Ignoring comorbid conditions in stratifying samples may mean missing clues to development of cancer. E.g., lung cancer (BAC) can develop in pulmonary fibrosis; rarely studied together, they may have similar pathways. Studying both can yield new paths

Such efforts could find similar/identical pathways for development of lung cancer and fibrosis, for example, leading to more research on early ID and treatment of either or both conditions. Sharing data across NIH divisions would be cost-effective.

The comorbid conditions may be in non-NCI divisions. NIH should convene cross-organizational committees to see intersections of relevant research and survey existing non-NCI grantees to ID prospective contributions of research data. E.g., NHLBI can share data on pulmonary fibrosis with NCI sharing data on lung cancer, or data from the National Lung Screening Trial can be mined for PF and cancer. Familial cases may yield genomes to be studied.

We may miss key genomic data if we restrict data collection to the US and don't collect family history of the cancer and comorbidities. We may see a case as sporadic when, with family history or access to int'l registries, would label it familial.

Collecting family history is inexpensive done prospectively, can find patients whose genome should be sequenced, and match a family with related families, to provide larger samples. Global access to tissue/bio-banks can identify familial cases.

Family History of the target cancer and associated co-morbidities should be included in NIH/FDA proposed Clinical Trials Protocol Template under Medical History section 7.1.1. We need global access to tissue and biobank registries for qualified researchers, with information about what data are routinely collected. Since most of us in the US came from "across the pond" in some sense, such info is critical, and can lead to new research directions.

Standard breast cancer treatment includes excision followed by several weeks of radiotherapy. Stereotactic radiosurgery has proven an effective alternative to surgery in lung/brain cancer but has yet to be explored for breast cancer.

Data generated from this study could revolutionize the management of early stage breast cancer. A single, noninvasive, outpatient procedure, performed in 90 minutes, could completely replace the current 11+ week standard of surgery and radiation.

Preoperative stereotactic breast radiosurgery will be piloted with this novel device. To develop a completely non-surgical approach to breast cancer, we must identify predictors of response to treatment. Extensive pre- and post-radiation functional MRI, serum biomarker sampling, and pathologic assessment will help to identify surrogates for complete pathologic response (pCR). We expect a pCR in 80+% of patients as seen in other disease sites.

I have heard that HAMLET gets at least partly inactivated by albumin in blood. An antibody that binds to the site so that HAMLET can´t bind to albumin would be good if that is possible. HAMLET could perhaps be bound to contrastagent to detect cancer.

Cancerpatients with metastasis and no hope of being cured by present techniques can hopefully get HAMLET treatment, live longer and perhaps be cured without suffering from adverse effects. Peopel with high risk of getting cancer can prevent it.

Inject HAMLET in metastasis. (Repeat if necessary or cool the area down if blood/albumin is present). HAMLET could be administered by percutan intervention. Inhale HAMLET to treat lungcancer. Operationarea or cancer could be covered by HAMLET to reduce risk of cancer cells being left in the area. Profylactic inhalation, lavage,drink it, topical use on skin (albinos), cervix(SIN1) or in body cavities to prevent cancer if hereditary risk.

Only 3% of cancer patients participate in clinical trials, for a variety of reasons that aren’t well understood. Better information about how potential participants perceive risk and benefit could influence recruitment and retention.

Decision-making is a key avenue through which behavioral processes may influence perceptions of risk and benefits of various cancer treatments. Findings from this research may influence population of a new generation of cancer trials.

Multidisciplinary research on decision-making offers a fresh avenue for elucidating risk- benefit perception to improve clinical trial participation. Application of this type of research to this problem can help determine what factors influence participation, and what decision supports are most helpful in various groups.

Patient needs, preferences, and values are not consistently assessed or considered as part of clinical research studies. There is also limited follow-up with patient participants regarding study results.

Patients will be engaged as active partners, not passive participants. Better inclusion and understanding of their role might facilitate adherence of currently enrolled patients as well as recruitment of new enrollees.

Develop communication protocols informed by patients, caregivers, and families. Provide mechanisms for patients to communicate personal goals related to clinical trial in which they have been enrolled. Allow for the meaningful incorporation of patient-reported outcomes into findings. Report back to patients and families in a timely manner, before public dissemination. Request feedback to improve process.

