Showing 8 ideas for tag "cancer"

Goal 2: Reduce Human Disease

Thrombprophylaxis in cancer patients

What is needed to identify the cancer patients that would benefit from thromboprophylaxis and the agents that should be used?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

The close relationship between cancer and thrombosis has been known since the days of Armand Trousseau, who first described the clinical association between idiopathic venous thromboembolism (VTE) and occult malignancy in 1865. Today, we know that some cancers are associated with a hypercoagulable state and up to four-fold increase in thrombosis risk, with chemotherapy elevating this risk even more. Thrombosis has a significant impact on the morbidity and mortality of cancer; therefore, it is important to identify which patients may be at higher risk than others, especially before starting chemo-radiotherapy or surgery. However, there is no standard of care for thromboprophylaxis in cancer patients. Identification specific groups of risk for thrombosis and appropriate anticoagulation regimen, especially in mid-level risk groups, would provide direct benefit to the outcome in cancer patients.

Feasibility and challenges of addressing this CQ or CC

Epidemiologic and population-based studies provide detailed information on the scale of the problem and the identification of VTE risk factors, including those related to the tumor (tumor type, clinical stage, chemotherapy, use of anti-angiogenic drugs or erythropoietic growth factors, and insertion of central venous catheters), and those related to individual patient characteristics (sex, race, age, previous VTE history, immobilization, and obesity). Additional factors and biomarkers of thrombosis have been established in recent years. A new generation of oral anticoagulants that potentially can make thromboprophylaxis in cancer patients safer and easier, has been developed. All these achievements may transform the current empirical nature of anticoagulants use in cancer to scientifically justified, efficient and safe thromboprophylaxis.

 

 

While there is a clear progress in our understanding of the mechanisms associated with the development of malignancy, we know little of the mechanisms of cancer-related thrombosis. There is evident lack of collaboration between basic scientists and clinical oncologists, which would be required for natural history and biomarker studies. Efficient collaboration is required between National Cancer Institute and National Heart, Lung, and Blood Institute to coordinate efforts and leverage resources in addressing this important research and clinical challenge.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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Goal 2: Reduce Human Disease

Conduct a clinical trial whether maximizing melatonin using orange eyeglasses in the evning reduces breast cancer.

Epidemiological studies have shown totally blind women have about half the incidence of breast cancer as blind women who retain light control of melatonin suppression or of women with normal vision. Studies show shift worker that reduces melatonin and disrupts the circadian rhythm increases the risk of breast cancer. Studies show human breast cancer grafts grown on rats but supplied with human blood grow rapidly if the... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

About 250,000 new cases of breast cancer are diagnosed each year in just the U.S. The evidence suggests this number could be cut in half by simply changing to low-blue light bulbs or by wearing blue blocking glasses for a few hours before bedtime. A similar situation exists for prostate cancer. Without clinical trials the medical community will not believe it is true, despite all the evidence.Since there are no expensive drugs involved, no drug company will fund this type of trial so the federal government or foundations are the only likely funders. Reducing breast cancer incidence to half is worth billions of dollars to say nothing about the reduction in human suffering.

Feasibility and challenges of addressing this CQ or CC

By using women at high risk for cancer the time to carry out a trial of modest size will be reduced. Since there is essentially no risk and improved sleep is a side effect, compliance should be high.

Name of idea submitter and other team members who worked on this idea Richardd L. Hansler PhD Edward Carome PhD Vilnis Kubulins MS

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Goal 2: Reduce Human Disease

Reducing CV events in breast cancer survivors -knowledge gaps

Identifying breast cancer survivors at high risk for CV morbidity and mortality to allow targeting of management strategies to reduce CV events and thereby improve overall cancer-related survival.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Chemotherapy for breast cancer stages I-III is known to be associated with or induce cardiotoxicity. Over 35% of these women develop progressive fatigue and exercise intolerance, and heart failure limiting their daily activities and frequently interfering with their ability to return to work. CV disease are the leading cause of morbidity and mortality for those surviving beyond 5 to 8 years from their breast cancer diagnosis. The excess of CV morbidity and mortality in these patients threatens to offset reductions in cancer-related survival. Identifying breast cancer survivors at high risk for CV morbidity and mortality could allow targeting of cardiovascular disease reducing therapeutic interventions.

