Commentary - September 2010
Tex Med . 2010;106(9):17-20.
By William Gimson
CPRIT - The Cancer Prevention & Research Institute of Texas - was created from hope. Discouraged after the cancer deaths of several close friends, a small group of concerned Texans banded together in summer 2006 to promote the idea for a new cancer research initiative in Texas. They were buoyed in these efforts by the support of the Texas Legislature and spurred to action by the grim knowledge that more than 100,000 Texans are diagnosed with cancer each year. Cancer takes a terrible toll in this state; it kills 40,000 people annually, making it the second leading cause of death in Texas. The disease costs the Texas economy $22 billion annually - more than $60 million each day. But through CPRIT, a first-of-its-kind organization, Texas is fighting back.
This is the story of the organization, from the first call to action and statewide referendum to the creation in 2009 of what has the potential to be the nation's foremost cancer research institute and the successful completion of its first full year of operations.
A Dream to Accelerate the Cure for Cancer
The initiative to place Texas at the forefront of cancer research and prevention efforts gained considerable momentum in early 2007 when Gov. Rick Perry declared in his State of the State speech, "I don't know when the day will come that we find a cure for cancer, but I do know that it is my dream to accelerate its arrival with a multibillion-dollar cancer research initiative that can save lives and provide millions renewed hope."
Following the governor's call, State Rep. Jim Keffer (R-Eastland) and State Sen. Jane Nelson (R-Lewisville) filed legislation to sell bonds to fund cancer research and cancer prevention programs and create a new state agency to oversee Texas' cancer-related activities. By the time the legislation passed the House, more than 100 state representatives had signed on as sponsors. It also had the support of concerned Texans across the state, including a network of strong cancer research advocates like KillCancer.org, the Lance Armstrong Foundation, Susan G. Komen for the Cure, the Texas Medical Association, and the American Cancer Society.
Texas Takes on Cancer
But the cancer research initiative approved by the Texas Legislature would be implemented only through an amendment to the Texas Constitution, which required approval in a statewide election. On Nov. 6, 2007, Texas voters overwhelmingly endorsed Proposition 15, the constitutional amendment that established CPRIT and authorized issuance of $3 billion in bonds to fund groundbreaking cancer research and prevention programs and services in Texas.
With the passage of Proposition 15, Texas was positioned to become the second largest funding source for cancer research in the United States. Given the charge to take on cancer, the nascent institute needed a strong governing body to lead the way. The governor, lieutenant governor, and speaker of the House each appointed three members of the public to serve on the CPRIT Oversight Committee. In addition to the nine appointed members, the attorney general and the state comptroller also are members of the institute's governing body. The CPRIT Oversight Committee is a remarkable group of very dedicated individuals (see "CPRIT Oversight Committee."). Each member brings a true public servant mentality, coupled with the persistence to get the job done and the passion to really make a difference in the lives of their fellow Texans. With an eye toward the creation of a world-class institute in Texas, newly appointed Oversight Committee Chair Jimmy Mansour moved the board forward with several broad initiatives.
Creating an Agency
Mr. Mansour crisscrossed the state and the country on fact-finding missions during the summer and fall of 2008. He visited federal officials, the heads of major academic health and research institutions, and leading cancer organizations, as well as many preeminent cancer researchers, seeking input and listening to warnings about potential pitfalls.
Through these fact-finding meetings, several important principles emerged for CPRIT. The institute would rely upon the best science to drive the decisions about Texas' investment in cancer research and prevention programs. This means that the CPRIT selection process needed to be a strong peer review system free of regionalism, favoritism, and conflicts of interest. CPRIT's activities must be impactful. If CPRIT is to succeed, it should demonstrate that Texas is willing to devote its resources to innovative and groundbreaking research and not just serve as an extension of the current federal research funding.
Beginning in 2008, Mr. Mansour, with the ongoing support of oncologist and Vice Chair Joseph Bailes, MD, convened a series of "kitchen cabinet" meetings with other Oversight Committee members and interested stakeholders. Their goal was to prepare for the upcoming 2009 legislative session. The principles that emerged during Mr. Mansour's fact-finding missions were translated into legislative priorities fundamental to CPRIT's success: a strong outside peer review process that relies upon nationally-renowned scientists, unambiguous conflict-of-interest provisions, a strong management team for the agency, and a commitment to high-impact translational research.
I was honored to join CPRIT in March 2009 as its executive director after serving as the chief operating officer for the Centers for Disease Control and Prevention. I immediately began recruiting a well-known and respected group of experts for the institute's leadership team. I was incredibly lucky that my first hire was Alfred Gilman, MD, a Nobel Prize-winning scientist and the former executive vice president for academic affairs and provost of The University of Texas Southwestern Medical Center. Dr. Gilman agreed to serve as CPRIT's chief scientific officer, spearheading the largest division of CPRIT, our research effort.
