEPTUALIZED SOCIAL
DETERMINANTS OF HEALTH AND I
THINK THAT IS IMPORTANT BECAUSE
SHE PROVIDED SOME SHARED
DEFINITIONS, NOMENCLATURE, THAT
REALLY TO ENSURE THERE IS A
COMMON LANGUAGE TO BE USED IN
THIS SPACE.
THERE IS A DIFFERENCE BETWEEN
SOCIAL NEEDS, SOCIAL
DETERMINANTS AND SOCIAL RISK AND
THE WORKING DEFINITIONS FOR
THESE TERMS WERE SHARED WITH THE
SUBCOMMITTEE AND AGAIN, REALLY
IMPORTANT TO DEFINE THESE SO AS
RESEARCHERS AND THESE GRANTS ARE
BEING FUNDED, THAT ALL THE
RESEARCHERS ARE SPEAKING A
COMMON LANGUAGE AND THE OUTCOMES
WILL BE COMPARABLE OR COMPARABLE
ACROSS STUDY PROGRAMS AND
INITIATIVES.
THERE WERE ROBUST DISCUSSION
THAT FOLLOWED INCLUDING SOME
RECOMMENDATIONS FROM THE
SUBCOMMITTEE THAT INCLUDED
SUGGESTIONS AROUND DISSEMINATION
OF THE RCC PROGRAMS AND OUTCOMES
THAT COME BACK AND MAKING SURE
THAT THE DISSEMINATION INCLUDES
INTENTIONAL DISSEMINATION BACK
TO THE COMMUNITIES.
THAT'S A REALLY IMPORTANT
COMPONENT.
ALSO THERE WAS A SUGGESTION TO
MAKE SURE THERE IS INCLUSION OF
PATIENT ADVOCATES AND COMMUNITY
VOICES IN THE WORK THAT IS BEING
DONE NOT JUST AT THE NIH BUT
ALSO AS PART OF THESE GRANTS.
AND A SUGGESTION THAT THERE BE A
CRITICAL REVIEW OF THE PROPOSALS
SUBMITTED RELATED TO SOCIAL
DETERMINANTS OF HEALTH TO ENSURE
THAT THE OBJECTIVES OF THE GRANT
IS BEING ADDRESSED IN A
SUBSTANTIVE WAY AND NOT JUST
PLAYING LIP SERVICE BUT REAL
PARTNERSHIPS THAT ARE BEING
BUILT PARTICULARLY WITH
COMMUNITIES THAT ARE MOST
IMPACTED BY SOCIAL DETERMINANTS
OF HEALTH.
SO AFTER DR. GODDARD GAVE HER
PRESENTATION, WE HAD
CONVERSATION AND TURNED TO
CONSIDERATION OF WHERE THE
SUBCOMMITTEE WANTS TO FOCUS THE
EFFORT OVER THE NEXT YEAR OR SO
AND IT'S THAT CONVERSATION THAT
SPARKED THE NEED FOR NOVEL
MEASURES AND MEASURE LITTLE.
ALL OF GOVERNMENT EFFORT IS
NEEDED TO MITIGATE CROSSCUTTING
CHALLENGES IN HEALTH EQUITY, FOR
EXAMPLE, HOUSING INSECURITY,
LACK OF TRANSPORTATION,
GOVERNMENT AGENCIES THAT WORK
WITH THAT, WITH THOSE TWO
ISSUES.
BUT WE REALLY NEED TO FIGURE OUT
WAYS TO MINIMIZE
MISCOMMUNICATIONS AND DUPLICATE
EFFORTS TO HAVE STANDARDIZED
MEASURES FOR SOCIAL DETERMINANTS
OF HEALTH AND FIGURE OUT HOW TO
IMPLEMENT THEM.
AND REALLY THE TRADITIONAL
EPIDEMIOLOGY METHODS ARE
INSUFFICIENT TO ADDRESS SOME OF
THESE NEW TECHNOLOGIES.
IT REALLY PROVIDES JUST A STATIC
SNAPSHOT THAT DOESN'T ALWAYS
TAKE INTO CONSIDERATION THE
COMPLEXITY OF HOW SOCIAL
DETERMINANTS MAY CHANGE OVER
TIME AND HOW THEY MIGHT IMPACT
THE BIOLOGIC BASIS OF HEALTH.
AND SO REALLY HAVING SOME NOVEL
AND DYNAMIC TECHNIQUES TO
METHODOLOGIES.
