Cancer Liver Ultrasound

>> good afternoon. and welcome to the latestgoogle hangout by the national cancer institute. my name is cynthia [inaudible], and i'm theassociate director for public affairs at nci. i welcome you to what promises to be an interestingdiscussion about how you can submit your cancer research ideas to the national cancer moonshotblue ribbon panel. as many of you know, we've had a lot of excitement over the past severalmonths since the president announced the national cancer moonshot initiative in his state ofthe union address in january. he immediately put vice-president biden in charge of thiseffort, and we've been gaining momentum ever since. recently the nci announced the blueribbon panel that will play an instrumental role in the scientific leadership of thisinitiative. the blue ribbon panel is seeking

ideas for preventing, detecting, and treatingcancer, as well as basic research and survivorship. we will remind you throughout the hangoutto submit your ideas to cancerresearchideas.cancer.gov. again, that url is cancerresearchideas.cancer.gov.i will start by introducing the panelists and lead a brief discussion before takingquestions from you on twitter. if you would like to ask us questions during this hangout,please use #cancermoonshot. again, that's #cancermoonshot. submit your questions relatedto offering the ideas to the blue ribbon panel for their consideration. i'm pleased todayto be joined by two co-chairs of the blue ribbon panel, as well as an additional memberof the panel in his role as a cancer advocate. i will introduce each one at a time and letthem tell you just a little bit about themselves.

first, we have dr. deanna singer who is theacting deputy director for nci and also the director of nci's division of cancer biology.dr. singer? >> thanks, cynthia, for sponsoring this googlehangout and for inviting us to be able to tell everybody about the blue ribbon panel.as cynthia told you, i am the director of the division of cancer biology, which hasthe responsibility of managing a large grant portfolio in basic cancer research. i'm alsoa molecular biologist with an active research program here at the nci [inaudible] regulation.but most recently, i'm now a co-chair of the blue ribbon panel with liz jaffee, who you'llmeet in a minute, and with tyler jacks. and i'm looking forward to being able to tellyou about the activities of that panel.

>> thank you, dr. singer. next i would liketo introduce another co-chair of the blue ribbon panel, dr. elizabeth jaffee of thesidney kimmel comprehensive cancer center at johns hopkins university. dr. jaffee? >> thank you, cynthia. hi, i'm liz jaffee,and i'm the deputy director of the sidney kimmel cancer center at johns hopkins. i'malso a member of the national cancer advisory board at the nci. and i'm a medical oncologistby training. and i'm an expert in cancer [inaudible]. and i am co-chairing this committee with bothdr. deanna singer and dr. tyler jacks. >> thank you. and then we have mr. david arons,who is the chief executive officer of the national brain tumor society. mr. arons?

>> thank you, cynthia. hi, everyone. in myrole i'm currently the chair of the national cancer institute's national council of researchadvocates. we're a federal advisory committee of patient advocates and research advocatesthat help the director of the nci be responsive to the advocacy community and to help bringa patient advocacy voice to the nci. with my other hat, i'm the ceo of the nationalbrain tumor society, which is a cancer/patient advocacy organization on behalf of the braintumor community -- one of the major areas of cancer. and so very pleased to be partof this and very much looking forward to this conversation today. >> great, thank you all for coming today.before we get to your questions and a few

questions that i actually have for you, ineed to do a brief virtual housekeeping so to speak on submitting your ideas and commentsto cancerresearchideas.cancer.gov. the ideas and comments submitted to the website reflectthe views of the author and not the views of the national cancer institute, the nationalinstitutes of health, the department of health and human services, nor the federal government.please remember that your posts are public and your comments as well. so please do notprovide any personal information such as email addresses. and finally, please keep in mindthis platform is not a solicitation for grant proposals but a solicitation for ideas andcomments on the scientific opportunities for the national cancer moonshot initiative. okay,let's get started. dr. singer, i'm going to

give you the first question. can you giveus an overview of the blue ribbon panel and how it will inform the president's cancerinitiative? >> sure, happy to. let me start by puttingthe blue ribbon panel in the context of the broader initiative. for those of you who listenedto the president's state of the union address back in january, you probably remember whenhe turned around to look at vice-president biden and announce a moonshot for cancer toreally accelerate our understanding of cancer. as a result of that announcement, a task forcewas established, of which vice-president biden is the chair. the task force consists of theagency heads of about 13 or 14 different federal agencies. and its job really is to look acrossthe entire spectrum of both cancer research,

