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Strengthening the Role of Cancer Centers
Many important discoveries are occurring in the basic biologic, clinical,
and behavioral sciences that relate to cancer. The committee
recommends that the National Cancer Institute seren~hen its core
support of cancer centers in order to exploit fully the application of
these advances in the prevention and treatment of cancer and its
consequences. The committee believes that cancer centers provide an
interdisciplinary environment that is valuable not only for research but
also for the translation of research discoveries into better methods of
prevention, early detection, diagnosis, treatment, and of meeting the
long-term needs of survivors and family members.
Recent advances in the new biology, cellular and molecular, have greatly
increased our understanding of the etiology of cancer. For this reason,
support of basic research should remain a high priority of the NCI, and the
core grant program should continue to include basic science centers. Advances
in basic science wall continue to increase the understanding of cancer processes
and result in better treatment and prevention in the future. Recent examples
include the discovery of oncogenes and their cellular counterparts, proto-
oncogenes; increased understanding of processes of metastasis; and greater
elucidation of the mechanisms of the viral transformation of cells to
malignancy (and other diseases, such as AIDS). The rapid growth in
understanding of the developmental stages in chemical and radiation
carcinogenesis has the potential of greatly increasing the capacity to prevent
the development of cancers.
A number of basic biomedical discoveries, however, are ready now to be
extended into clinical practice and better methods of prevention. Cancer
centers encounter relatively large numbers of cases of many types of cancer,
which makes it more efficient for centers to conduct clinical trials of new
forms of therapy in meaningful numbers of tumors of specific kinds. The
centers also provide economical shared research services and resources and
leaders who attract substantial amounts of additional research funds. Lacking
hard evidence of the effects of the existence of cancer centers on the nature
or quality of research conducted in them, the committee relied on its
judgment, based on its expertise in biomedical research and study of existing
information on cancer centers and their achievements. The committee,
including its members without cancer center affiliations, concluded that centers
fulfill an important objective for the NCI. The interdisciplinary focus of
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centers and the opportunity they provide to bridge the basic, clinical, and
behavioral sciences will enable them to be particularly effective in translating
the new understanding of cancer processes into better methods of diagnosis,
treatment, and prevention of cancer. Ultimately, the widespread application of
these better methods should lead to better health of the public by reducing
mortality and morbidity and increasing survival rates from cancer.
For example, there are unprecedented opportunities to use immune
mechanisms and naturally occurring and genetically engineered biological
substances in immunotherapy, hormone therapy, and other new treatments that
are being added to the oncologists' traditional armamentarium of surgery,
radiation, and chemotherapy. Researchers have developed methods of
removing the white blood cells from the blood or tumors of a cancer patient
and activating them in vitro with natural substances, such as interIeukin-2, that
stimulate the immune system. The activated cells can then be reinfected in
the patient with more interieukin-2, where they increase the body's ability to
destroy tumor cells. This promising type of immunotherapy is being tested
experimentally at a number of cancer centers with patients who have cancers
that are especially difficult to treat (e.g., melanoma, renal cell).
Laboratory discoveries that promise to have important clinical uses
include human growth factors, such as G-CSF and GM-CSF,6 which are
substances that stimulate the production of new white blood cells to replace
those that are destroyed by chemotherapy. These factors have been produced
using genes that have been cloned, and early experimental trials indicate that
their use should enhance the effectiveness of chemotherapy by allowing the
administration of larger doses as well as resulting in diminished side effects.
These factors have also shown improvement in the defenses of
immunocompromised patients, and increased recovery from bone marrow
transplantation in experimental settings, and are now being tested further in
clinical settings.
Other discoveries in immunology will enable clinicians to manipulate
parts of the immune system in ways never before possible, with implications
not only for cancer but for diseases such as arthritis, diabetes, and AIDS.
6 G-CSF is pluripotent granulocyte colony-stimulating factor; GM-CSF is
granulocyte-macrophage colony-stimulating factor.
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Other examples of recent laboratory discoveries that have potential
clinical applications include: substances that increase antitumor immunity and
tumor-cell killing; nucleic acids that can enter tumor cells and "turn off' genes
that cause the cells to be neoplastic; and tumor-reactive monoclonal antibodies
that can target towns, radioactive isotopes, or chemotherapeutic agents
specifically on cancer cells. It will be possible to use supercomputers and
crystallographic techniques for the molecular modeling of drug interactions and
to design new drugs and drugs that are effective against drug-resistant tumors.
Advances in epidemiologic and prevention research, in the laboratory
and in the field, are also very promising. For example, large-scale nutrition
intervention and chemoprevention trials are under way that will reveal the role
of diet and nutrition in cancer and the efficacy of venous vitamins, minerals,
and other substances such as fiber in preventing cancer.
Research on behavior is providing scientific knowledge that shows
promise for the development of clinical interventions. The focus of such
research includes increasing tolerance for side effects of treatments, preserving
ability to perform usual activities, and enabling patients to overcome barriers
to treatment, care, and rehabilitation, and improve their quality of life as
survivors.
These advances in cancer research in recent years have reinforced the
initial wisdom that led to the development of the national cancer centers
program. Advances in basic, clinical, prevention, epidemiologic, and behavioral
research have brought breakthroughs closer that will reduce cancer incidence,
morbidity, and mortality and improve the functioning and quality of life of
survivors and their families.7 NCI-supported cancer centers, diverse in
character and multidisciplinary in scope, have played an important role in
furthering those important advances.
In addition to supporting a network of cancer centers, NC! supports
other mechanisms--e."., individual investigator and program project research
7 Survivorship research is conducted in the areas of rehabilitation, quality
of life, and reentry for cancer patients, including, for example, biomedical
research on long-term effects of radiation and chemotherapy, reproductive
health of younger patients, or cognitive dysfunction resulting from secondary
nervous system treatment; and psychosocial research on the role and
effectiveness of peer and professional counseling, systems for dealing with
altered self-image, or barriers to insurance coverage and employment.
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Representative terms from entire chapter:
blood cells