Feasibility and challenges of addressing this CQ or CC

creating a multisite registry of women with Stage 1-3 breast cancer scheduled to receive chemotherapy and a control population women of similar demographic and CV risk profile without neoplasia, would allow to collect data at baseline and during/after cancer treatment related modern therapy, pre/post treatment functional status, including fatigue, behavioral and psychosocial risk factors and quality of life, and serum biomarkers indicative of myocardial injury, fibrosis, and heart failure.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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Goal 2: Reduce Human Disease

Why is the heart resistant to cancer?

Cancer of the heart is almost unheard of, whereas most other organs can develop cancer. Why is this?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

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If we could understand why cancer does not develop in the heart, this might help to develop strategies to protect other organs from doing so.

Feasibility and challenges of addressing this CQ or CC

To my knowledge, no one has looked at this problem, because cardiologists and oncologists train in different fields. With molecular profiling, iPS technology, and animal models, this question can be addressed.

Name of idea submitter and other team members who worked on this idea Henry Chang, M.D.

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Goal 3: Advance Translational Research

The Future of Fibrosis Research

A critical challenge in the area of fibrosis research (including heart, lung and other organs) is the absence of a central system to act as air traffic control for progress, innovations and gaps in the science. Like the area of cancer research was 30 years ago, the fibrosis research area is fragmented and disconnected. The answer in the cancer effort to creating a centralized, focused system was with the National Cancer... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

By addressing the issues related to stalled or slow progress in deadly fibrotic diseases which are on the increase worldwide and account for one in four deaths in the industrialized world, NHLBI can become part of the solution of this global crisis. A system that incorporates all research outcomes to date (failed and successful research projects and clinical trials included) as well as a centralized IT-based system to monitor research efforts globally and a method for matchmaking researchers with similar mindsets and efforts that will result in exponential, not incremental change in fibrotic research efforts.

Feasibility and challenges of addressing this CQ or CC

The model of a centralized system of research in a disease area is clearly the model that is the National Cancer Institute. A National Center for Fibrotic Research will allow for similar progress and innovation in the fibrotic disease space. Challenges would include only any limitations in vision from leadership at NHLBI. The expectation and hope is that NHLBI will see the Future of Fibrosis, Embrace it and Own it.

Name of idea submitter and other team members who worked on this idea Teresa Barnes and Dolly Kervitsky

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Goal 3: Advance Translational Research

Applying Imaging in Chronic Lung Diseases

How can chest CT or other imaging tools be optimally used to characterize expression and progression of chronic lung disease?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Chest CT scans provide anatomical information on disease pattern and severity that cannot be readily obtained otherwise. These imaging studies could be essential in reclassifying chronic lung diseases more effectively and in assessing disease progression more accurately.

Feasibility and challenges of addressing this CQ or CC

The increasing use of chest CT scans for lung cancer screening will provide a large number of imaging studies that could transform pulmonary research in multiple chronic lung diseases. However, the images will need to be appropriately collected and analyzed.

