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M O L E C U L A R O N C O L O G Y 1 ( 2 0 0 7 ) 1 1 – 1 3

News & Views

Translational cancer research in the USA

Hannah Brown

Seven years ago, when Dr. Brian Druker of the University of

Oregon, OR, USA, announced the spectacular first results

from a phase I trial of imatinib mesylate (Glivec) to an expec-

tant audience at the 91st American Association for Cancer Re-

search annual meeting, the translational research community

gained its first major success story.

Although the characteristic translocation between chro-

mosomes 9 and 22, present in most cases of chronic myeloge-

nous leukaemia (CML), had been known for at least two

decades, it was not until Dr. Druker started working with

library of compounds from Swiss pharmaceutical giant Novar-

tis in the 1990s that a specific inhibitor for the BCR–ABL kinase

(the mutated protein product of the translocation) was identi-

fied. But in what has become a typical translational story of

pitfalls and challenges, Dr. Druker’s journey from his lab to

the clinic was a difficult one. ‘‘There were a lot of hurdles,’’

Dr. Druker recalls.

The problems were compounded by a lack of interest from

Novartis, which had nearly decided to give up on the project

because of the small potential market of patients with CML.

Dr. Druker also had to contend with scepticism from

colleagues about the plausibility of successfully targeting a

molecular abnormality with a single-molecule drug. ‘‘For years

people had talked about targeting specific abnormalities

in cancer but nothing had really worked,’’ he says. These

failuresddue, Dr. Druker says, to inadequate understanding

of the biology of tumoursdmade researchers and clinicians

unsure whether targeted treatment was possible, or even

whether kinase inhibitors like imatinib would be tolerated

by patients.

But Dr. Druker refused to lose faith in the drug or in

his deep understanding of the molecular mechanisms that

underlay its effects. His perseverance soon paid off. The first

results from human trials of imatinib were astounding. All

the 31 patients participating in a phase I dose-escalation study

achieved complete responses with 300 mg of drugda result

E-mail address: hannah@two-cultures.com

doi:10.1016/j.molonc.2007.02.001

made even more surprising by the fact that the study

was aiming only to assess tolerance and the patients

involved had tried other therapies without success. ‘‘In these

circumstances, significant responses are not expected,’’

Dr. Druker told journalists at the time.

Professor Robert Bast, Vice President for Translational

Research at the University of Texas MD Anderson Cancer

Center, TX, USA, who calls imatinib ‘‘the poster child for

targeted therapy,’’ says Dr. Druker’s achievement shows

that an ‘‘understanding of biology enables understanding in

the clinic.’’ This simple proof-of-concept helped kick started

the burgeoning field of translational cancer research.

While pinning down a definition of the field has become

something of a controversy, Lynn Matrisian, Professor of

Cancer Biology at Vanderbilt University Medical Center, TN,

USA, who is also co-chair of the National Cancer Institute’s

(NCI) Translational Research Working Group (TRWG), says

she and the 63 members of her discussion forum spent

a long time carefully constructing a statement that covers

most viewpoints. ‘‘We wordsmithed it to death,’’ she laughs.

The result is a broad definition that encompasses new treat-

ments, diagnostics, other interventional devices, and risk-

assessment technology: ‘‘Translational research transforms

scientific discoveries arising from laboratory, clinical, or

population studies into clinical applications to reduce cancer

incidence, morbidity, and mortality,’’ the statement says.

Matrisian’s personal emphasis, however, is on moving

between the lab and the clinic. ‘‘I am a basic scientist so I think

in terms of going from bench to bedside, but I wanted to en-

compass things going the other way as welldtaking a clinical

observation and going to the lab to figure out what is hap-

pening,’’ she explains.

1. A fast-moving field

During the past 10 years’ rapid growth in translational

activity, much of the new research has been spurred by ‘‘an

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explosion in understanding of cancer at the molecular level’’,

says Professor Bast. This increasing knowledge has coincided

with widespread disillusionment about traditional chemo-

therapeutic approaches. ‘‘Strategies that served us well with

childhood leukaemia and breast cancer in the 1980s are

slowing in their effectiveness because studies that show just

a few months’ more survival are not getting us towards cure

or control as quickly as we want,’’ Professor Bast explains.

