SLIDES & TRANSCRIPTS
Friday, December 13, 2002

Prostate and GU SPOREs

Jorge Gomez, M.D., Ph.D.

But related to the SPORE program, and pertaining to this particular group, we have in 2002, have funded up to 11 prostate SPORES and 1 genitourinary SPORE that is focused on bladder cancer. We expect that for fiscal year 2003, if we happen to have a budget, we will perhaps increase the funding for prostate SPORES up to 12, and go to 2 genitourinary SPORES. And perhaps in 2004, up to 3 genitourinary SPORES.

I think our focus in GU is going to change, in terms in particular because of the recommendations of the progress review group. And we will probably increase in different ways, in forms of funding that we have for kidney and bladder cancers.

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The SPORE Program underwent a series of changes in the last 5-7 years, and some of those include the expansion of the program to accept and expand to many other different organ sites. For all of you that don't know, the SPORE program is a multidisciplinary group of investigators, basic, clinical, and translational investigators working together in a particular disease. And these are really teams of investigators of about 20, 30, and sometimes 40 investigators in a particular institution, and sometimes a consortium of institutions working together.

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So in the year 2000, we finally started to increase the number of SPORES in different diseases, including genitourinary diseases. You can see in the year 2000, we accepted applications for genitourinary cancers.

In the year 2002, we again accepted applications for the GU SPORES, and in 2004, again, we are planning to have additional applications. This particular scheme may actually change if the implementation plan of the Progress Review Group also may include some additional receipt dates for SPORES in additional years. So we are not really carving this in stone, and hopefully this will perhaps change to benefit the kidney and bladder cancers in particular.

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So the future expansion of the program, certainly you saw the numbers related to breast, prostate, lung, and ovarian cancer sites. So we are a very slow growth for those sites. We are really planning to increase the funding in leukemia, lymphoma, or the focus of the program on those particular organ sites that include genitourinary cancers. So that is kidney and bladder in particular.

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So very quickly, I would like to revise where the program is going, and that is where in particular, phase two of the program, where we are expanding all the different organ sites, and we hope that by the year 2003, we have a particular density of organ sites that includes also genitourinary cancer SPORES.

And we hope by the year 2004, we have a substantial number of what we call the minor organ sites that include kidney and bladder. And we hope that we have a critical density of these particular organ sites.

And just in passing also, I would like to mention that the program is also undergoing further changes related to how the program is focusing in a variety of issues related to organ and disease. As you can see, this is the only program at the NCI that is actually openly sponsoring disease-oriented research.

And we hope that we take this program into a new phase, where we are going to have a variety of clinical trials going on in the SPORES that will hopefully impact, that are going to be molecular-target type of trials, and hopefully impact different diseases, perhaps.

So the emphasis will be in the next phase of the program on inter-site research, that is clinical trials and interventions that we do in bladder cancer, may also be applicable to prostate cancer, and so forth. And using common and molecular mechanisms for these types of interventions. We also hope that in this new phase of the program, we will enhance and collaborate and coordinate this program with many other programs of the NCI.

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So initially, the program was focused on a particular site, or a particular disease, and these were not very well integrated. We were really focused on multidisciplinary research, and in a very almost shy way, we initiated human endpoint studies.

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And I think we are going into a new phase the program where we are sponsoring a lot of inter-SPORE collaborations. And we are focusing on human endpoint studies. So we are not taking the translational research just as a matter of a 20-year project.

As a matter of fact, we are pushing very hard that every one of these projects in these SPORES, they are focused on the human disease. They actually have human endpoints and clinical trials, and very good molecular targets in the different diseases, including in bladder, in the prostate cancers.

We hope that, in this new phase of the program, we are going to start linking, as a matter of fact, different diseases and different organ sites in designing the ranges that pertain to prevention, diagnosis, treatment, and early detection in all the different diseases whenever it's appropriate. We are not going to force issues that are of course not appropriate or scientifically valid.

And then we are going to also focus and coordinate in these programs with other programs of the NCI, including with the intramural program. And we are going to focus on molecular mechanisms like angiogenesis and apoptosis and metastasis and so forth, in order to design interventions that pertain to more than one particular organ site.

TOP

So I would like to say that we are also waiting for a P30/P50 working group that was assembled by the NCI director as an advisory group that formulated recommendations to the NCI regarding the expansion of the SPORE program, and the future directions of the program. These recommendations are expected in early 2003.

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As you can see, the state of funding for GU cancers is very disproportional. We have a tremendous expansion of the prostate cancer research, up to $300 million in fiscal year 2001-02 as a matter of fact. For kidney cancer, as a matter of fact, it is very abysmal. I would say $90 million are being spent in the year 2001, and $12 million in bladder cancer research in 2001 as well. So what are we going to do about it? I think we have a problem, and we are really taking this to heart.

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And the NCI really has used the progress review groups in order to sponsor, to increase, and identify the gaps in order to increase the funding for these particular organ sites.

So in kidney and bladder cancer, the PRG formal recommendations that were presented to the National Cancer Advisory Board in 2002. Dr. Vogelzang is going to expand over this issue. But we have an implementation plan that is going to be carried out in 2002, and we expect to have a report back sometime in 2005 to these groups.

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The background - I'm just going to say a little about the background, and I'm not going to say anything else about it, because the Dr. Vogelzang will expand on this. But these progress review programs are advisors to the NCI to identify scientific gaps or areas that need a special emphasis. In this particular case, we are going to increase the emphasis on kidney and bladder cancers. They were first assembled in 1996, and expanded to different organ sites.

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These are particularly important, because they help us to develop a national agenda for specific cancers, in particular, kidney and bladder cancer at this point. We solicit the extensive input from the scientific community. We create an outline.

They create, as a matter of fact, an outline that prioritizes research needs in kidney and bladder cancers. They communicate these through recommendations, they will set out that research agenda for the National Cancer Institute in the next 5-10 years.

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The composition of this group was basic, clinical, and population scientists.

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And the chairs were Dr. Peter Jones, and Nicholas Vogelzang. I serve as Executive Director from the National Cancer Institute.

Thank you very much.

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