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Pathways to Discovery: Winter 2012

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Cancer Act Speeds Access to Innovative Treatments

Publically funded clinical trials have had a huge impact on the health of Americans.
Richard L. Schilsky, MD

The National Cancer Act (NCA) of 1971 made cancer diagnosis and treatment a national priority. On the 40th anniversary of that landmark action, the U.S. Senate reaffirmed the act and cancer experts are reflecting on the benefits of the NCA and are creating a strategy for future progress against cancer.

One of the immediate results of the NCA was the creation of National Cancer Institute (NCI)-designated cancer centers, such as The University of Chicago Comprehensive Cancer Center, which became hubs for the development of innovative cancer treatments (see Fall 2011 Pathways).

Another benefit took about 15 years to develop. In the mid-1980s, NCI's Clinical Trials Cooperative Group Program made it easier for patients to participate in clinical trials in their communities, without having to travel to large academic medical centers.

"Publically funded clinical trials have had a huge impact on the health of Americans because they addressed issues that are not often addressed by drug company-sponsored trials," said UCCCC Co-Deputy Director Richard L. Schilsky, MD, professor of medicine and chief of the Section of Hematology/Oncology. Publically funded trials developed curative therapies for childhood malignancies and adjuvant chemotherapy—treatment after the primary therapy—for cancers including breast, colorectal, and lung.

"Essentially every proven combined modality strategy, such as the combination of chemotherapy and radiation therapy for head and neck cancer, has been proven effective in publically funded clinical trials," said Dr. Schilsky.

Cancer Imaging Program
Multimodality strategies became even more effective as technology improved and cancer researchers built stronger networks of transdisciplinary collaborators.

In 1994 when Dr. Schilsky was the director, the UCCCC developed one of the first cancer imaging programs in the nation.

"It was clear to me that imaging would be increasingly important in every aspect of cancer detection and management," said Dr. Schilsky. "We had an outstanding faculty, we had resources from our Cancer Center Support Grant—it was an easy decision to incorporate the imaging program into the cancer center."

UChicago's Radiology Department, which includes medical physics, was already world renowned. Paul Harper, MD, Katherine Lathrop, MS, and Robert Beck, BS, pioneered diagnostic uses of radiation and introduced technetium-99m as a radiotracer agent used in nuclear medicine exams. Alexander Gottschalk, MD, originated the use of the Anger scintillation ("Gamma") camera in clinical studies, Kurt Rossmann, PhD, established modern X-ray imaging research, Charles Metz, PhD, developed receiver operator characteristic (ROC) methodology software that is now used worldwide for quantitative evaluation of diagnostic performance, and Kunio Doi, PhD, investigated fundamental imaging properties of various radiographic systems and their relationship to diagnostic accuracy and patient exposure.

Since the 1980s, UChicago imaging scientists have been focused on the development of computer-aided diagnosis (CAD) methods for the detection and differential diagnosis of abnormalities on radiologic images. Because the NCA stressed the need to quickly translate basic research into patient care, NIH funding enabled Dr. Doi, Maryellen Giger, PhD, Heang-Ping Chan, PhD, and others to quickly develop CAD systems.

"CAD is now available in approximately 70% of all hospital-based mammography screening programs in the U.S.," said Dr. Giger, professor of radiology and the first director of the UCCCC's Advanced Imaging Program.

"The Advanced Imaging Program developed at a time when the Radiology Department was transitioning from an analog department to a digital department," said Dr. Giger. "In the late 1980s, it would take me more than an hour to digitize one chest radiograph. Now it's practically instantaneous."

NIH funding also led to the establishment of the Scientific Visualization and Image Analysis Core. This Cancer Center core facility increased computing power that enabled CAD research, as well as substantial developments in 3D image acquisition and tomographic reconstruction in the labs of Chin-Tu Chen, PhD, Xiaochuan Pan, PhD, and Charles Pelizzari, PhD. Their research led to improved methods for positron emission tomography (PET), computed tomography (CT), and magnetic resonance (MR) imaging.

Gregory Karczmar, PhD, who now co-directs the Advanced Imaging Program, clinically translated those MR imaging developments to improve breast cancer detection.

Progress Against Cancer
"When I started as an oncologist 30 years ago, there were literally only a handful of effective cancer drugs," reflected Dr. Schilsky. "Now there are hundreds of effective drugs, and many of them can be administered on an outpatient basis. I think this is the most exciting time we've had in cancer research, and I am very optimistic that, with continued funding, we'll see an even more
dramatic acceleration of the progress against cancer in the next 20 years."

Dr. Giger added that without continued funding from NCI and other sources, the United States stands to lose its place as a global leader in medical innovation, "There will be many missed opportunities."

40 Years of Cancer Progress
In late September, the American Association for Cancer Research (AACR) unveiled a cancer progress report that outlines research successes since 1971 and presents future opportunities. To view a copy of the report, go to the AACR website at aacr.org. To see a list of major cancer events and discoveries at UChicago, see our interactive timeline at cancer.uchicago.edu/about/timeline.shtml.

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