THOSE ARE THINGS THAT NEED TO BE
DEVELOPED, VALIDATED AND
IMPLEMENTED.
WE ALSO SUGGESTED THAT THERE BE
AN IMPROVED -- WE START TO THINK
ABOUT BIDIRECTIONAL
COMMUNICATION BETWEEN THE
RESEARCHERS AND THE COMMUNITY.
ALREADY EFFORTS WITH THAT.
BUT AGAIN, AS POINTED OUT,
HAVING DIVERSE COMMUNITY VOICES
AND PATIENT ADVOCATES BEING
INCLUDED IN SOCIAL DETERMINANTS
OF HEALTH RELATED PROGRAMS AS
MEMBERS OF THE EXECUTIVE
COMMITTEES, REALLY IMPORTANT.
AND THE RESULTS OF THE NIH
RESEARCH SHOULD BE DISSEMINATED
AGAIN TO BROADER COMMUNITIES.
SO WE WOULD LOVE PERHAPS AS THE
SUB COMMITTEE TO FIGURE OUT WAYS
TO DO THAT.
WE ALSO THINK IT'S SO IMPORTANT
TO HAVE BASIC SCIENTISTS BE
ENGAGED IN THE CONVERSATIONS IS.
EXAMPLES OF SUCCESSFUL
ENGAGEMENT EFFORTS SHOULD BE
DISSEMINATED WITHIN THE
SCIENTIFIC AND BROADER
COMMUNITIES.
WE HAD WONDERFUL SUBCOMMITTEE
MEMBER DR. ANNA NEVIS INDICATED
SHE HAD EXAMPLES OF HOW
COMMUNITY ENGAGEMENT IMPACTED
THE DIRECTION OF BASIC AND
TRANSLATIONAL SCIENCE AND WE
WOULD BE HAPPY TO SHARE THAT.
SO THAT MAY BE SOMETHING TO
CONSIDER IN A FUTURE MEETING.
AND WE TALKED ABOUT WORKFORCE
TRAINING AND EARLY CAREER
SUPPORT.
THERE IS SUCH A GROWING NEED IN
PUBLIC HEALTH THAT REALLY
REQUIRES A LARGER COMMUNITY
HEALTH CARE AND RESEARCH
WORKFORCE.
WE ARE IN A DEFSILT AND SO, WE
NEED TO HAVE MORE TRAINING
PROGRAMS TO SUPPORT CAREERS AND
PREVENTION, ESPECIALLY FOR
PEOPLE FROM MARGINALLITES AND
UNDERREPRESENTED COMMUNITIES AND
TO INCLUDE BASIC AND
TRANSLATIONAL RESEARCHERS.
SO AGAIN FOR ACTION ITEMS, I
THINK FOR OUR FUTURE MEETINGS,
WE ARE STILL GOING TO THINK
ABOUT WHAT WE'D LIKE TO ACHIEVE
BUT PERHAPS HAVING THE MEMBERS
OF THE COMPASS PROGRAM AND TEAMS
BE INVITED TO SPEAK AT THE NEXT
SUBCOMMITTEE MEETING ABOUT THE
BEST PRACTICES AND THINGS THAT
THEY ARE LEARNING FROM THOSE
PARTNERSHIP EFFORTS AND
CERTAINLY MAYBE EVEN IN ASKING
OUR OWN MEMBERS TO SHARE THEIR
EXPERIENCES REGARDING HOW
COMMUNITY ENGAGEMENT HAS REALLY
CHANGED THE FACE OF RESEARCH.
THOSE MIGHT BE SOME THINGS THAT
WE CAN START AS A WAY TO REALLY
HELP TO FIGURE OUT THE DIRECTION
THAT THE SUBCOMMITTEE WOULD LIKE
TO GO IN OVER THE NEXT YEAR.
THANK YOU FOR ALLOWING ME A
CHANCE TO GIVE A BRIEF UPDATE
AND THERE WILL BE FURTHER
UPDATES AS DOCUMENTATION IS
IMPROVED OVER THE NEXT WEEK OR
SO.
>> GREAT.
THANKS, KARIN.
I GUESS WE NEED TO KEEP THESE
ROUGHLY TO A 10-MINUTE OR SO --
FOR EACH ONE BECAUSE WE ONLY
HAVE ABOUT 30 MINUTES FOR THE
OVERALL SESSION.
SO, I GUESS ARE THERE ANY
QUESTIONS FOR KARIN?