healthcare delivery, access to care, and policiesthat might be affecting our ability to effectively treat cancer. one of the components of thetask force is the blue ribbon panel, which is charged with really identifying the scientificopportunities that could be accelerated by the support through the cancer moonshot initiative.ideas, it's science that is identified through the blue ribbon panel will then be transferredup to the task force, through the nci for implementation. >> great, thank you for that overview. dr.jaffee, as another co-chair of the blue ribbon panel, i heard dr. singer mention that theareas of scientific opportunities is what the blue ribbon panel will be looking at.can you explain the main areas of focus and

how those areas were identified? >> yes. so the blue ribbon panel had discussedwhat are the important barriers and opportunities that we need to address in order to be ableto accelerate the development of new therapies and also ways to prevent cancer so that wecan really impact patients more rapidly and help make their lives -- improve their liveswhen they do get cancer. and so some of the areas were identified by the group. and thesewere seven areas that we've established working groups. the first is on enhancing clinicaltrials. the second is enhancing data sharing. the third one is immunology, immunotherapy,and immunoprevention -- so looking at both treatment with the immune system, as wellas preventing cancer with the immune system.

a fourth one is implementation science. afifth one is pediatric oncology, and we felt that this should be a separate category becausepediatric cancers biologically are very different from adult cancers and these cancers havenot received the attention that adult cancers have received in the past. precision preventionand early detection or early diagnosis and detection is another area. and then the finalarea is tumor evolution and progression, which would include metastasis. so we've establishedthese seven areas of priority, and we've established seven working groups that have about ten totwelve experts per working group to help come up with recommendations. >> okay. thank you for that overview. mr.arons, i know that you are a member of the

expanding clinical trials working group; isthere anything you'd like to add about how the working groups are going so far? i believeyou just got started this week with your first meetings. >> we did, cynthia. we just had our firstworking group one called expanding clinical trials this week. and it was amazing to saythe least. the group gelled very quickly. these are all senior scientists as well asmyself as a patient advocate. and there's another patient advocate, ellen siegel, whoparticipates. but very quick we got to down business in terms of talking about what isgoing to improve and strengthen clinical trials to make sure the evaluation of new medicinesis getting better so that we can find new

and stronger treatments that work for cancerpatients. but the sort of secret sauce in the conversation was the realization thatit comes back down to the patient, that as phenomenal as the researchers are and as phenomenalas the research is, what's really going to accelerate cancer research is far more robustengagement by patients in the research process and by getting more and more americans engagedin the research process through donating tissue and being involved in clinical research. andthat's just going to have to happen if we're going to achieve that moonshot effect. >> so david, as a follow up to that mentioningadvocates, during this blue ribbon panel time period for soliciting ideas on the scientificareas and also we talked about survivorship

and basic research as well, how do you recommendto advocates that they get involved and stay engaged throughout this moonshot initiative? >> well, certainly participating, weighingin, and writing down your ideas and getting them to the website. they are -- i know firsthandthey are being read every single day by the nci staff. and then those ideas are beingliterally given to the working group members. so we can see what members of the public arewriting in about. what are your ideas for accelerating cancer research? they're notbeing taken lightly; they're being taken significantly. they're a key part of this process. so thefirst line of advocacy is weighing in through the website and also by contacting nci staff,members of the blue ribbon panel. everyone

wants to hear your ideas. but the first lineis writing down those ideas and getting them in to that centralized location. you shouldalso know as advocates that all the working groups have to address other cross-cuttingthemes that are important to all the working groups, such as health disparities. healthdisparities cross cuts every area of cancer research and is very important for advocatesto know that we're considering that. we're considering data across the board, consideringa variety of things that must come together to accelerate this, as well as public policy.while it is public policy issues are really for the task force overall to consider, thereis no doubt that public policy issues are being flagged in these working groups, particularlyin the working group that i was on. we started

to name a number of public policy issues thatare going to be central for creating an enabling environment for cancer research to be acceleratedin. so advocates, if you have policy ideas -- as vice-president biden would say, thisis the time to weigh in with everyone's ideas. it's a great time to advocate. >> great. and i'd also like to remind folksthat to submit your ideas to cancerresearchideas.cancer.gov. but the nice thing about this platform isthat all of the comments are public -- or i'm sorry, all of the ideas are comment, andtherefore, others viewing those ideas also have the opportunity to comment and even takethat idea potentially to the next level through their thoughts on top of what you've alreadyposted. so it's a very engaging, interactive

