Advocacy of Special Funding Initiatives for Kidney Cancer Research

ACKC has been advocating for increased funding for kidney cancer research since 2004, initially by seeking a congressional appropriation for kidney cancer research within the Department of Defense’s CDMRP initiative. This effort has enabled the DoD to award over $9 million in grants to kidney cancer researchers since FY2006.

Department of Defense Funding

Kidney cancer has been included in the Defense Health Program, Congressionally Directed Medical Research Program (CDMRP), peer reviewed cancer program along with ten other cancer groups. Research grants are awarded after vying against these other group applicants. Just recently, the House Appropriations Committee approved a $10 million line item within the Defense Health Program. Read more here:

House Appropriations Committee Approves $10M for Kidney Cancer Research

National Cancer Institute Funding

Recently, we joined with AACR (American Assocication for Cancer Research) and OVAC (One Voice Against Cancer) in Washington, DC to advocate for increased NIH funding for cancer research. ACKC supported the $264 million in the NCI budget in FY 16 as well as the $2 billion increase in funding passed in the Omnibus Budget agreement in December, 2015.

Further, ACKC was able to obtain specific language in the Omnibus bill regarding the need for additional kidney cancer funding:

The agreement encourages support of meritorious scientific research on kidney cancer, specifically early detection of the disease. The agreement encourages to NCI to support a Specialized Program of Research Excellence in kidney cancer and other research programs for subtypes of kidney cancer, such as papillary and chromophobe. NCI should provide an update on these efforts in the fiscal year 2017 budget request.

ACKC Action Pays Off in Congress Budget Deal

Specialized Programs of Research Excellence

ACKC recently met with staff of the NCI Translational Research Program in Bethesda, MD. ACKC conveyed its support and advocacy positions regarding funding the NIH/NCI and the Specialized Programs of Research Excellence (SPORE). ACKC supports awarding two new kidney cancer SPOREs.

View all SPOREs currently awarded, by state and research facility.

Recently, ACKC has been working with Congressional offices in support of a recent SPORE kidney cancer grant application submitted by Dr. James Brugarolas and his team at the University of Texas Southwestern. ACKC submitted its own support letter. DirTHechtltr 1.5.16  Working with Texas Congressional offices, we were able to assist with this Congressional outreach. UTSW SPORE NCI Brugarolas Ltr Final

The SPORE program has contributed enormously to the study and treatment of kidney cancer for over a decade. The sole kidney cancer SPORE program, which is resident at Dana Farber/Harvard Cancer Center, has been in existence since 2003 (with a break in funding in 2014), and has made significant progress in the basic and translational science of kidney cancer, which has resulted in clinical progress against the disease.

Nonetheless, we are concerned that there exists only one kidney cancer SPORE, and, more generally, that overall funding for the SPORE program has been cut by over 20% in the last five years, which is not reflective of the NCI budget as a whole over this period.

Many of the anti-angiogenic therapies, e.g., bevacizumab and sunitinib, which were considered to be “wonder” drugs just a few years ago, were developed initially to treat kidney cancer due to its highly vascular nature. These same drugs were then tested and went on to help patients of other cancers. However, the best of these drugs, sunitinib — the front-line treatment for metastatic kidney cancer — has been shown to increase median overall survival by only 14 months over the then standard treatment, interferon-alpha, when it was approved by the FDA nearly 11 years ago. We hope that nivolumab (anti-PD-1), the first FDA-approved checkpoint inhibitor therapy for kidney cancer, and cabozantinib (anti-c-Met/VEGFR2) will provide more durable results in more patients, but clearly there remains a need for breakthrough therapies that can only be developed via significant advances in our understanding of the biology of the disease. We believe that the SPORE program through its collaboration with outside researchers, its single-minded focus on tackling the major unresolved questions about the disease, and its adequate, long-term funding is the best way to deliver that promise. We believe that establishing two additional kidney cancer SPORE programs would significantly increase the opportunities for effective collaboration with other researchers. Meaningful breakthroughs in kidney cancer can be best accomplished through multidisciplinary and inter-institutional collaboration, and that kind of collaboration is best fostered through multiple kidney cancer SPOREs.

One of the major side benefits of the kidney cancer SPORE has been to introduce young investigators to the field and keep them working in kidney cancer as they move on to other institutions. For example, Dr. Eric Jonasch, who was a young investigator working at the Boston SPORE, now directs the kidney cancer program at MD Anderson Cancer Center. Dr. Daniel George, who also did his early work on kidney cancer at the Boston SPORE, is now the director of the genitourinary program at Duke University. Despite these successful examples, it is an unfortunate reality that many promising up-and-coming researchers leave kidney cancer research to pursue other avenues of research where both government and private foundation funding is more plentiful.