ANY BURNING QUESTIONS?
THERE BEEN NONE, THEN WE NEED TO
VOTE TO ACCEPT THE REPORT FROM
THE SUBCOMMITTEE.
IS THERE A MOTION TO ACCEPT?
>> MOTION TO ACCEPT.
>> SECOND.
>> PROPERLY MOVED AND SECONDED.
ANY FURTHER QUESTIONS OR
DISCUSSION?
THERE BEING NONE, WE WILL VOTE.
ARE THERE ANY NEIGHS? NAYs?
ABSTENTIONS.
>> IT'S UNANIMOUS.
>> WONDERFUL.
THE NEXT REPORT WILL BE GIVEN TO
US BY RICHARD WHO CHAIRS THE
AD-HOC COMMITTEE ON EXPERIMENTAL
THERAPEUTICS.
RICHARD.
>> THANK YOU VERY MUCH.
CAN YOU HEAR ME?
>> YES.
>> GOOD.
BECAUSE THERE WERE TECHNICAL
PROBLEMS EARLIER.
THE SUBCOMMITTEE MEMBERS MET AND
IT WAS REALLY THE PRINCIPLE
REASON FOR MEETING QUARTERLY IS
TO ALTER OR AT LEAST PERHAPS
IMPROVE OR UPDATE THE MISSION
STATEMENT FOR THE SUBCOMMITTEE
ON EXPERIMENTAL THERAPEUTICS
BECAUSE IT WAS LAST WRITTEN IN
2006.
THE UPDATED LANGUAGE WAS READ
CAREFULLY BUT AFTER A ROBUST
CONVERSATION, AND I THINK IT WAS
GREAT THAT WE WERE ABLE TO HAVE
THAT, WE DECIDED THAT WE WERE
GOING TO HAVE A SUBCOMMITTEE OF
THE SUB COMMITTEE.
IN OTHER WORDS, A FEW PEOPLE WHO
WOULD BE WILLING TO WRITE MAYBE
A MORE BROAD RATHER THAN MORE
SPECIFIC KIND OF MISSION
STATEMENT THAT WOULD HELP US
TODAY AND INTO THE FUTURE.
AND SO, THE RIGOROUS
CONVERSATION REALLY LED BY
DR. BARKER AND AMY AND JULIE,
ULTIMATELY WE DECIDED THAT IT
WOULD BE BETTER IF WE WERE TO
LOOK AT TRAINING AS WELL AS
OTHER ASPECTS THAT EXPERIMENTAL
THERAPEUTICS COULD OFFER THE NCA
ABOUT AND CANCER COMMUNITY IN
GENERAL.
THERE WAS CONVERSATION ABOUT THE
DIFFERENCES BETWEEN REQUIREMENTS
FOR ACADEMIC RESEARCH AND
REGULATORY APPROVAL LEADING TO
COMMERCIALIZATION WHICH OFTEN
CAUSES DEVELOPMENT OF
THERAPEUTICS TO FAIL.
SO THE SUBCOMMITTEE SOUGHT A
ROLE IN TRAINING ACADEMIC
COLLEAGUES IN THE REQUIREMENTS
OF THIS WOULD BE ADVANTAGEOUS.
AND SO, RATHER THAN THE ACTION
ITEM FOR THE NCAB WAS GOING TO
BE TO ACCEPT THE
PREVIOUSLY-THOUGHT OF UPDATED
VERSION.
AND THE BECAUSE WE DECIDED WE
ARE GOING TO UPDATE ANOTHER
TIME, WE ARE GOING TO PUT THAT
OFF UNTIL THE JUNE MEETING.
SO, FUNDAMENTALLY WHAT WE ALL
DECIDED WAS, THAT THERE WAS
ABSOLUTELY A GOOD REASON TO
UPDATE THE MISSION STATEMENT BUT
WE NEED TO WORK ON IT A LITTLE
BIT MORE.
SO THAT'S REALLY WHAT WE
DISCUSSED AND IT WAS AN
EXCELLENT DISCUSSION.
THANK YOU.
>> I HAVE A POINT OF QUESTION.
GIVEN THAT THERE WAS GOING TO BE
A VOTE ABOUT THE REVISED MISSION
STATEMENT.
WE WILL FOREGO THAT VOTE.
>> THE BOARD HAD TWO ACTIONS.
ONE WAS TO ACCEPT THE REPORT
THAT RICHARD JUST GAVE US.
