Page images
PDF
EPUB

tumor infiltrating lymphocytes armed with a gene that produces a potent antitumor agent, tumor necrosis factor, and this again is a result of the gene transfer technology that we were discussing.

Major progress has been made in reducing deaths from childhood cancers and in preventing or treating many common cancers in adults as well. However, there has been less progress in reducing the death rate from common solid tumors in patients age 65 and over. Many Americans, the poor, the underserved and members of some minority groups do not have access to state-of-the-art prevention, early diagnosis and treatment, and have disproportionately high cancer incidence and mortality rates. We must increase our efforts in cancer prevention and control.

Research on cancers that affect women is a high priority for the National Cancer Institute as cancer is the second leading cause of death among women in the United States with more than 150,000 women expected to die in 1991 of cancers of the lung, breast, colon, and reproductive tract.

NCI supported scientists are unraveling the genetic mysteries of the cancer cell and important new theories of how cancer evolves from the normal cell are emerging with increasing information about oncogenes and suppressor genes.

The NCI cancer centers program provides interdisciplinary cancer research and state-of-the-art diagnosis, treatment and rehabilitation, prevention, and cancer control, as well as community outreach and research on a number of cancers, including AIDS-related cancers, throughout the Nation.

Additionally, NCI's ability to transfer technology effectively rests on community programs such as the clinical cooperative groups and the community clinical oncology program which we refer to as our CCOP program. The latter are especially important in getting state-of-the-art treatment to rural areas, and we now have active participation in NCI funded clinical trials in many small towns throughout the country, some with wonderful names like Spirit Lake, Royal, and Rembrandt.

Among other new cancer drugs, there is a great interest in taxol as it can kill various cancer cells. This is an important drug. It is derived from the bark of yew trees and is in very short supply, but NCI is undertaking taxol development from alternative renewable resources. This is an important and, in fact, an emergency priority of the Institute.

Prevention is the most effective way to eliminate a disease, and NCI is studying smoking cessation, diet, chemoprevention, cancer vaccines, and the use of special hormones to prevent tumors.

The NCI has assisted in evaluating potential environmental issues such as those related to nuclear powerplant facilities.

The NCI also has an important mission in AIDS research, and works closely with other Federal agencies. While not the lead agency at the National Institutes of Health, the NCI is proud of its supporting role. NCI scientists have made vital contributions in areas such as basic biomedical research on the pathogenesis and natural history of the Human Immunodeficiency Virus (HIV). We have drug development programs and vaccine development programs. The NCI intramural program is a leader in developing new therapies for children with AIDS and pediatric research in AIDS is an important priority of the institute. As people with AIDS are surviving longer, the incidence of AIDS related cancers is increasing, and NCI is working to meet this challenge.

PREPARED STATEMENT One measure of the success of the National Cancer Act is that there are over 6 million survivors in the United States, people who have had cancer and who have survived. We have accrued a new understanding of the basic biology of cancer which in turn is pointing to effective prevention, diagnosis, and treatment. We must continue our progress, and the NCI stands to fulfill that goal.

Mr. Chairman, the 1992 budget request for the Institute totals $1,810,230,000.

I would be very pleased to answer any questions. (The statement follows:

STATEMENT OF DR. SAMUEL BRODER

This year, the twentieth since the National Cancer Act, was passed, has been marked by high scientific achievement for the National Cancer Program. Research on gene therapies is progressing, resulting in new ways of Intervening against cancer. Studies assessing the cancer risk posed by

nuclear facilities have been conducted.

New drugs to treat cancer patients

have been developed and new prevention strategies using vitamin derivatives have proven effective. A high level of sophistication in recombinant DNA

technology has been achieved and much of the biotechnology Industry in the United States has emerged from basic science investigations in these areas.

One measure of the success of the National Cancer Act is that there are over

six million cancer survivors in the United States today. Despite these and many other successes, the priority placed on cancer research by the National

Cancer Act is as needed today as it was in 1971 when the National Cancer

Program was founded.

There will be over a million new cases of cancer and a

Many

half million people will die of cancer in the United States this year. Americans who could benefit from the findings of this research do not

currently have access to state-of-the-art prevention, early diagnosis and

treatment.

The National Cancer Institute also has an important role in AIDS research and works closely with the National Institute of Allergy and Infectious

Diseases and other Federal agencies.

NCI scientists have made vital

contributions using basic biomedical research to study the pathogenesis and

natural history of Human Immunodeficiency Virus (HIV) Infection, AIDS drug

development, and vaccine development.

The NCI Intramural progran is one of

the most important centers in the world for developing new therapies for

children with AIDS.

A new challenge is now on the horizon:

as people with

AIDS are surviving longer, the incidence of AIDS-related cancers is

increasing, and NCI is working to meet this challenge.

