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1. Cancer Research:The Past and Future and the Hoosier Oncology Group Nasser Hanna, MD
Associate Professor
Indiana University
IU Simon Cancer Center
Chairman, Hoosier Oncology Group
2. Volunteering and Service
A civilization flourishes when people plant trees under which they will never sit
Greek Proverb
3. Scope of the problem in the U.S. 1.4 million people will be diagnosed with cancer this year
More than 560,000 people will die from cancer this year
Second leading cause of death behind heart disease
1 in 3 women will get cancer in their lifetime
Breast: 1 in 8; Lung: 1 in 16; Colon 1 in 19
1 in 2 men will get cancer in their lifetime
Prostate: 1 in 6; Lung 1 in 13; colon 1 in 18
6. To understand where we go from here, we must first understand where we have come from
7. The Initial Study of Cancer Oldest description of cancer dates back to 1600 BC: breast ulcers cauterized with a fire drill
2nd century, Galen declared that cancer, caused by excess black bile, was incurable
thought prevailed for the next 1000 years
1761, Giovanni Morgagni studied autopsies and described macroscopic findings of cancer
1846, advent of anesthesia allowed for cancer surgery
19th century, Rudolph Virchow studied microscopic details of cancer
8. The first cancer therapies 1878, Thomas Beatson observed that oopherectomy resulted in cessation of breast milk production
Charles Huggins reported orchiectomy caused prostate cancers to shrink
1896, Wilhelm Roentgen invented the x-ray machine
9. The systemic approach to cancer Cancer therapies of 20th Century discovered largely by serendipity
Mustard gas exposure to naval personnel led to myelosuppression
birth of alkylating agents
Folates caused leukemic cells to grow
Sidney Farber evaluated anti-folates against leukemia
led to methotrexate (MTX)
19561st cure of metastatic cancerchoriocarcinoma with MTX
10. Modern Chemotherapy Vinca alkaloids derived from the Madagascar periwinkle during a screen for diabetic drugs
1955, NCI developed the first cancer cell lines and animal models to study cancer
100,000s of compounds screened
1964taxanes discovered from the yew tree
1966camptothecans from chinese ornamental tree
Platinum discovered while evaluating the electric field effect on bacterial growth
Bacterial stopped dividing
caused by the platinum on the electrodes
1973, War on Cancer is declared
11. Cooperative Group Structure NCI-supported groups
NCCTG
SWOG
ECOG
SECSG
RTOG
CALGB
NSABP
LCSG
GITSG
12. Why is progress not faster? Pre-clinical models are unreliable
Clinical trials take too long to initiate and complete
Too few participants
Trials designed for incremental gains due to a poor understanding of the complex biology of the disease
Sources of funding limit research
Lack of cooperation, etc.
13. Research Opportunities Most community practices lacked the infrastructure to conduct research
Patient access to university cancer care limited by logistics
HOG was conceived in 1984, modeled after the NCCTG
Indiana University as the research base
Indiana community physician partnerships
Research, Infrastructure/training, Education
14. The Hoosier Oncology Group (HOG)
A non-profit, 501(c)3 cancer research organization
Maintains infrastructure to facilitate research from hypothesis to publication
15. HOG HISTORY Subsidiary of the Walther Cancer Institute 1984-2007
Initiated well over 100 trials enrolling thousands of subjects
Fostered collaboration between the private sector, other research organizations, and academic centers
16. Results of Success Reputation as a research organization that efficiently and accurately evaluates the activity of new anti-cancer therapies
19. Quality of Life
Prozac vs Placebo
Only study to evaluate placebo-controlled, phase III trial in cancer population
Testing anti-emetics
Olanzapine (without dexamethasone) is highly effective in reducing delayed N/V in moderately to highly emetogenic regimens
20. Small cell lung cancer VIP better than EP in ED SCLC
VIP + oral VP-16 not better than VIP alone in ED SCLC
21. Phase III Study of Cisplatin Plus Etoposide or IrinotecanHanna et al JCO 2006
22. Overall Survival
23. Non-small cell lung cancer Single agent cisplatin/XRT not better than XRT in stage III NSCLC
Cisplatin/Gem better than Cis alone in stage IV NSCLC
Pemetrexed comparable to Docetaxel in 2nd line NSCLC
24. ChemoRT
Cisplatin 50 mg/m2 IV d 1,8,29,36Etoposide 50 mg/m2 IV d 1-5 & 29-33Concurrent RT 59.4 Gy (1.8 Gy/fr) HOG LUN 01-24/USO 02-033Hanna et al, JCO 2007
25. Cisplatin/Etoposide/XRT +/- Docetaxel in Stage III NSCLC
26. Hoosier Oncology Group, Inc. Present Day
27. Hoosier Oncology Group Incorporated July 2007
Supported by grants from NCI, DOD, Walther Cancer Institute
Endowed funds from charitable contributions
Capacity to run investigator (primarily) and industry initiated trials
28. HOGs growing strength Funding increases and capacity improvements on an annual basis
21 active trials in diverse disease sites
The place to go for quick phase II trials
Lacks the inefficiencies of many cooperative groups
Loyal and dedicated staff of 21
Easily adaptable to changing research environment
Our studies request NO unfunded mandates
HOG answers important and fundamental questions in oncology
Honest brokers of research
Avoid marketing studies
29. What obstacles HOG AVOIDS Procedural (policiesoccur in group but also within NCI, NIH, CTEP, CIRB, US FDA, pharmaceutical industry)
Structural (multiple participants in process, with independent needs to move forward), infrastructural (approval needed from one system to move to another)
Synchronicity (protocol devo, contracts, drug acquisition, etc. occur within different groups)