AND THE SECOND WAS TO ACCEPT THE
MISSION STATEMENT.
WE WILL NOT ACCEPT THE MISSION
STATEMENT TODAY.
WE DO NEED TO ACCEPT THE REPORT.
>> GOT IT.
ARE THERE ANY ADDITIONAL
QUESTIONS FOR DR. BOXER?
THERE BEING NONE, WE WILL NOW
VOTE TO ACCEPT HIS REPORT.
IS THERE A MOTION TO ACCEPT?
>> SO MOVED.
>> SECOND?
>> SECOND.
>> PROPERLY MOVED AND SECONDED.
ANY FURTHER DISCUSSION OR
QUESTIONS?
THERE BEING NONE, WE'LL GO AHEAD
AND VOTE.
ARE THERE ANY NAYs?
ANY ABSTENTIONS?
THERE BEING NONE, IT'S UNANIM
UNANIMOUS.
>> CORRECT.
>> GREAT.
AND OUR FINAL REPORT WILL BE
BROUGHT TO US BY ANN BARKER WHO
CHAIRS THE SUBCOMMITTEE ON
PLANNING AND BUDGET.
SO ANN WILL GIVE THAT REPORT.
>> YES, THANK YOU, JOHN.
FIRST I WANT TO THANK THE
COMMITTEE.
IT WAS A REALLY GOOD DISCUSSION,
ONE OF THE BEST WE'VE HAD.
AND I WANT TO THANK WEST ON WHO
GAVE US A REALLY SCARY,
SOMEWHAT, BUT REALLY INTERESTING
OVERVIEW OF THE BUDGET PROCESS
FOR THE NCI.
AND WE TALKED ABOUT THE
LEGISLATIVE SIDE OF THAT, WHICH
IS ALWAYS TWO THINGS THAT ARE
HIGHLY CONNECTED, OBVIOUSLY.
WE STARTED WITH ACTUALLY
REVIEWING A CHARGE FOR THIS
COMMITTEE AND IT'S PRETTY
SIMPLE.
IT COMES DOWN TO ESSENTIALLY
WHAT CAN WE DO TO ASSIST OUR NEW
DIRECTOR?
AND SHE WAS KIND ENOUGH TO JOIN
US AND MADE IT VERY CLEAR THAT
SHE WOULD BE LOOKING TO THIS
SUBCOMMITTEE FOR HELP.
SO, WE ARE THERE AND HOPING THAT
WE CAN HELP.
AND I'M HOPING AT OUR
SUBCOMMITTEE, WE WILL REALLY
DEDICATE ITSELF TO THINKING MORE
ABOUT HOW WE MIGHT DO THIS.
AND SO, A COUPLE OF THINGS WE
TRIED TO DO WITH THIS MEETING
TODAY IS TO GIVE EVERYBODY AN
OVERVIEW OF VERY COMPLEX PROCESS
THAT IS THE NCI'S BUDGET
PROCESS.
AND THERE ARE SO MANY STEPS IN
THIS THAT IT'S REALLY HARD TO
CAPTURE BUT I THINK WESTON DID A
BEAUTIFUL JOB OF DOING THIS.
IT'S IMPORTANT THAT WE
UNDERSTAND THIS BECAUSE THERE
ARE SO MANY PLACES IN THIS
PROCESS WHERE INFLUENCE CAN BE
APPLIED, NOT NECESSARILY AS A
BOARD BUT AS INDIVIDUAL
CONTRIBUTORS TO OUR INSTITUTIONS
OR INDIVIDUALLY.
AND ALSO I THINK THE NCI HAS ITS
OWN OPPORTUNITIES TO INFLUENCE
THIS PROCESS, BUT MOSTLY IT'S
THE EXTRAMURAL COMMUNITY THAT
CAN INFLUENCE THIS PROCESS.
SO, I THINK WITH DR. RATHMELL WE
HAD A GOOD DISCUSSION ABOUT HOW
WE MIGHT BE MOST HELPFUL.
I WON'T SAY MUCH ABOUT THE
SLIDES THAT WESTON SHOWED, I
THINK THOSE WILL BE AVAILABLE TO
YOU.
BUT ESSENTIALLY, THE PROCESS FOR
NCI IS A BIT DIFFERENT AND I
THINK WE ALL KNOW THIS.
WE HAVE THE REGULAR PRESIDENT'S
BUDGET THAT COMES THROUGH, THAT
BUDGET IS INFORMED BY WHAT NCI
HAS SUBMITTED FOR ITS BUDGET
REQUEST.