Now, with several targeted-drug successes besides Glivec

attracting a growing army of researchers to the translational

field, Professor Matrisian says there is an urgent need for

some central planning. She believes the rapid and diverse

evolution of the field, in which individual researchers have

largely pursued their own approaches, means there is now

a hotch-potch of techniques and processes with no systematic

way of identifying bottlenecks or smoothing the journey

between lab and clinic. ‘‘We have only just started to realise

that it will take some real planning to make it work better,’’

she says.

The USA leads the world in basic cancer research and with

that strong foundation, says Professor Matrisian, the country

‘‘has the potential to do the best translational research in the

world.’’ But the system is not optimally designed to achieve

that goal. ‘‘We came to the realisation is that basic research

just needs to bubble.but that doesn’t work very well for push-

ing ideas through the kinds of steps needed to get to clinical tri-

als,’’ Professor Matrisian explains. This is where the TRWG

comes in. Established in the summer of 2005 by the NCI, its

purpose is to work on a list of recommendations for how

best to organise and invest in translational research. TRWG’s

draft report describing these recommendations will be pre-

sented to the National Cancer Advisory Board in June 2007.

To learn what has worked in the past and come up with

ideas for emulating successes on a larger scale, the TRWG

picked 20 success stories in translational research to study

closely. ‘‘We asked ‘How does an agent get to phase I and

beyond?’,’’ says Professor Matrisian. Although the diversity

of products they chose to analyse meant it was difficult to

draw broad generalisations, the team did learn some inter-

esting lessons about common bottlenecks. Most of the prod-

ucts experienced problems at one stage or another. Several

cases required the development of new technology to validate

the discovery. Some had problems in preclinical development.

Others encountered difficulties in early-stage clinical trials

because of issues to do with regulatory approval or patient

recruitment. Professor Matrisian says the main lesson of the

exercise was that to develop translational research ‘‘you

need assays, you need to generate material that you can

actually use in a trial, and you need to pool funding that is

sitting in lots of different pots’’. She adds: ‘‘You can essentially

get stuck at any stage. None of them are easy. The bottom line

is it’s a chain and you can break it at any place. You have to

make every link strong’’.

In a series of meetings over many months that involved

consultations with experts all over the world, from academia,

philanthropic organisations, and industry, the TRWG ana-

lysed NCI’s current portfolio of translational research projects

and drew up a list of recommendations for how to optimise

the system. An implementation plan, the final stage of

TRWG’s work, is almost ready to be delivered to the National

Cancer Advisory Board. Professor Matrisian is hopeful that the

recommendations will be taken on board. ‘‘I am optimistic’’,

she says. ‘‘I’m very impressed with what we have done and

I realise that I am biased, but I do think that this plan is

our best bet to make it work. It would really make a big

difference,’’ she says.

However, there remain several significant barriers to

efficient translational research in the USA. Among them is

addressing the existing sharp divide between academia

and industry. ‘‘Industry is very good at the developmental

process, having a lead compound, optimising it, and doing

toxicological studies. They know the regulatory process,’’

explains Professor Matrisian. ‘‘Those things are very rare in

academics, so there is a big advantage to partnering with

industry.’’

From his experience, however, Dr. Druker thinks that part-

nerships between academic departments and biotechnology

companies face significant challenges because bureaucratic

problems seem to hinder, rather than promote, cross-sector

cooperation. ‘‘There is too much bureaucracy involved in try-

ing to get compounds from companies to labs. That is clearly

an area where the government should intervene,’’ he says. For

at least part of the problem Dr. Druker blames the Bayh-Dole

Act, introduced in 1980 to help universities to reap the

commercial benefits of government-funded research by out-

licensing patented compounds. He says what the Act has

actually meant in practice is that ‘‘academic institutions try

to make money on other people’s products’’, which can slow

the pace of research and distort priorities. Dr. Druker asserts

that the purpose of academia is to advance knowledge and im-

prove health and warns that if universities instead try to make

money out of someone else’s product ‘‘the drug companies are

not going to work with us’’da situation that will end up dam-

aging translational research.