Name of idea submitter and other team members who worked on this idea Ed Silverman, James Crapo and COPDGene Executive Committee

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47 up votes
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Goal 2: Reduce Human Disease

Understand the Impact of Thrombosis in Children with Cancer

CC: Despite the potential impact that venous thrombotic events (VTE) have on children with cancer, several unresolved issues remain. To date, we are yet to understand:
- incidence/prevalence of VTE according to cancer type/staging
- ideal imaging modalities to diagnose/follow VTE
- thromboprophylaxis according to thrombosis risk stratification (development of VTE predictors)
- efficacy/safety to anticoagulate children... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Venous thrombotic events (VTE) are now occurring in 1/200 children admitted to a tertiary pediatric facility. In around 70-90% of cases, VTE occurs in children with an underlying condition, amongst which cancer represents up to 1/3 of patients. Within this group of patients, the thrombotic complications are associated with a higher morbidity (e.g. higher recurrence rates, high rate of CNS events in acute leukemia) and mortality. Nevertheless, the clinical challenges highlighted in the itemized Critical Challenge Section illustrate the lack of basic science, translational and clinical research available, as well as the paucity of evidence-based medicine recommendations necessary to acoount for the increasing number of patients with this complication.
On the other hand, pediatric oncology is one of the areas of pediatric care where the medical progresses of the last decades have drastically changed the natural history of cancer in children. In light of much higher survival rates for almost all types of pediatric cancer, the focus has now shifted towards decreasing treatment-related, as well as disease-related morbidities, increasing the quality of life of the many survivors. Because VTE is now recognized as one of the significant remaining complications within this patient population, addressing the list summarized herein would contribute to further improve the care of children with cancer.

Feasibility and challenges of addressing this CQ or CC

The infrastructure that is already in place under the Children's Oncology Group (COG), where almost any new clinical and/or translational idea related to the care of children with cancer becomes part of a clinical trial, could be rolled over to explore many of the items listed under the CC Section.
As a principle, VTE in children with cancer develop due to: a) host-related factors; b) chemotherapy/treatment-related factors; and c) disease-related issues. Therefore, protocol- and disease-specific studies could address, under the auspices of COG, the prevalence of VTE according to cancer type in a prospective manner. Similarly, high risk groups for VTE could be submitted to standardized imaging and/or biomarker investigation prospectivelly, in addition to collection of outcome data related to VTE and to anticoagulation protocols. Furthermore, tumor specimens/genetic markers could be evaluated and correlated to the study outcomes. The challenges of reaching consensus during protocol development would allow identification of equipoise for certain clinical scenarios, obviating the need of trials, or the use of consensus techniques, before diagnostic/therapeutic protocols could be adopted.
In conclusion, the develoment of a multidisciplinary task force (i.e. pediatric radiologists, oncologists, hematologists, molecular biology experts), which, for the most part, is already in place (i.e. COG), would be instrumental to foster research on this extremely clinically relevant area.

Name of idea submitter and other team members who worked on this idea Leonardo R. Brandao, MD, MSc;

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Goal 2: Reduce Human Disease

The Use of Therapeutic Apheresis to Reduce Circulating Levels of Galectin-3 and other Cancer and Inflammation Promoting Factors

Inflammation plays roles in cancer initiation, promotion, and progression. Elevated circulating galectin-3 (Gal-3) protein and other cancer and inflammation promoting factors (CIPFs) such as C-reactive protein and VEGF are associated with tumorigenesis and may play causative roles. Plasma Gal-3 is a biomarker, prognosticator, and pathogenic mediator of diverse cancers and is emerging as a therapeutic target. Preliminary... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Apheresis therapy in a clinical setting, both alone and in combination with conventional protocols, shows great potential to enhance treatment regimens, reduce dosage and side effects, improve drug deliver to target tissues, reduce long term treatment related morbidity and improve outcomes with significant benefits for patients with a broad range of cancer types and stages.

Feasibility and challenges of addressing this CQ or CC

The need for well designed, randomized clinical trials would be readily feasible with the appropriate IND. Grant support will be needed for further development of this concept, as well as to develop columns with more optimized and specific capabilities, in addition to clinical trials demonstrating efficacy.

Apheresis is highly underutilized and underfunded in the US, while Apheresis research and development is much more advanced and widely utilized in Europe and Asia.

Name of idea submitter and other team members who worked on this idea Isaac Eliaz, MD

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