THAT GETS TAKEN INTO
CONSIDERATION BUT WE HAVE
ANOTHER AVENUE WHICH GOES BACK
TO 1971 WHERE WE CAN SUBMIT A
BYPASS BUDGET AND THEN IN THE
EARLY DAYS OF THE NATIONAL
CANCER ACT WAS TO GO RIGHT TO
THE PRESIDENT AND IN THEORY, NOW
THE PRESIDENT COULD ACT AND WORK
AROUND CONGRESS.
THAT HASN'T HAPPENED IN A LONG
TIME.
BUT I THINK ONE OF THE THINGS
THAT THE BYPASS BUDGET OFFERS US
AND DR. RATHMELL WAS VERY CLEAR,
THAT WE CAN HELP HERE, IS HAVING
INPUT, THE SUBCOMMITTEE AND THE
NCAB OVERALL THROUGH THE
SUBCOMMITTEE TO HAVE INPUT INTO
THAT PROCESS.
MAYBE WE CAN, AND I'M HOPING WE
CAN HELP IN TERMS OF ASSISTING
NCI IN THIS REGARD.
IT'S VERY COMPLEX PROCESS THAT
WE WENT THROUGH A FEW TIMES.
THE OTHER THING ABOUT THE BYPASS
BUDGET IS THAT WE NEED TO MAKE
PEOPLE AWARE OF THIS BUDGET.
ON THE HILL, EACH IN THE
PRESIDENT'S OFFICE.
ALL KINDS OF WE CAN TALK
[ TECHNICAL DIFFICULTIES ]
>> THIS IS GREAT DIALOGUE.
THIS IS REALLY IMPORTANT
ACTIVITY.
ANY ADDITIONAL QUESTIONS OR
COMMENTS?
IF NOT, WE NEED TO -- WE NEED A
MOTION TO ACCEPT THE REPORT
GIVEN BY ANN.
IS THERE A MOTION?
>> SO MOVED.
>> SECOND.
PROPERLY MOVED AND SECONDED.
ANY ADDITIONAL QUESTIONS OR
DISCUSSION?
THERE BEING NONE, WE NEED TO
VOTE TO ACCEPT THE REPORT.
I WILL ASK ARE THERE ANY NAYs?
ANY ABSTENTIONS?
THERE BEING NONE, IT'S UNANIM
UNANIMOUS.
>> IT IS.
>> OKAY, FANTASTIC.
SO NOW MOVING ON TO OTHER
BUSINESS.
THERE WAS THE MISSION STATEMENT
BUT I THINK WE'RE GOING TO
FOREGO THAT VOTE AND TABLE IT
UNTIL --
>> RIGHT.
>> YES, PAULETTE?
>> WE NEED TO ESTABLISH A
WORKING GROUP AND IT WILL BE
PRESENTED TO US.
>> THE TIMING TO TALK TO YOU
ABOUT THIS, BECAUSE THIS IS A
WORKING GROUP -- WHATEVER KARIN
IS -- YOUR AD-HOC COMMITTEE.
IT'S AN OVERARCHING UMBRELLA OF
WHAT I'M ASKING THIS WORKING
GROUP TO TAKE A LOOK AT.
IN THE EARLY WEEKS OF MY ROLE,
IT'S BEEN REALLY APPARENT HOW
MUCH ATTENTION THERE IS TO THE
PARTICULARLY RURAL URBAN CANCER
DISPARITIES IN OUTCOME, BUT MORE
THAN RURAL.
IT'S MORE ISSUES OF ACCESS TO
CARE AND HOW BEST THE RESEARCH
COMMUNITY CAN SUPPORT IMPROVING
OUTCOMES TO PATIENTS ACROSS ALL
OF AMERICA.
IT'S A BIG VERY DIFFUSE
QUESTION.
I'M GETTING IT FROM THE WHITE
HOUSE, FROM OTHER PLACES, AND SO
EARLY INITIATIVES THAT WERE
HAPPENING LAST YEAR HAVE NOT
REALLY QUITE LANDED.
SO WHAT I DECIDED WE NEEDED WAS
MORE INFORMATION.
WHEN I SEE LOTS AND LOTS OF BITS
COMING AT ME IS, WHAT I THINK IS
WE NEED SMART PEOPLE TO SIT DOWN
IN A ROOM AND THINK ABOUT WHAT
WE COULD DO IN THIS SPACE.