Professor Bast suggests that there are other problems for

academic translational research. He says that the barriers to

establishing tissue repositories, particularly when it comes

to finding funding without strings attached, hinder research.

What are most needed are large repositories containing tissue

samples with annotated information, such as how long people

lived and what drugs they responded to. ‘‘Sometimes those

details are more useful than the actual tissue,’’ he says.

Consent is another tricky issue, particularly for new types of

clinical studies. ‘‘One of the problems that has arisen over

last decade is what constitutes adequate patient consent for

use of tissues,’’ says Professor Bast. ‘‘Every time you come

up with a new marker, do you then have to go back to patients

to ask for permission to test their tissue samples for a

response?’’ he asks.

The reason much translational research is complex and

challenging to organise is that it requires researchers to

rethink the early phases of clinical trials to incorporate the

to-ing and fro-ing between lab and patient. For Professor

Matrisian, the kind of analysis of outcomes and responses that

typifies translational work is as important for failed com-

pounds as for successful ones. ‘‘One thing we felt very

strongly about is the ability to work in what we called ‘produc-

tive failure’. Lots of things fail, but our idea was that if you are

going to fail you should at least understand why, so the drug is

not just dead in the water.’’ You either find out if the problem

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is something that can be fixed, or you need to divert your

money elsewhere, she adds.

2. Looking to the future

If some of these problems can be resolved by the TRWG’s

implementation plan, translational research, in all its guises,

promises to deliver some remarkable achievements during

the next few years. Professor Bast believes it will be a crucial

time for ‘‘identifying the ground rules’’ for combining targeted

agents and taking forward techniques of molecular imaging.

‘‘There is the opportunity to non-invasively tell whether a

cancer will respond or has responded,’’ he explains. ‘‘We will

also be able to tell non-invasively whether the treatment is

on target through molecular markers that will bind to active

rather than inactive receptors, showing that receptors have

been deactivated by drug.’’

Professor Matrisian believes some of the most exciting

areas are nanotechnology and the application of basic infor-

mation on the tumour microenvironment. But she thinks

translational research will also prove valuable for taking drugs

that are used for other purposes and applying them to tumour

control. A better understanding of how drugs and tumours

work at the molecular level could resurrect old compounds

that looked ineffective. ‘‘Lots of products went through clini-

cal trials before we had a full understanding of the biology

behind what was being targeted,’’ she says. ‘‘We lost a lot of

resources without knowing what to do about it.’’

There is, however, a cost implication for this sort of early

clinical investigative work. ‘‘If you are to add tissue acquisi-

tion and new assays, those things do cost, but it prevents

you going on to large-scale trials that are not going to work,’’

says Professor Matrisian. ‘‘It is short-term expensive but

long-term cost effective,’’ she says. Professor Bast adds that

the ability to identify sub-sets of potential responders from

groups of patients with the same tumour type, or pin-point

high-risk groups will save on treatment costs. ‘‘One of the

secrets of being cost effective is to identify people who are

most at risk. Preventing cancer can be more cost effective

than treating recurrent metastatic cancer,’’ he explains.

Watching the development of the translational research

field, Dr. Druker feels the optimism that drove him through

Glivec’s first difficult stages was entirely justified. He believes

there are hints of a change in the way patients are treated.

‘‘We are getting much better at targeting critical abnormalities

‘The field is on its way’,’’ he says. However, Dr. Druker main-

tains that a full and complete cataloguing of the abnormalities

in cancer cells is still needed. ‘‘The quality of translation is

directly proportional to the quality of understanding of

disease,’’ he says.

Hannah Brown is a freelance journalist based near

Cambridge, UK.