These awards would energize both young investigators and experienced researchers to stay in the field, and more importantly create the opportunities for productive collaboration among researchers in three kidney cancer SPOREs that are critical for breakthrough achievements in the treatment of kidney cancer.

SPORE Results

  • SPORE researchers identified c-Met as a potential mechanism by which kidney cancers acquire resistance to VEGF inhibitors. This breakthrough led researchers to study several Met inhibitors, and to their eventual focus on the drug that became cabozantinib. Critically, the work of the kidney cancer SPORE program led to a Phase I trial which showed activity in kidney cancer patients. As such, this work provided important proof-of-concept data to convince the developer (Exelixis) and kidney cancer clinicians to initiate a Phase III trial (METEOR), which very recently demonstrated that cabozantinib nearly doubled progression-free survival compared with standard everolimus therapy in patients with metastatic kidney cancer.
  • The SPORE group identified PD-1 as an early target for kidney cancer immunotherapy, developing antibody-based approaches to inhibit it long before PD-1 became a hot target in oncology. While the clinical successes for kidney cancer in this area have been accomplished in conjunction with industry, the SPORE group helped to establish a focus for development of anti-PD-1 immunotherapy in kidney cancer, which might otherwise not have happened. Ultimately, these efforts have led to multiple clinical trials of checkpoint inhibitors in kidney cancer, either as monotherapy, in combination with VEGF inhibitors, or through dual checkpoint inhibition.
  • SPORE researchers identified HIF-2 alpha as a major oncogenic driver in VHL null kidney cancer. Despite its important role in this disease, as a transcription factor HIF2-alpha has long been considered ‘undruggable’ by the pharmaceutical industry. Hence, the SPORE group focused on identifying and characterizing small molecule inhibitors of HIF-2 alpha. Promisingly, in collaboration with Peloton Therapeutics, Inc., the researchers are now testing a potent HIF2-alpha inhibitor (PT2385) – the only such drug available for clinical testing at this time. The potent anti-tumor effects of this compound in pre-clinical studies provides hope that the findings of the kidney cancer SPORE can ultimately be translated into HIF2-alpha inhibitors for testing in clinical trials for kidney cancer patients. Again, this is another clear case in which the kidney cancer SPORE has fostered interest from industry in developing drugs and clinical trials for this disease.

Following are the SPOREs currently awarded, by state and research facility.

State Research Facility # of
SPOREs
SPORE Organ Site(s)
Alabama University of Alabama at Birmingham 1 Pancreatic
Arizona Mayo Clinic 1 Myeloma
California Beckman Research Institute of City of Hope 1 Lymphoma
University of California, Los Angeles 1 Prostate
University of California, San Francisco 1 Brain
Colorado University of Colorado Cancer Center 1 Lung
Connecticut Yale University 2 Lung, Skin
Florida H. Lee Moffitt Cancer Center and Research Institute 1 Skin
Illinois Northwestern University 1 Prostate
Indiana Indiana University 1 Hyperactive RAS
Iowa University of Iowa 1 Lymphoma
University of Iowa/Mayo Clinic 1 Neuroendrocrine Tumors
Massachusetts Dana-Farber Harvard Cancer Institute 5 Breast, GI, Kidney, Myeloma, Prostate
Massachusetts General Hospital 1 Brain
Maryland John Hopkins University 4 Cervical, GI, Head & Neck, Prostate
Michigan University of Michigan 3 GI, Head & Neck, Prostate
Sarcoma Alliance for Research through Collaboration 1 Sarcoma
Minnesota Mayo Clinic, Rochester 4 Brain, Breast, Ovarian, Pancreatic
Missouri Washington University in St. Louis 1 Leukemia
Nebraska University of Nebraska Medical Center 1 Pancreatic
New York Memorial Sloan-Kettering Cancer Center 3 Prostate, Sarcoma, Thyroid
Roswell Park Cancer Institute 1 Ovarian
North Carolina Duke University 1 Brain
University of North Carolina at Chapel Hill 1 Breast
Ohio Case Western Reserve University 1 GI
Ohio State University 1 Thyroid
Pennsylvania University of Pittsburgh 3 Head & Neck, Lung, Skin
Wistar Institute 1 Skin
Tennessee Vanderbuilt University 2 Breast, GI
Texas Baylor College of Medicine 2 Breast, Lymphoma
University of Texas/MD Anderson 8 Bladder, Brain, Endometrial, Leukemia, Myeloma, Ovarian, Prostate, Skin
University of Texas/Southwestern Medical Center 1 Kidney, Lung
Washington Fred Hutchinson Cancer Research Center 3 Breast, Ovarian, Prostate
22 States 33 Research Facilities 62 Total SPOREs 2 Kidney Cancer
SPOREs