SO, WHAT I ASKED SOME FOLKS TO
DO AND I HAVEN'T CHARGED THE
ENTIRE GROUP, TO MAKE A SMALL
READING GROUP TO WORK FOR A
PERIOD OF SIX MONTHS TO LOOK AT
WHAT PROBLEMS WE CAN SOLVE IN
THE SHORT TERM AND MEDIUM-TERM
FUTURE.
WHAT THE NCI'S ROLE SHOULD BE IN
TACKLING ISSUES AROUND OBTAINING
OPTIMAL CARE TO THE POINT OF THE
NATIONAL CANCER PLAN.
AND WHAT OTHER RESOURCES OR
COMPONENTS OF THE GOVERNMENT --
HERE I'M TALKING ABOUT SHOULD WE
BE PARTNERING WITH THE V.A --
AND I'M PULLING THAT OUT AS ONE
OPTION.
OTHER PLACES TO BE USING
EXISTING NETWORKS TO TRY TO
REACH PEOPLE.
SORRY.
IT'S COMING OUT A LITTLE BIT
JUMBLED BUT HOPEFULLY THAT MAKES
SENSE.
I NEED MORE INFORMATION TO KNOW
WHERE TO PUT INVESTMENTS AND
WHERE WE NEED TO TAKE SOME OF
THIS FORWARD.
WHAT I WAS THINKING IS A
GROUP -- AND YOU SEEN THE CHARGE
THAT I'VE ASKED FROM THEM.
I WAS THINKING ABOUT HAVING THIS
ROLE UP TO REPORT TO THE BSA IN
PART BECAUSE SOME OF THE FOLKS
THAT WE INITIALLY ASKED WERE BSA
MEMBERS.
BUT WORKING GROUPS LIKE THIS
HAVE TO BE AUTHORIZED BY THE
NCAB.
I WILL HAVE NCBA REPRESENTATION
ON THAT WORKING GROUP AND WE'LL
HAVE REPORTS SO THAT BOTH BOARDS
GET TO SEE WHAT THEY COME UP
WITH.
I'LL STOP THERE AND ANSWER ANY
QUESTIONS.
>> YES ISABEL?
>> THANK YOU.
YOU'RE REMINDING ME OF A
COMMITTEE ASKING THEM TO LOOK AT
THE ISSUES.
I WOULD ASK THAT YOU ASK
SCIENTISTS TO SHARE SOME OF THE
BEST OUTCOMES IN WORKING WITH
COMMUNITY-BASED ORGANIZATIONS
WHICH YOU CAN THEN SAY, THESE
ARE BEST PRACTICES.
THEY HAVE BEEN WORKING HERE.
THEY WORKED THIS WAY.
THAT WAY YOU'RE INCLUDING
COMMUNITY IN YOUR WORKING ACROSS
THAT BRIDGE AND YOU'RE REALLY
STARTING TO MOVE FROM -- I MEAN
RESEARCH IS GREAT.
A LOT OF US CAN'T WAIT FOR
RESEARCH, YOU KNOW, BECAUSE
WE'RE SICK NOW.
AND SO MOVING IT INTO COMMUNITY
USING THEIR BEST PRACTICES IS A
WAY TO INVEST NOT JUST RESEARCH
BUT IN COMMUNITY ENGAGEMENT, BE
IT COMPASS OR WHATEVER.
BUT REALLY, WHAT IS THE WORD I
WANT TO SAY.
NOT ONLY FOR IMPACT, BUT FOR
SCALING.
BECAUSE THERE ARE THOSE PEOPLE
IN COMMUNITY DOING WORK RIGHT
NOW JUST GETTING PEOPLE INTO
SCREENINGS, HELPING PEOPLE
THROUGH SYSTEMS AND ET CETERA.
IF YOU FOUND SOME GREAT BEST
PRACTICES, THEY COULD BE PUSHED
OUT BY THE NCI AS RESEARCHERS
WHEN YOU DO THIS, HERE IS THIS,
RIGHT?
I MEAN I JUST THINK --
>> THAT'S EXACTLY -- WE HAD SOME
THINKING MEETINGS BEFORE WE GOT
TO THIS POINT AND THE IDEA
AROUND BRINGING IMPLEMENTATION
SCIENCE HERE FOR SURE, ONE OF
THE PEOPLE WE TALKED TO FROM THE
BSA IS THE ROB WIN WHO WORKED
WITH FEDERALLY QUALIFIED HEALTH
CARE CENTERS WHO -- YES, THEY
ARE REALLY GREAT EXAMPLES OF
PLACES THAT ARE DOING THIS WELL.