Soon after he came on board, I was able to convince Rebecca Garcia, MD, former vice president of health sciences for Susan G. Komen for the Cure, to join CPRIT as the chief prevention officer. The institute is able to dedicate up to 10 percent of its funding specifically to evidence-based prevention services such as screening.
To carry out CPRIT's mission, we must be able to move lifesaving discoveries from laboratories to patients as quickly as possible. This requires a commitment to commercialization activities. I was able to fill that need with the recruitment of Jerry Cobbs as the chief commercialization officer. He came to CPRIT with more than 25 years of capital markets experience, including serving as a senior executive for health sciences and biotechnology industries.
The Important Work Begins
CPRIT's new team quickly set about its work of finding and funding the most creative, innovative cancer research and prevention programs in Texas. Impact - the potential to save lives and influence science - would be the single most important criterion for CPRIT funding. Will the proposal, if successful, change the way other scientists think about and conduct their own research? Will it change the way physicians evaluate and treat their patients? Does it propose new and better ways to offer cancer prevention services that reach more Texans? Will the proposal ultimately decrease the burden of cancer in the state?
To encourage innovation and impact, the institute created several types of grants. Research awards would span the spectrum from basic science to translational research and clinical applications and would vary in amount and duration from the relatively modest short-term projects targeting early-stage ideas to the complex, multiyear research programs at laboratories and research facilities throughout the state. Similarly, several different cancer prevention awards would target unique projects and new partnerships, especially those employing novel methods to increase services provided, to increase early detection of cancer, and ultimately to increase survival rates.
Fair and Impartial Review
As a new state agency and a learning organization, CPRIT was guided by the best practices of other state agencies and national organizations that award grants for cancer research and prevention programs, such as the National Cancer Institute (NCI), the American Cancer Society, the Lance Armstrong Foundation, and Susan G. Komen for the Cure.
CPRIT followed the lead of these organizations to establish an impartial scientific peer review process through which all research and prevention grant proposals are thoroughly reviewed and scored. Scientific peer review provides an objective evaluation of the proposed hypothesis, methodology to prove the hypothesis, and prospective findings. CPRIT awards money only to organizations located in Texas and as a consequence recruited more than 150 experts in cancer research, cancer prevention, or bioscience commercialization who live and work outside the state to participate on the peer review panels. (Four members of the Commercialization Review Council reside in Texas and were selected for their knowledge of the state's life sciences business community.) Using nonresident reviewers helped reduce potential conflicts of interest between the reviewers and the proposals under review.
The institute's peer review process is overseen by research, prevention, and commercialization review councils. The councils assess the evaluations completed by the committees conducting peer review and submit a final list of funding recommendations to the institute's executive director. Texas law affords great weight to the review council's funding recommendations, requiring the executive director's final award recommendations to be based substantially on the list submitted by the review council. The executive director's list of awards is considered final, and the Oversight Committee may set aside the funding recommendations only if eight of the 11 members vote to do so.
Focus on Commercialization
Because groundbreaking research is most valuable when it can be translated into products that are available to Texans, it was decided that a crucial component of the institute's mission must be to create and support the life science infrastructure in Texas that accelerates the movement of new cancer drugs, diagnostics, and therapies from the laboratory to the patient. The institute's ability to promote commercialization pathways distinguishes it from more traditional cancer research funding sources.
Any research proposals submitted by companies for institute awards require an additional diligence review to determine whether there is a commercial path for the prospective discovery. The commercialization review ensures that CPRIT is investing in research with the highest probability of reaching and benefiting people.
By engaging the business community in these efforts, Texas will see a return on its invested research dollars, while also enhancing opportunities for breakthrough cancer-related technologies. Commercializing cancer research benefits Texans in a variety of ways, including the introduction of new products; the creation of new, highly skilled jobs; increased economic activity; enhanced state revenues; and reduced health care costs and lost productivity.
Establishing a Legacy of Talent
Consistent with its mission to augment the state's cancer research superiority, CPRIT created an ambitious program to attract top talent to Texas in both the academic and private industry sectors. The CPRIT Scholar in Cancer Research program recruits exceptional researchers to Texas universities and cancer research institutions. The individuals recruited through the CPRIT scholar program are the best in their field, and their presence in Texas will attract other scientists and industry members eager to collaborate with scientists working on the cutting edge of cancer research. The seven CPRIT scholars successfully recruited to Texas the first year are expected to attract an additional $15 million in extramural funding each year throughout their careers in Texas.
Similarly, the institute created a program to recruit industry partners with a proven record of commercialization in the field of cancer. The goal of this program is to encourage the creation of new Texas-based companies and to persuade out-of-state companies to relocate here. By targeting exceptionally qualified companies, the institute advances both economic development and cancer care efforts in the state. Stimulating the development of a strong bioscience industry in Texas will also increase the number of high-quality jobs statewide.