way to share your ideas. dr. singer, whereis the blue ribbon panel in its development of recommendations, and what is the timelinefor folks to remember? >> yeah, so that's a great question. the timelineis actually very aggressive. the blue ribbon panel is to have its report finished and submittedto the national cancer advisory board by august. the blue ribbon panel was named in the beginningof april -- april 4th, actually -- and since then has met twice to identify those areasthat need further investigation that dr. jaffee outlined. those working groups were populated.and all of them by the end of this week will have met and have started to discuss whatthey think are the special opportunities that are poised to be accelerated through thisinitiative. each working group has been asked

to identify two to three recommendations thatwill then go forward to the blue ribbon panel. the blue ribbon panel is scheduled to meetnext month to go over all of those recommendations. and as mr. arons alluded to, we expect thatmany of the recommendations will, in fact, be cross-cutting, overlap a number of differentworking groups. and what we're hoping is that we can synthesize those recommendations inways that are synergistic to really give rise to very powerful aspirational recommendationsthat really can be accomplished within a five-year timeframe. our charge has been to identifythose initiatives that can be accelerated from a decade to five years and be accomplishedin a really rapid timeframe. and that's what we're striving very hard to do, is to identifythose recommendations. ultimately, the blue

ribbon panel will have five to ten overarchingrecommendations that will go forward through the nci to the task force for implementation. >> great. so the cancerresearchideas.cancer.govplatform for submitting ideas opened on april 15th. as dr. singer mentioned, the blue ribbonpanel just got together on april 4th. so we opened it almost immediately following. andas of monday, may 9th, just yesterday, -- there have been more than 120 ideas submitted andon those 120 ideas, 70 additional comments. so i'd like to ask dr. jaffee, you are thechair, actually, of the immunotherapy and immunoprevention working group; what are yourthoughts on some of the ideas and comments that you guys have been reviewing?

>> so i believe we have been receiving somevery important thoughts and ideas for this. one big thought, which has been circulatingin the community for a while but it's ready to go but really does need to be resourcedwell is something we're calling the immune atlas. and the immune atlas, what that reallyentails is trying to basically dissect the immune environment that is within not onlycancers but also in the pre-malignant lesions. so we now know that cancer is not as simplea process as a series of genetic changes, if you call that simple. that's not reallyso simple. but we know that cancers develop as a result of multiple genetic and othertypes of changes, including immune changes. and the immune system can -- that gets intothe cancer -- can sometimes help the cancer

grow instead of prevent it from growing. andthe reason is that the cancer changes the function of those immune cells that are gettingin to become more cancer-promoting. and so the idea would be to figure out what are theearliest and then progressive changes that occur within the immune component of the cancerso that once we know what those signals are, we can develop drugs and approaches -- immune-basedapproaches -- that can alter that. so i believe that that is one of the areas that the groupwill pursue again. this is what we're learning from the website, what i'm hearing from manyof my colleagues as a high priority area [inaudible]. >> very impressive. thank you for sharingthat level of specificity. i think that helps to give our audience an idea of really therichness of the scientific thought that you're

looking for when folks are submitting thoseideas. and then, david, i'm going to throw it back to you. we already mentioned thatyou're on the expanding clinical trials working group. and i know that just yesterday, asyou mentioned, you had a really great discussion. are there any specific ideas or thoughts thatyou have on ideas that have been brought to the working group that you've been discussing,that you either think are promising or you'd like to highlight as a good example of whatfolks should be submitting? >> sure. we focused a lot on how do we getmore patients involved in clinical trials? how do we make sure that we're reducing the-- or actually, increasing the incentives for community-based hospitals to get patientsenrolled in clinical trials, even if they

in their own hospitals do not have a particularclinical trial. and so given that most cancer patients are not able to go to an nci-designatedcancer hospital, how do we make sure that that fact alone is not a deterrent from patientsenrolling in clinical research if they feel that their doctor thinks it's best for theirtreatment. so how do we create a nationwide tapestry of centers where it's much easierto get involved in clinical trials if it's the right thing for the patient? and comingup with a much bolder system for getting patients engaged in clinical research was one of theideas we were talking about yesterday. and it's also an idea that's been talked aboutand ideas submitted through the website. so it was an example of the working group andthen people submitting ideas on the website

are actually coming together. >> great. before we start taking some questionson twitter -- can you guys hear me okay? [ inaudible ] >> i just wanted to ask dr. singer if therewas anything that she would like to add as an overview of the cancerresearchideas.cancer.govsubmission process that we haven't touched on [inaudible]. >> i think david [inaudible] and liz did reallygood jobs describing how we're using those ideas. as [inaudible] we read them every day[inaudible]. >> we need to have them by july 1st. we arereading them [inaudible].