AND TRYING TO NOT REINVENT THE
WHEEL IS 100% --
>> LET ME ADD AND I STAY PERHAPS
IRREVERENTLY.
THE COMMUNITY USES LOGIC AND
GOES TO WORK.
>> I LIKE THAT.
>> GREAT.
IF THERE IS NO FURTHER
DISCUSSION, WE NEED --
>> I THOUGHT I I SAW ANOTHER
HAND.
>> YES.
>> OKAY, WAS IT YOU, FRED?
>> YES, QUICK COMMENT.
WONDERING WHETHER THERE ARE ANY
THOUGHTS OF INVOLVING MAYBE
SOMEONE FROM CDC, CANCER CONTROL
THAT ALSO GO OUT TO COMMUNITIES
AND MAYBE SOMETHING IN TERMS OF
NOT DUPLICATING EFFORT, MAYBE.
>> THAT IS A VERY GOOD THOUGHT.
I DON'T KNOW IF WE TALKED ABOUT
CDC.
THE PEOPLE I'M ASKING TO
CO-CHAIR INCLUDE THE AMERICAN
CANCER SOCIETY, SO THEY ARE VERY
EMBEDDED IN COMMUNITIES.
BUT CDC IS A GREAT SUGGESTION.
>> FANTASTIC.
OKAY, SO IS THERE A MOTION TO
APPROVE THE ESTABLISHMENT OF THE
AD-HOC BSA WORKING GROUP IN
SUPPORT OF EFFORTS TO ENHANCE
COMMUNITY CANCER RESEARCH AND
QUALITY CARE?
>> SO MOVED.
>> SECOND.
>> GREAT.
IT'S BEEN PROPERLY MOVED AND
SECONDED.
ANY ADDITIONAL QUESTIONS?
THERE BEING NONE, WE NEED TO
VOTE TO APPROVE THE
ESTABLISHMENT OF THIS AD-HOC BSA
WORKING GROUP IN SUPPORT OF
EFFORTS TO ENHANCE COMMUNITY
CANCER RESEARCH AND QUALITY
CARE.
I WILL ASK ARE THERE ANY NAYs?
ANY ABSTENTIONS?
THERE BEING NONE, IT'S
UNANIMOUS.
>> IT IS UNANIMOUS APPROVAL.
>> THANK YOU.
>> OKAY, FANTASTIC.
SO PRIOR TO ADJOURNING OPEN
SESSION, ARE THERE ANY OTHER
ISSUES OR FUTURE AGENDA ITEMS
THAT ANYONE WOULD LIKE TO BRING
TO THE TABLE?
I KNOW I'D LOVE TO HEAR A LITTLE
BIT MORE ABOUT NCI'S PLANS
AROUND AI AND I THINK THAT
THAT -- DATA SCIENCE.
I THINK THAT WOULD BE A
IMPORTANT AGENDA ITEM.
I THINK WE ALSO WILL HAVE THE --
REVISITING THE EXPERIMENTAL
THERAPEUTICS MISSION STATEMENT.
SO I'M SURE THAT WILL BE ON A
FUTURE -- AND I ALSO THOUGHT
ABOUT NCORP AND WHERE IT IS NOW
AND WHERE IT IS LOOKING TO GO IN
THE FUTURE AND CAN BE PART OF
SOME OF THE, YOU WERE JUST
TALKING ABOUT, KIM, AS WE THINK
ABOUT COMMUNITY CANCER RESEARCH
AND QUALITY CARE.
>> JOHN?
>> SUSAN'S HAND AND THEN ISABEL,
LET ME GO TO SUSAN FIRST.
>> JOHN, I DON'T WANT KNOW IF
IT'S APPROPRIATE FOR NCAB BUT I
WOULD LOVE TO HEAR A
PRESENTATION ABOUT THE HRSA
ACCESS TO CANCER SCREENING WHERE
THE FEDERALLY QUALIFIED HEALTH
CENTERS HAD TO PARTNER WITH AN
NCI CENTER.
SO I THINK THERE IS RELEVANCE
HERE AND TOUCHES ON A LOT OF THE
THINGS WE ARE TRYING TO ADVANCE,
IF IT'S APPROPRIATE.
>> I THINK IT SHOULD BE.
