Transcript Talk Title - University of Florida College of Pharmacy

Finding the Lethal Phenotype:
Research Partnership Needs
Timothy R. Rebbeck
Increases in Anti-Malaria Spending…
= Reductions in Malaria Deaths…
1,000,000
900,000
Deaths in Africa
800,000
700,000
600,000
500,000
400,000
2000
2010
2020
Year
Malaria (World Malaria Report 2010)
2030
…While Cancer Deaths Increase
1,000,000
900,000
Deaths in Africa
800,000
700,000
600,000
500,000
400,000
2000
2010
2020
Year
Malaria (World Malaria Report 2010)
Cancer (GLOBOCAN 2008)
2030
Increasingly Elderly Population
in the Developing World
2000
2050
More
Developed
Countries
Less
Developed
Countries
World Cancer Report 2008
Changes in Lifestyle and Exposures
(Concomitant Increase in Specific Cancers)
Prevalence of BMI>25 (Men)
2002
2010
WHO Global Infobase 2011
Number of People Served by Each Radiotherapy Center
Sources: International Atomic Energy Agency, Directory of Radiotherapy Centers, http://www-nawebiaea.org/nuhu/dirac/, Population Division of
the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision, and
http://esa.un.org/unpp. Jemal et al. 2011
Percent of Population Covered by Cancer Registries
(Number of Registries / Number of Countries Reporting)
32.5%
(100/29)
83.0%
(54/2)
4.0%
(44/15)
1.1%
(5/5)
5.5%
(11/7)
80.5%
(11/2)
IARC-Compliant Tumor Registries (2010):
Algeria, Egypt, Tunisia, Uganda, Zimbabwe
Age Standardized Estimates (ASE) of Incidence and Mortality for
Five Leading Cancers in Men of African Descent by Geography
Incidence*
Location
Africa
Caribbean
US
(African
American)
Mortality*
Cancer
Number of
Deaths
ASE**
CaP Mortality:
Incidence
Rate Ratio
17.5
Prostate
28,006
12.5
0.71
34,612
11.7
Liver
33,826
11.7
Lung
20,821
8.4
Lung
19,429
7.9
Colorectal
19,049
6.9
Esophagus
16,678
6.5
Bladder
16,938
6.7
Colorectal
14,707
5.5
Prostate
15,950
71.1
Prostate
6,543
26.3
Lung
5,555
25.7
Lung
5,157
23.6
Colorectal
3,186
14.4
Colorectal
2,010
8.8
Stomach
2,418
11.2
Stomach
1,769
8.0
Larynx
1,469
7.1
Liver
1,304
6.1
Prostate
30,068
159.6
Lung
9,834
51.9
Lung
11,712
60.4
Prostate
4,908
23.9
Colorectal
8,298
42.0
Colorectal
3,422
17.5
Kidney
3,600
18.2
Pancreas
1,893
9.8
Bladder
2,415
12.2
Liver
1,592
8.2
Cancer
Number of
Cases
ASE**
Prostate
39,460
Liver
0.41
0.15
*African and Caribbean incidence and mortality estimates from GLOBOCAN 2008 and include men of all races. US
incidence rates from SEER-17 for the year 2008, estimated numbers of cases for the total US based on the SEER-17
rates, and US mortality data for the entire country for the year 2007; all include only African American men.
** ASE: Age-standardized Estimates per 100,000 population adjusted to the 1960 world population.
Prostate Cancer Deaths*
(Globocan 2008)
Year
US
Africa
2010
28,660
28,006
2030
53,651
57,048
% Increase
87%
104%
*All Races/Ethnicities
What is needed to
develop research
capacity in Africa?
Opportunities/Questions
Logistical Goals:
Develop Centers of Research Excellence
Identify research partners
Research exchanges
Research resources: registry, biosample, laboratory, population,
database, administrative
Funding opportunities
Scientific Goals:
 What are the leading cancer problems that require research?
 What are research opportunities unique to Africa?
 Basic research
 Population and behavioral research
 Clinical Research
Needs
 Capacity building: research and training relevant to
local conditions and culture
 Provide common resources to achieve economies of
scale: regional centers of excellence?
 Develop joint (collaborative, multicenter) projects – not
“sample providers”
 Advocacy (explaining why research is important):
 Community engagement
 Media and governments
 Academic/medical engagement: respect and
understanding of research
Critical Components
 Dedicated Influential Local PI:
Maintain support of superiors
Willingness to promote junior researchers
 Environment that fosters PIs:
Research track
Dedicated research time vs. clinic load
Academic (not just scientific) training
 Research Focus:
Achievable goals
Realistic timeline
 Mentorship:
Scientific and academic
Regular communication with bidirectional visits
Challenges
 Resource Limitations:
 Limited tumor registration
 No central investment in cancer research
 Limited research infrastructure in cancer (IRB,
protocols, study staff, administration)
 Limited funding mechanisms
 Academic Issues:
 Lack of protected time for investigators
 No academic tracks
 Limited culture of research
 The “vacation myth”
 Lack of research training
 Education: Limited understanding about the
importance of cancer in the population
Men of African Descent and Carcinoma of
the Prostate (MADCaP) - Africa
 Establish Centers to:
 Create knowledge about cancer in Africa.
 Translate this knowledge to improved prevention,
detection, and treatment of cancer in Africa.
 These Centers will:
 Offer high quality facilities for training, research and
advocacy.
 Help to implement national cancer plans.
 Reduce dependence on foreign institutions for training
and service and minimize brain drain.
Key Components and Leverage Points
Advisory Board:






Afrox Representative
AORTIC representatives:
 At Large
 President
 President-Elect
 Executive Director
ASCP Representative
IAEA Representative
IARC Representative
UICC Representative
Dakar Cancer Consortium,
Dakar, Senegal
Univ. of Ibadan,
Nigeria
Academic Partnerships:









Albert Einstein, New York
(Ibadan)
Fred Hutchinson Center, Seattle
(Uganda)
Harvard University (Botswana)
Moffitt Cancer Center, Tampa
(South Africa)
NCI, Bethesda (Ghana)
University of Chicago (Nigeria,
Uganda)
University of Pennsylvania,
Philadelphia (Botswana, Senegal)
University of Pittsburgh (Nigeria)
University of Southern California,
Los Angeles (Uganda)
Korle-Bu Hospital,
37 Military Hospital,
University of Accra,
Ghana
Mulago Hospital,
Makerere University,
Kampala, Uganda
University of Botswana,
Gaborone, Botswana
Tygerberg Hospital,
Stellenbosch University,
Cape Town, South Africa
Network Partnerships:
 Prostate Cancer
Transatlantic
Consortium (CaPTC)
 African Caribbean
Cancer Consortium
(AC3)




National Health
Laboratory Service,
Johannesburg, South Africa
NGO Partnerships:
Afrox, Oxford
ASCP, Washington
IAEA, Vienna
IARC, Lyon
Dakar Cancer Consortium:
A Public-Private Partnership
Private Lab
Public Hospital
University
Foundation
Hôpital Général de Grand Yoff
Centre de Diagnostic et de Recherche en
Medicine Moleculaire
Université Cheikh Anta Diop
Bio24
Institut de Formation et de Recherche
en Urologie
Hôpital Aristide le Dantec
Institut Pasteur
Clinical Data Accrual
Laboratory Research
Biobank
Developmental Process
Development
Implementation
African Centers: Accra,
Benin City, Dakar, Kampala,
Stellenbosch, Others
AORTIC
Strategic
Planning
Meeting,
Dakar
AORTIC
Strategic
Planning
Report
Distance Learning:
Pathology:
Project Management:
Registries:
12/2010
Identify
Potential
Centers
and
Partners
IAEA-VUCC
ASCP
Afrox
IARC
Steering
Committee,
External Advisory
Board
Establish
ACES
Structure
and
Processes
Evaluation
Success
Metrics
Report to
AORTIC
Council &
Board
Common
Protocols
12/2011
Site Visits and
Implementation
Evaluation
Extramural
Funding
12/2012+
Acknowledgements
PHS Grants R01-CA085074 and P50-CA105641,
AACR Landon Foundation Award, US State Department Fulbright Program
Accra, Ghana
Benin City, Nigeria
Bethesda, USA
Cape Town, RSA
Dakar, Senegal
Ibadan, Nigeria
Johannesburg, RSA
New York, USA
Kampala, Uganda
Los Angeles, USA
Philadelphia, USA
Sunny Mante
Edward Yeboah
Michael Okobia
Ann Hsing
Pedro Fernandez
Chris Heyns
Serigne Gueye
Mohamed Jalloh
A. Olupelumi Adebiyi
M.C. Asuzu
Oluwafemi Popoola
Chantal Babb
Margaret Urban
Ilir Agalliu
Thomas Rohan
David W. Lounsbury
Stephen Watya
Chris Haiman
Brian Henderson
Baoli Chang
Shannon Lynch
Elaine Spangler
Sarah Tishkoff
Amy Walker
Charnita Zeigler-Johnson
37 Military Hospital
Korle-Bu Hospital
University of Benin
NCI
Stellenbosch University
Stellenbosch University
Hôpital Général de Grand Yoff
Hôpital Général de Grand Yoff
University College Hospital
University College Hospital
University College Hospital
National Health Laboratory
National Health Laboratory
Albert Einstein University
Albert Einstein University
Albert Einstein University
Mulago Hospital, Makerere University
University of Southern California
University of Southern California
University of Pennsylvania
University of Pennsylvania
University of Pennsylvania
University of Pennsylvania
University of Pennsylvania
University of Pennsylvania