Dear Dr. von Eschenbach,
I am personally very encouraged by the direction the NCI has taken under your leadership, and want to take this opportunity to thank you for the great work that you do on our behalf.
Today in your presentation to advocacy leaders the importance of host/tumor interactions was touched upon, but not described, understandably, due to time constraints. As you know, one aspect of host/tumor interactions involves immune recognition of abnormal cells, or the failure of this system to identify and eliminate these cells. From a lay person's perspective, identifying how the immune system can be induced to recognize and fight cancer appears to be a promising research area for both the prevention and treatment of many cancers.
Our question is this: Is the NCI planning to fully explore how immunity can be directed against cancers, including how tumors may escape or suppress immunity?
Our sense is that this research would benefit from a coordinated approach that pools ideas, data, and technologies from diverse areas, including discoveries made in autoimmune disease.
Here are some related suggestions:
(1) As you know, the reluctance of patients to participate in clinical trials is often an obstacle to progress, but it's our impression that patients will be more willing to participate in immune-based studies. And so we ask: Why not start clinical research in a promising place where you are most likely to answer the questions quickly?
(2) For approaches with a favorable toxicity profile, choose patients with indolent cancers who are in watchful waiting status. This will provide an opportunity to advance clinical science while removing a common ethical tension in clinical research: administering an investigational drug with unknown benefit - and probable toxicity - when the need for [a proven] treatment is at hand.
(3) Applying immune therapies early, prior to immune suppressing chemotherapy, is more likely to be effective.
(4) Finally, discoveries made in this population - including the identification of biomarkers of immune response - could then be applied to enable faster evaluations of new immune-based therapeutics, and be applied more widely, such as to maintain or consolidate responses to standard therapies.
Thank you for listening - and for embracing transparency as policy!
Sincerely,
Karl Schwartz BA, MFA
President, Patients Against Lymphoma