WE'VE HEARD OTHER PARTNERSHIP
TYPES OF INITIATIVES BROUGHT TO
THE NCAB.
>> JOHN?
>> HOLD ON.
WAIT A MINUTE.
I'M TRYING TO GO IN ORDER.
I THINK ISABEL AND THEN ANN AND
THEN I'LL COME BACK TO YOU,
HOWARD.
>> THANK YOU.
I JUST SIMPLY WANTED TO
FOLLOWING UP ON YOUR
CONSIDERATION OF AI AT ONE OF
OUR NEXT MEETINGS TO HAVE A
LONGER DISCUSSION.
I WOULD LOVE FOR US TO BE ABLE
TO INVITE THEM.
I DON'T KNOW IF THAT'S POSSIBLE.
SOME OF THE PATIENT ADVOCATES
WHO ARE WORKING ON THESE BILL OF
RIGHTS SO YOU CAN HEAR THAT
PERSPECTIVE.
I'D LOVE TO BE ABLE TO INVITE
THEM TO THE TABLE.
IS IT APPROPRIATE?
>> AS PART OF THE OPEN MEETING,
PAULETTE?
IS THAT POSSIBLE?
YES.
SO PAULETTE IS NODDING.
SO WE CAN CIRCLE BACK ON THAT,
ISABEL.
GREAT IDEA.
ANN AND THEN HOWARD.
>> I WONDER IF IT WOULD BE GOOD
SOMETIME THIS YEAR TO GET AN
UPDATE ON WHAT ARPA-H IS DOING.
I GET A CALL EVERY OTHER WEEK
ASKING FOR A LETTER OF
RECOMMENDATION FOR THINGS THAT I
WISH THAT WE WERE DOING AT NCI,
OR MAYBE WE HAVE DONE AT NCI.
SO I THINK WE NEED TO CATCH-UP
AS A BOARD AND SEE HOW MUCH
OVERLAP DO WE HAVE?
HOW IS ARPA-H PROCEEDING?
IT'S VERY INTERESTING, DON'T GET
ME WRONG, VERY INTERESTING
PROJECTS BEING FUNDED BUT I
THINK IT WOULD BE JUST GOOD FOR
THE BOARD TO HEAR ABOUT THAT IN
TERMS OF HOW WE MIGHT EXTEND OUR
RESOURCES MORE AND MORE
STRATEGICALLY.
>> I REMEMBER THERE WAS GOING TO
BE A PRESENTATION BUT I THINK IT
GOT PULLED AT THE LAST MINUTE.
SO IT WOULD BE GREAT, IF YOU GET
TO THE A CHANCE TO CIRCLE BACK
WITH THE ARPA-H LEADERSHIP TO
MAYBE PRESENT ANYTHING THAT IS
GOING ON, COLLABORATIVELY
BETWEEN THOSE AGENCIES.
>> THAT WOULD BE GOOD.
AND I WANT PEOPLE TO KNOW THAT I
AM MEETING WITH THE LEADERSHIP
OF ARPA-H REGULARLY SO WE STAY
IN SYNC.
SO BUT DEFINITELY ESPECIALLY NOW
THE PROJECTS ARE STARTING TO GET
OFF THE GROUND.
THIS WILL BE A GOOD TIME FOR
THEM TO COME BACK.
>> GREAT.
IN THE INTEREST OF TIME --
ANYONE HAVE ANY OTHER THOUGHTS
OR COMMENTS OR QUESTIONS?
MAKE SURE YOU SEND THEM TO
PAULETTE WITHIN THE NEXT COUPLE
OF DAYS AND WE'LL SEE IF WE CAN
GET THOSE THINGS ADDED TO AN
UPCOMING AGENDA.
SO WE'LL GO AHEAD AND ADJOURN
THE OPEN SESSION.
THIS CONCLUDES THE OPEN SESSION.
THERE IS ROUGHLY NINE MINUTE
BREAK NOW.
SO ONLY BOARD MEMBERS AND
DESIGNATED NCI STAFF SHOULD
RETURN.
ALL OTHERS SHOULD SIGN OFF NOW
AND THOSE WHO ARE ATTENDING THE
CLOSED SESSION, SHOULD SIGN BACK
ON AGAIN IN ABOUT 8 OR 9 MINUTES
USING THE SEPARATE LINK THAT WAS
SENT IN THE E-MAIL.
SO YOU'LL LOG OFF OF HERE AND GO
TO THE NEW LINK AND AGAIN WE'LL
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