30. Why efficiency matters Trial design frequently becomes obsolete
Rapidly changing nature of cancer care
Investigators become discouraged
Sites become disinterested
31. Hoosier Oncology Group Clinical Trial Working Groups led by national leaders in their fields.
Target Diseases:
-Thoracic -Breast
-GI -GU
-GYN -Hematology
-QoL/Symptom Control -Head & Neck
32. HOG: One Stop Shop Study Start Up
Growing network of community sites and
academic centers
200 community and 125 academic physicians representing over 40+ community and academic sites in the US
International sites including Peru, UK, Canada and Australia
34. HOG Academic Partners Academic:
Indiana University Simon Cancer Center
Washington University Medical Center in St. Louis
Rush-Presbyterian
University of Chicago
UT Southwestern Medical Center at Dallas
Northwestern University Feinberg School of Medicine
Fox Chase Cancer Center
University of Nebraska Medical Center
University Hospitals of Cleveland
Baylor University Houston
Medical University of South Carolina
Royal Adelaide Hospital Cancer Centre
Oregon Health Science University
Royal Hospital London-Barts
35. DoD - Center of Excellence for Individualization of Therapy for Breast Cancer Clinical Trial Core
Miller/Sledge: IU
Clinical Research Office
HOG
Patient Advocacy Core
Mary Lou Smith: Research Advocacy Network
Biostatistics & Data Management Core
Changyu Shen: IU Pathology Core
Ann Thor: Colorado
Genomics Core
Jenny Chang: Baylor/Houston
Proteomics
Bob Hickey: IU
Pharmacogenetics & Pharmacogenomics Core
Leyland-Jones: Montreal HOG created tracking system which allows us to know where any given sample is at any give time.HOG created tracking system which allows us to know where any given sample is at any give time.
36. The Vision of the HOG Unparalleled community-academic partnerships
Cancer Research
Physician/Nurse education
Patient Advocacy/Outreach
37. Mission Statement To reduce the burden of cancer through the conduct of high quality research and education, as guided by the collaborative efforts of the IU Simon Cancer Center, academic physician scientists, community cancer investigators, and patient advocates.
38. What can patient representatives do in the HOG?
39. Patient Committee Led by Patient representative from the Board
Recruits from patient advocates, Board members, sites, other
Review patient issues/initiatives such as accrual to studies, ICS, fundraising, collaborate with other groups (RAN, etc.)
Quarterly mtg with HOG staff advocate
Meet bi-annually at CTWG mtg
Bi-annual report to Board (written or in-person)
40. Research Partnerships Committee Led by Executive Director
Members include: Chief Community officer; Chairman of Board; other Board members; patients; assistance via Emeritus Board prn
Interacting with current and future research partners along with HOG staff point person
Phone calls, lunches, site visits
Engage new relationships (MCCRC, Fox, Arkansas, GU consortium, etc.)
41. Scientific Oversight Committee Led by Chief Medical Officer
Composition reflects HOG values for research
Chief Community Officer or other community oncologist (can be non-Board member)
Patient representative
Statistician
HOG Proj Mgr. Leader
Review (via conf call approx q2mo) scientific integrity of trials, potential for peer review funding, IIT vs IST, ability to complete trial, financially neutral or better or justify if not, community support
Review/approve LOIs and protocols
42. Lifes most persistent and urgent question is, What are you doing for others?-Dr. Martin Luther King, Jr.
43. What can you do? Hold elected officials accountable for cancer research funding and prevention programs
Hold elected officials accountable to enhance prevention
Indiana receives $600 million/yr from tobacco taxes and the Master Settlement Agreement
Spends $10 million on tobacco control
Spends $2 BILLION on tobacco-related disease
Demand that research monies are well spent by the pharmaceutical industry, academia, and the NCI
Encourage patients to enter clinical trials
Demand physicians participate in clinical trials
Join the HOG Board as a patient advocate
Lead the Patient Committee
Serve on the Scientific Oversight Committee
Serve on the Research Partnerships Committee
Never, Never, Never lose sight of PREVENTION
44. Tobacco: The Facts in the U.S. Causes more deaths than alcohol use, car crashes, suicide, AIDS, homicide and illegal drug use COMBINED
20% of all U.S. deaths
50% of all lifetime smokers
30% of ALL cancer deaths
45. Tobacco: A Global Genocide Over 1 billion smokers in the world today
1.6 billion by 2025
300 million in China consume 1.7 trillion cigs/yr
10 million cigarettes sold every MINUTE
100,000 kids start EVERY DAY
20% of teens age 13-15
50% will smoke at least 15-20 years
500 MILLION of all living people TODAY will die due to tobacco
Entirety of North AND Central America COMBINED
Someone dies every 8 SECONDS
46. The Tobacco Market Controlled by just a few corporations in U.S., Japan, Great Britain
Phillip Morris controls 50% of U.S. market
50% of all tobacco co. expenditures goes to promotional allowances and items
T-shirts, lighters, key rings, etc.
50% of young people in the world live in developing nations where they can get free cigarettes
12% of all Chinese govt revenues
40% of all TV/radio ads in Russia
47. The key events in 2009 to reduce the future suffering from cancer came from ADVOCATES, NOT DOCTORS
48. 2009 Achievements The single most important occurrence in 2009 to reduce the suffering and death from lung cancer
SCHIP legislation
Increased cigarette tax will result in 2 million fewer smokers
Most important health policy to impede the tobacco cartel in the U.S.
FDA regulation of tobacco products
49. A final word The future depends on what we do in the present
Mahatma Ghandi
50. www.hoosieroncologygroup.org