>> okay. it seems like we're getting a littlebit of feedback. so if folks could mute their speakers, that might be helpful [inaudible]the feedback. all right. but i did get [inaudible] dr. singer july 1 [inaudible]. okay. so let's[inaudible] we have scientist advocates, members of the public provide input. and if you'dlike to ask questions relevant to this google hangout, please use [inaudible]. okay. solet's go to our first question. we have alex [inaudible]. and her question is: what typesof technology will best support this initiative, particularly from a data [inaudible] perspective? >> were you able to hear the question? >> there's a lot of feedback for me. couldyou repeat the question?

>> sure. i'll say it very slowly. what typesof technology would best support this initiative, >> so we've been hoping that technology acrossthe board in all of the working groups, we need to develop new [inaudible] in terms of[inaudible] for actually [inaudible] and for therapy. in the clinical trials working groupyesterday there was a discussion of novel technology that would allow assessments ofa patient's response to therapy. certainly in the area of [inaudible], computation, weneed to develop new algorithms, we need to be able to assess cancer [inaudible] networkof [inaudible]. the data sharing working group is going to be addressing many of the questionsof what kinds of [inaudible] are needed and what kinds of technology. and how do we sharedata [inaudible] fashion across the [inaudible]?

>> i think we're going to have to pause justfor a minute because i do not believe our audience is able to hear the responses atthis time. so let's just give it a minute for our technical folks to [inaudible] fixthe feedback. >> david [inaudible]? do you have them handy? >> yes. >> i don't know why [inaudible]. >> okay. i'm just going to [inaudible] moretime. it's [inaudible]. and as soon as we get the feedback fixed, we will start takingthose questions again. >> okay. can you hear us, david?

>> that seems to have fixed it, great. >> okay. >> all right. thank you, audience members,for being patient. we're going to go, then, to -- let's see, what's our next one? we alsohave [inaudible] who asked us via google+: how can we ensure that the benefits from thecancer moonshot initiative will extend to minorities in marginalized communities? david,would you like to take that? >> sure. all of the working groups, for example,are thinking about health disparities and thinking about ways that all of the cancerresearch across all those themes address health disparities, including minorities. so, forexample, i'm sure even in clinical trials

we'll be talking about clinical trial designand ways that clinical trials of the future will be enriched to make sure that minoritiesare represented in those clinical trials, to make sure that clinical trials evolutionare robust and capture -- not only are able to address not only the homogeneity of thetumor but the homogeneity of america. and that's really what we're trying to make sureis that cancer research doesn't discriminate. you know, any american can get cancer at anytime. and so in populations sciences, that working group, or even tumor biology issuesaffecting all americans are here. and like we've said earlier, policy issues are goingto come up to make sure that everyone has access to cancer care, that everyone has -- thatcancer treatment and even cancer treatment

that is related to research is reimbursed.those things also address health disparities and are very important for minorities, aswell as any segment of the population. so cancer is truly one of those things that hitseverybody. and so access to it and the quality of care are traditionally the issues wherehealth disparities really come into play. they also come into play in research. andi think all of these working groups have that front in mind -- front in mind -- based onthe conversations that i've been in. >> great. well, i think that leads perfectlyinto a question that we're getting from david in boston. and dr. jaffee, i'm going to askyou to field this question. he really wants to know: will all stakeholders really collaboratein such a competitive space? what are your

thoughts? >> so i think that's a great question. i thinkthat the answer is that is part of our mission. i think the vice-president made it clear thathe wants us to remove any silos and barriers to being able to collaborate between institutions,between groups. and i think there really is good buy-in, in the community with the rightmechanisms to really stimulate collaborative research. and we already have examples throughprogram grants at the national cancer institute, [inaudible] grants, stand up to cancer grantsthat are national. so i do believe that we are able to, we are motivated to do it. andwith the right mechanisms, which i think this moonshot will provide, this will happen.