There is a critical need for greater enrollment in clinical trials. The major barriers are 1) not all doctors inform/refer patients to trials and 2) Medicare rules can limit patient's access to out-of-state trials.

By increasing enrollment in trials, we will develop new and better therapies much more rapidly than our current process. Expanding Medicare patient access to trials will greatly aid in this process.

Require clinicians to discuss clinical trial options with all patients. Make mandatory and track outcomes/compliance (with EMRs, as with safety training in hospitals). Make these data public to encourage competition across institutions for 100% compliance. For access, allow Medicare patients to access clinical trials across state lines rather than restricting access to in-state options.

Patients have a hard time finding a trial that they qualify for and do not have access to all trials. All patients need to have access to all trials.

All patients would have access to clinical trials regardless of where they live. This would lead to equitable opportunities for new therapies among all patients.
Trials would accrue faster.
New treatments would move forward faster.

Develop systems that identify the best trial for the patient based on eligibility and patient preference.
Bring the trial to the patient. Have easy open/easy enrollment trials that can be opened when the patient needs it and where the patient is.
Have pre-qualified sites, including community sites, that can open any government funded trial at anytime – using central irb and on-line forms, etc. that is low on cost/resources.

Patients need help finding clinical trial that gives them best chance of effective treatment. Currently they can search trials to match geographic and inclusion requirements, but have no way to assess medical suitability of each trial.

More patients will be willing to participate in clinical trials because they will have help finding a trial that meets their needs and offers a valid treatment option they feel comfortable with.

Make preclinical data available to pts and healthcare providers. Create regional centers staffed by patient navigators (PNs) and docs trained in clinical trial assessment: how to evaluate trial reqts nationwide, use IT tools to match EHR data to reqts, assess which trial has best chance of helping (e.g., this drug treats brain mets, that one is more potent for EGFR, etc.), find patient supports for travel, & collaborate with patients.

Clinical trials for rare and oncogene-driven cancers are often underpowered. Limited trial locations create barriers to patients (travel, time away from family and work, travel costs)

More patients will be able to enroll and have access to targeted and immunotherapies, trials will be adequately powered, researchers will have access to more diverse patient tissues, more researchers can access data.

Have more community-based (CB) hospitals partner with academic medical centers (ala Lung MAP model) to act as clinical trial check-in sites. Telehealth allows real-time connection with primary investigators when needed. Train docs at CB sites to perform required hands-on exams of patients and properly collect necessary tissues and data. Forward tissues to central NCI biobanks. Open source genomic analysis of tissues.

Sequential metronomic chemotherapy is not widely utilized by Medical Oncologists due to not having been studied in many clinical trials.

We have found that sequential metronomic dosing effectively decreasing the burden of disease with more manageable adverse effects. Research into metronomic chemotherapy may eventually benefit patients' quality of life and treatment outcomes.

More funding and attention needs to be given to perform clinical trials assessing the efficacy of metronomic chemotherapy.

Sequential metronomic chemotherapy is not widely utilized by Medical Oncologists due to not having been studied in many clinical trials.

We have found that sequential metronomic dosing effectively decreasing the burden of disease with more manageable adverse effects. Research into metronomic chemotherapy may eventually benefit patients' quality of life and treatment outcomes.

More funding and attention needs to be given to perform clinical trials assessing the efficacy of metronomic chemotherapy.

Clinical trials are mainly focused on patients with advanced cancers who have failed standard therapy. Though tumor mutations are detected in patients with all stages of cancers, few opportunities exist to improve treatment for early stage cancers.

Focusing efforts on effective treatment of early stage cancer can dramatically reduce the morbidity associated with current treatment modalities and help reduce the incidence of treatment related secondary cancers.

To create an infrastructure that specifically enables rapid enrollment of early stage patients into clinical trials that matches an individual’s tumor genetic profile to novel therapies. In addition, the proposed infrastructure would develop and standardize methods to rapidly screen novel compounds for efficacy against specific genetic mutations and the patient’s tumor genetic profile.