It is clear that the nature of clinical trials is changing for treatment, imaging, and cancer control prevention, Cancer Care Delivery Research (CCDR), etc.
- NCI continues to conduct trials that industry cannot / will not conduct. The main reason is that their ultimate goals of drug approvals are independent of the follow-up that is critical for the general population for adverse events and efficacy. Similarly, in cancer control (symptom science, in particular), industry has not engaged the basic science researchers in identifying mechanisms for which targets/predictive biomarkers can be identified. NCI is at the helm of these initiatives.
- NCI continues to be interested in cancer prevention, whether it is a scientifically meritorious large trial or smaller ones that will better identify high risk populations and interventions for them. History has proven that the evidence for prevention has emanated from NCI. We are focusing our efforts to use implementation science to help promote this evidence / uptake into the community settings.
- NCI supports both academic and community research. The goals for those different institutions are meant to be different, yet complementary. Ultimately, it is about being able to introduce the clinical interventions into the community settings as the science evolves, and being in the position to translate the interventions that are effective into the general populations.
- Finally, although biomarkers and genomically driven trials are being conducted by non-NCI programs, it is really NCI that is making the multi-disciplinary approach to understand the infrastructure, physicians and patients gaps to support genomic research in clinical practices.
NCI appreciates the competition and dramatic changes in the delivery of cancer care and hence is working to develop research in the delivery of care that will improve cancer outcomes in the community settings.