>> great, great. dr. singer, i'm going togive the next question to you. let's see. pamela says that she is very glad that themoonshot will focus on pediatric cancers but asks how the moonshot will address adolescentand young adult cancers. >> that was actually a specific topic thatwe've raised a couple of times. the young adult cancers -- adolescent and young adultcancers -- we now recognize are distinct from both pediatric cancers and adult cancers.and the working group is going to discuss whether there are specific research opportunitiesthat will focus on that spectrum of the population. so they haven't been forgotten. we're verywell aware of it; we're well aware of the distinctions. and that is a topic that wewill be talking about.

>> and dr. singer, another question for you.let's see, we have a question from rodney asking about funding opportunities and iffunds are going to be available for small business interest, or is the money going togo to the same big players that is [inaudible] it always does? can you talk a little bitabout new funding opportunities that might be available? >> sure, i'd be glad to. so as liz mentioned,one of the big motivations here is to develop collaborations. what i didn't mention earlieris that the blue ribbon panel, as well as all of the working groups have representativesfrom across a broad spectrum, not just cancer researchers. we have representatives fromthe private sector. we have representatives

on every working group from the advocacy community,as david can tell you. and so there's a real commitment to collaborate across all of those;and therefore, as we develop whatever funding opportunities come out of the recommendations,we expect that we will use some of our traditional mechanisms. we expect we will be developingnew mechanisms. and we fully expect that small business grants -- sbir, sttr's -- will beamong those that will be used to implement all of the recommendations that are comingout of the blue ribbon panel. >> great. well, i think we just have timefor one or two more questions before we have to wrap this up. so, david, i think this mightbe a good one for you. [inaudible] asked are cro -- clinical research organizations -- involvedin any of the working groups, especially since

they carry out a large percentage of the clinicaltrials around the world? >> you know, i'm not sure whether we havecro's specifically -- members of cro organizations specifically represented on the working groups,but definitely the people on the working groups work with cro's every day. you know, i thinkof just in the imaging world alone probably, you know, anyone who works in clinical trialsis relying upon cro's for imaging, for example. and so i don't know of any particular crocompanies that are literally named on the working groups or panels, but i'm sure we'reall drawing upon cro experience. because it's invaluable to advancing cancer research. cro'sdo -- they're a critical and essential part of advancing particularly clinical cancerresearch. and so if any cro has ideas, i think

every working group would welcome them tosubmit ideas to the website because they're key partners. >> great, thank you. i think we're going togo ahead and take the last question. and dr. singer, i think this would be most appropriatefor you. we had several questions come in about this topic, but specifically one formichael asking how this national cancer moonshot effort is working with other initiatives,you know, such as cancer genome atlas, other major initiatives that nci has been conductingover the years; how does this fit into the bigger piece of the picture? >> so a number of the cancer initiatives arecomplementary to what we're doing here. and

i should note that the nci is going to continueto support a large spectrum of cancer research with our appropriated budget. what we're talkingabout for the cancer moonshot really is to support really exceptional opportunities thatare positioned to really move forward with a quantal leap that is going to benefit fromthe funds and the support that will be forthcoming from the moonshot. so initiatives that wehave within the institute are going to inform the kinds of recommendations that will comeout of the blue ribbon panel. we're also very aware of initiatives that are ongoing in othervenues -- some of the new foundations. and we're being very cognizant of wanting to complementwhat everybody is doing so that we have -- the whole is greater than the sum of the partsin terms of what we're attempting to achieve

here. >> wow. that was a great way to put it. andi think we're going to end there: the sum is greater than the whole of its parts. that'sfantastic. well, that's all the time that we have for today. i want to thank mr. arons,dr. jaffee, and dr. singer for spending the time with us. we hope that you enjoyed thehangout. we want you to know that shortly after this wraps up, we'll have the entirevideo available on nci's youtube channel. and i also want you to remember a couple ofimportant dates. july 1 is when all of the ideas and comments that you want to post tocancerresearchideas.cancer.gov should be posted and commented on, that the working groupsbe working diligently meeting weekly through

june and so that the ncab can produce itsfinal report up to the acting director, dr. douglas lowy, at the nci by late summer/earlyfall. so keep those ideas coming. we only have a few more weeks to get them in. andi just want to thank everyone for their time. >> thank you. >> have a good afternoon. >> afternoon.