Cancer is the second leading cause of

th among women in the United

States, with more than 150,000 women expected to die of lung, breast, and colon cancers and cancers of the reproductive tract in 1991.

Women

participate in every phase of NCI research and NCI strives for proportional

representation of women in all clinical trials.

Research on cancers that

affect the survival of women is an exceedingly high NCI priority.

Major progress has been made in reducing deaths fron childhood cancers..8 rehabilitation.

reduction of 36 percent between 1973 and 1987.

Almost two-thirds of children

with cancer now survive to the 5-year "cure" point.

There also has been

important progress in preventing or treating many common cancers in adults as

well, particularly in people under age 65 where, for instance, the death rate

for colorectal cancer has fallen by approximately 15 percent in the last 20 years. The death rate for ovarian cancer has fallen by approximately 25

percent, about the same for stomach cancer, by 30 percent for bladder cancer,

and by nearly 40 percent for cancer of the cervix.

There has been less progress in reducing the death rate from the common

solid tumors in patients aged 65 and over.

There are disproportionate rates

of cancer mortality in some minority groups as well as in poor and underserved

groups. Ironically, as technology for prevention, diagnosis and treatment Improves, the groups without access to the technology appear to suffer even

more.

In recognition of this, NCI has begun and will continue in 1992 to

develop new research and outreach programs to reach women, minority group members, older Individuals and other underserved groups.

The NCI cancer centers provide a resource within their geographic area

for Interdisciplinary cancer research and for state-of-the-art diagnosis, treatment, rehabilitation, prevention and control of cancer. In 1992, the

comprehensive cancer centers will continue to emphasize community service and

outreach activities.

In addition, the centers are emerging as a potent

national resource for study of and state-of-the-art treatment for the rapidly

increasing number of AIDS-related cancers as well.

NCI's ability to transfer technology effectively rests on programs such

as the cancer centers, the clinical Cooperative Groups and the Community

Clinical Oncology Program (CCOP). The CCOP is a network of community cancer specialists, primary care physicians, and other health care professionals who

conduct both clinical treatment research and cancer prevention and control

research studies in the areas of early detection and screening,

chemoprevention, smoking, patient management, continuing care,

and

The current program involves over 300 hospitals and 2,100

physicians. Approximately 5,000 patients per year are entered onto treatment clinical trials through the CCOP alone, which represents about one-third of

the annual Phase 111 accrual to NCI - approved randomized clinical trials.

New treatments continue to be developed.

NCI scientists and colleagues

from the National Heart, Lung and Blood Institute have conducted a number of

gene treatment studies. Last year, gene transfer research successfully traced tive activity of reinfused genes. Last September, a related study introduced

gene therapy for an extremely rare, inherited immune system disorder caused by the absence of the enzyme adenosine deaminase (ADA). The first patient, a 4

year old girl, has received monthly transfusions of gene-corrected white blood cells, and preliminary results suggest that her immune function has improved. We are now at the point of inserting genes for specific tumor-fighting

substances such as tumor necrosis factor into patients' genes.

The first two

patients were treated on January 29, 1991.

NCI - supported scientists are continuing to unravel the genetic mysteries of the cancer cell and as a result, important new theories of how cancer

evolves from the normal cell are emerging. About 10 years ago It was discovered that a gene, located at the 13914 position (on chromosome 13), was

missing in familial retinoblastoma, a rare childhood cancer of the eye.

The

protein produced by the gene at 13914 is called RB.

The normal RB gene

appears to play a role in the suppression of cancer.

Abnormalities in the RB

gene and the RB protein have been found in acute lymphocytic leukemia,

osteosarcomas and in many of the common "adult" tumors such as lung and

breast.

Abnormalities in another suppressor gene, p53, have been detected in

colorectal cancer and other common malignancies, including lung and breast

cancers.

The Li-Fraumeni syndrome is characterized by multiple tumors and is

inherited within families.

NCI - supported scientists have recently pinpointed

an Inherited mutation of p53 as the responsible factor for these multiple

tumors.

Finding this critical gene may allow counseling of individuals with this inherited syndrome, and increase the understanding of the mechanisms that result in the transformation of a normal cell into a malignant ceil.

NCI has an active drug development program for cancer and AIDS. NCT's

high capacity drug screen examines synthetic compounds and natural products

for activities against many human tumor cell lines and retroviruses such as

.

HIV.

A large number of the cancer drugs available today have been developed

through the support of the National Cancer Progran. Currently, there is great

interest in the compound taxol as it can kill ovarian and breast cancer cells.

Unfortunately, taxol is extracted from the bark of yew trees and stripping the bark kills the tree. However, so that clinical tests can go forvard, NCI is

making production of taxol fron alternative renewable sources a priority. The

« PreviousContinue »