Finally, the institute also supports the development and training of the next generation of highly qualified cancer biology researchers through its research training grant awards. The training programs at institutions across the state ensure that a diverse pool of exceptionally trained scientists is available to continue the important work in emerging cancer research fields. CPRIT's Research Training awards include a special focus on underrepresented racial and ethnic groups, individuals with disabilities, and individuals from disadvantaged backgrounds.
An Immediate Impact
There is no question that we know how to prevent some cancers (e.g., through smoking prevention and cessation and the human papillomavirus vaccine) and how to reduce the risk of getting others. We also know that early detection, through recommended cancer screenings, will save lives. CPRIT's prevention grants will make it possible for prevention strategies and services to reach many more Texans and ultimately decrease the burden of cancer.
The ability to reduce cancer death rates in the state depends in part on applying some of our current strategies more broadly. There are effective evidence-based strategies available that are not reaching all Texans. Through prevention programs, CPRIT will invest in building the capacity to deliver effective community-based interventions so that new technologies and services are made available to all.
In August 2009, the institute took another important step when it issued its initial requests for grant proposals. All told, the institute issued 16 different requests for grant proposals during its first year - eight for research proposals, five for prevention proposals, and three for company commercialization proposals. With more than 1,100 submissions to the institute from public and private entities, the response was phenomenal.
More than 150 peer reviewers from outside of Texas evaluated the grant proposals, performing 8,500 reviews over a 10-month period. (Each proposal is reviewed by more than one reviewer and may be reviewed more than one time.) The institute announced the grant awards in January, March, and June 2010, funding 155 grants totaling $216 million.
CPRIT's inaugural awards, representing the very best cancer research, commercialization, and prevention projects, set an ambitious course for the state over the next decade. Including recipient matching funds, more than $300 million was dedicated this year to find and fund some of the nation's very best cancer research and prevention programs. (For every research award, CPRIT requires the recipient to certify that its own funds are also dedicated to the cancer research project.) The recipient's matching funds must equal at least one-half of the Institute's grant award and be spent on the same area of cancer research.
The investment Texas is making will advance our knowledge of the causes, prevention, and treatment of cancer, while contributing to the research superiority and economic development of this state.
In addition to the many outstanding individual research and prevention projects, CPRIT was particularly successful this first year in promoting team science and collaborative endeavors, such as the development of a statewide clinical trials network. By fostering a noncompetitive, team science that brings together multidisciplinary approaches (prevention, basic biology, clinical science, statistics, bioinformatics, computer science, imaging, and others), CPRIT was responsible for the creation of several programs with extraordinary potential.
Innovations in Cancer Research and Prevention Conference
Although its primary purpose is to award money for cancer research and prevention, CPRIT will continue to be a magnet for attracting the best and brightest minds to the state and providing a forum to share that expertise. To that end, CPRIT is hosting the inaugural Innovations in Cancer Research and Prevention Conference on Nov. 17-19, 2010, in Austin. The hope is that this conference will offer the first of many opportunities for colleagues and scientists from all over the country to gather and share the latest in cancer research and prevention.
Program cochairs Ray DuBois, MD, of The University of Texas M.D. Anderson Cancer Center, and Amelie Ramirez, MD, of The University of Texas Health Science Center at San Antonio, have assembled an all-star lineup to present their ideas at this inaugural event. Phil Sharp, MD, Nobel Prize winner and professor at the Koch Cancer Institute at MIT, will be a keynote speaker, along with other well-known cancer researchers. The concluding session of the conference on Friday, Nov. 19, will allow representatives of organizations interested in receiving CPRIT grants to learn directly from those involved in the decision-making process how they may be successful with their grant requests.
Cancer is an epidemic that is draining this state of its resources, to say nothing of the toll it is taking on our friends and neighbors. And yet the opportunity for improving cancer care has never been greater because of rapid progress in biomedical research, especially advances that permit detailed definition of the genetic basis of different types of cancer. We have the ability to impact the lives of Texans today through proven cancer prevention programs and services. Investing in cancer research and prevention efforts isn't a luxury, it is a necessity. Now is not the time for incremental progress. We should not be content with marginal improvements. Now is the right time, the best time for innovation that will lead to dramatic leaps forward and many more lives saved.
*For every research award, CPRIT requires the recipient to certify that its own funds are also dedicated to the cancer research project. The recipient's matching funds must equal at least one-half of the Institute's grant award and be spent on the same area of cancer research.
William Gimson is the executive director of the Cancer Prevention and Research Institute of Texas.
CPRIT Oversight Committee
James M. Mansour, Chair
Joseph S. Bailes, MD, Vice Chair
Cindy Brinker Simmons, Secretary
Charles W. Tate, Executive Committee member
State District Judge Faith Johnson
Attorney General Greg Abbott
State Comptroller Susan Combs
Dee J. Kelly*
Malcolm Gillis, PhD, MA, BA*
U.S. Ambassador (Ret.) Jeanne Phillips*
Scott C. Sanders*
*Former Oversight Committee member and CPRIT ambassador.
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