We are international
The 3rd annual One Voice Against Cancer (OVAC) Advocacy Day will be held on June 3-4, 2002 at the Hyatt Regency on Washington, DC’s Capitol Hill.  The IMF supports the OVAC funding agenda because it is the best hope for increased federal funding to benefit all cancer patients, especially those with an interest in myeloma and other under-funded orphan cancers.  The IMF website has posted registration information.

Senator Tom Harkin (D-IA), chairman of the Senate Appropriations Subcom-mittee on Labor, Health and Human Services, and Education — which is responsible for funding most federal cancer research — has scheduled a hearing to highlight the OVAC agenda on the morning of June 4.  The hearing is expected to focus attention on funding of orphan cancers, especially multiple myeloma and pancreatic cancer, and determining methods of accelerating research that will benefit today's cancer patients.

OVAC is a coalition of the spectrum of cancer advocacy organizations which is dedicated to increasing funding for diversified research and prevention programs at the National Institutes of Health (NIH), the National Cancer Institute (NCI), and cancer programs at Centers for Disease Control and Prevention (CDC).  OVAC has been credited with maintaining recent funding increases for federal cancer research funding.

The New Paradigm

Why support the OVAC agenda and not just myeloma research?  The funding figures and the state of the science help explain.

This year the NCI will spend almost $4.2 billion on cancer research.  To compare, the American Cancer Society, the largest cancer research funding organization in the world, will invest more than $100 million over the same period.  And one of the most visible advocacy organizations, the Susan G. Komen Foundation for breast cancer research, has raised more than $240 million since its inception in 1982.

These numbers demonstrate why political advocacy is as important a task for members of the myeloma community as other fundraising activities.  While many organizations, including the IMF, annually raise cumulative millions for research, our federal government appropriates annual billions for cancer research agencies and institutes.  But as we engage in community fundraisers for research, let us also commit at least as much time and effort to educate our members of Congress about the value of allocating our fair share of tax dollars to cancer research.

The IMF also believes that the OVAC agenda is the best mechanism to support newly appointed NCI Director Dr. Andrew von Eschenbach's emphasis on the New Paradigm of cancer research.  This New Paradigm places less emphasis on research by body part or tumor type.  This new approach will put more emphasis on the most promising, state-of-the-art research of genomics, drugs that treat cancer at the molecular level.

The traditional way of thinking about cancer treatment has been “search and destroy,” which is best exemplified by chemo-therapy.  In plain English, these therapies try to kill cancers with toxic drugs with the hope that enough healthy cells survive the process to maintain the continued health of the patient.  As too many of us know, some of these treatments are as bad or worse than the disease they are trying to eliminate.

The New Paradigm, which replaces the “search and destroy” mindset with “command and control,” demonstrated with drugs like Gleevec® for chronic myelogenous leukemia, Iressa® for lung cancer, or Herceptin® for breast cancer, targets the molecular mechanisms that trigger growth of cancers without debilitating or destroying healthy cells, organs, or systems.

When we look at cancer at the molecular level, targets will not be conveniently categorized through body parts or tumor types.  The key is to identify, through research, the targets that trigger the malignant growth of cancer cells.  In the case of myeloma, there may be dozens, if not hundreds, of targets that must be identified.  And some of the targets in myeloma, at the molecular level, may look more like other traditional cancer types — lung, colon, kidney, or pancreatic — than other hematological cancers.

Congress recognized this opportunity in last year's appropriations bill when it declared “that NIH should distribute funding on the basis of scientific opportunity” and “urged [NIH] and the Administration to continue to resist pressures to earmark, set-aside and otherwise politicize” funding for medical research programs (House Report 107-229).

In other words, the appropriators, those who control the purse strings of the NIH and NCI, specifically granted the directors of the institutes the authority to ignore congressional attempts by other committees to authorize specific body part or tumor type programs in favor of “scientific opportunity.”  More precisely, they gave credence to NCI Director von Eschenbach’s vision of the New Paradigm in cancer research.        Director von Eschenbach underscored this view in a March 15, 2002 letter to the IMF stating, &Your view that promoting full funding for the NCI Director’s Bypass Budget request will best serve your constituents is an enlightened one.  A rising tide does indeed raise all ships.”

The OVAC agenda — which maintains support for the 5-year funding doubling pledge for NIH, fulfillment of the NCI Director’s annual Bypass Budget proposal, and the applied research programs at CDC — is the most logical and constructive plan to achieve those goals in the foreseeable future.

The Bigger Picture

Indirectly, fulfillment of the OVAC agenda would also support the goals of the IMF's other primary legislative priority — enactment of the Access to Cancer Therapies Act (H.R. 1624 and S. 913).  This legislation would provide Medicare coverage for all oral cancer drugs.  In addition to the drugs mentioned above, this bill would include coverage for Thalidomid® and all the future genomics-based drugs that will target tumor growth at the molecular level.

Currently, it is estimated that 5-10% of all cancer drugs are taken orally.  In the coming decade, that figure is expected to rise to at least 25%.  The logical outcome of the New Paradigm will be a dramatic acceleration in the discovery and approval of genomic drugs that may push those percentages even higher, and limit – and hopefully eliminate – the need for “search and destroy” chemotherapies.

Although this legislation is not a part of the OVAC agenda, which is appropriations-based, it completes the vision of the New Paradigm.  The IMF recognizes that support of a comprehensive, OVAC-based funding mechanism will provide the comprehensive framework that links federal activity to the translational research needed to produce the drugs and therapies needed by all cancer patients.

And the future of the IMF advocacy agenda will not be dictated by trying to carve out turf for myeloma research.  It will, instead, ensure that myeloma is represented in the new research.  This search for new therapeutic targets will create a logical, visible path from incurable condition to chronic, manageable disease to, ultimately, a cure for myeloma.