Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee

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Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee

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Dr. Yung first describes the The Defeat Glioblastoma Initiative, an inter-institutional collaboration he has established between UCSD, UCLA, Memorial Sloan-Kettering Cancer Center, and MD Anderson to address glioblastoma. He notes that the Initiative is poised to expand and add international collaborators. Dr. Yung next describes his service on the NCI Brain Malignancy Steering Committee, set up in 2001 response to the request from National Institute of Medicine to provide more review of applications for research funds. The aim is to identify high-value concepts, prevent duplication of efforts, and create collaborations. Dr. Yung explains that this committee's role reflects the new reality of team science and limited resources. Dr. Yung then comments on the challenges of creating collaborations between scientists who originally thought they would run projects independently.

Identifier

Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee

Publication Date

7-7-2014

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Service beyond MD Anderson; The Researcher; The Administrator; Contributions; Activities Outside Institution; Understanding Cancer, the History of Science, Cancer Research; Business of Research; Professional Practice; The Professional at Work; Leadership

Transcript

Tacey Ann Rosolowski, PhD:

There were a couple other things I wanted to ask you about, your other roles. Your in --- involvement in the glioblastoma multiform research collaborative. Now I don’t know --- Did --- I’m not sure we already talked about that, you know, the inter-institution organization. Yeah it’s an inter-institution collaboration and data sharing under the auspices of the National Brain Tumor Society.

Wai-Kwan Alfred Yung, MD:

That’s the --- the --- the --- the new project that I’m setting up with National _________ (). You know it’s --- it’s the initiative that we put together with several institutions including MD Anderson, you know, UCSD, ________ (), UCLA, and Memorial-Sloan Kettering. We put the talents of the executive levels which we mentioned earlier about you know putting the talents together with a more concentrated funding and say --- then turn them loose and say now we want you to work on these directions. Develop new drugs, find out why --- why the patient is resistant to the drug, find out --- keep --- find a marker that can divide the patient into a specific group, find out why the --- the --- the tumor escaped control, find out if there is any imaging way of --- if there is any molecular imaging to identify this patient without cutting open the patient. And these kind of --- giving these broad directions for this group of people. Do that and we’re going to give you 20 million dollars or 10 million dollars to do it in the next three to four years. That is the initiative --- the goal of the initiative.

Tacey Ann Rosolowski, PhD:

I see. Wow. So what’s the timeframe for getting this underway do you think?

Wai-Kwan Alfred Yung, MD:

We started the first year. The --- This group has started --- just started working the first year. So the --- next --- the next level is using to expand a national group into international collaborative. So whether we can divide up the topics and divide areas in terms of bringing in collaborators from Germany, from China, from Australia, you know.

Tacey Ann Rosolowski, PhD:

Yeah. Wow. And I read the aim is to double the five year survival rate of glioblastoma patients within five years so that’s a pretty …. Is that --- Is that bold?

Wai-Kwan Alfred Yung, MD:

Well, that’s bold. If you start with 10% and double it to 20% it’s not that bold.

Tacey Ann Rosolowski, PhD:

:0Yeah that’s why I was asking the question.

Wai-Kwan Alfred Yung, MD:

:0No, it’s not that bold. Initially we were going to go from 10% to 40%. That’s pretty bold.

Tacey Ann Rosolowski, PhD:

But you scaled back?

Wai-Kwan Alfred Yung, MD:

We scaled back to more reality or more realistic.

Tacey Ann Rosolowski, PhD:

Right. And it says that this group is relying very heavily on information from the Cancer Genome Atlas as well as immunotherapy approaches.

Wai-Kwan Alfred Yung, MD:

Not really but --- but we learn from them and we --- we use utilize the cancer genome, you know, data as a starting point in terms of characterizing the patient’s tumor as well as you know cell line that get generated from patients tumor but it’s not totally relying on that.

Tacey Ann Rosolowski, PhD:

Interesting. Okay. There’s also your role on the NCI Brain Malignancy Steering Committee. Is that something that’s --- you’d like to comment on?

Wai-Kwan Alfred Yung, MD:

The Brain Malignancy Committee is --- is --- is a new organization feature of the NCI in response to the request from the Institute of Medicine. The Institute of Medicine asked NCI to reform their clinical trial network and put some more emphasis on collaboration among the network. So one way to do that is that they formed a steering committee on each cancer. So there is a Lung Cancer Steering Committee, Breast Cancer Steering Committee, Ovarian Cancer, and the Brain Malignancy Steering Committee. The – The role of the steering committee is to reviewed proposals, review concepts and research trials with concepts from the big cooperative group when it involves a large number of patients or with even smaller cooperatives that rely on NCI resources. You know they need to be reviewed and was --- we’re hoping that using the brain malignancy committee with a group of people sitting there to --- to look at these concepts who are able to really identify a high value concept versus lower value concept to encourage investment in the high value concept and also to avoid competition from one group or the other group when they are doing a similar concept. They say, “Why don’t you guys work together?” Instead of two similar concepts, one concept and two groups work together.

Tacey Ann Rosolowski, PhD:

So, just because you said that this was a new ….

Wai-Kwan Alfred Yung, MD:

So it’s kind of the committee -- the committee is look at the national trends.

Tacey Ann Rosolowski, PhD:

Hmmm.. National trends. Because I was wondering I mean my question just to put it bluntly was what was wrong with the old system? You know weren’t people doing that before?

Wai-Kwan Alfred Yung, MD:

The --- The --- The old --- Without --- I think the committee plays a role in really looking at the national trend and the other idea is that usually a committee is able to chart national direction and then field it down to the cooperative group.

Tacey Ann Rosolowski, PhD:

So it’s --- So it’s just taking a new perspective. That sort of integrative perspective was missing --- missing before.

Wai-Kwan Alfred Yung, MD:

It’s a new perspective, yeah.

Tacey Ann Rosolowski, PhD:

Interesting. Now does that reflect kind of a new reality of what science is and doing --- doing biomedical research at this point?

Wai-Kwan Alfred Yung, MD:

I think so. I think there is a new reality of bigger science, better team science, and you need better coordination when the resources is scarce. Especially you know because you have a fixed pot of money, now you have to do more work. How do you make --- use that money efficiently instead of you know allowing a lot of duplication. Because in the old system there’s a lot of duplication. Even though it’s --- it’s competition but a lot of competition is self-centered competition and you --- you do a lot of duplication and a lot of wasting for a small thing.

Tacey Ann Rosolowski, PhD:

: Oh I see what you mean by self-centered competition. It’s like, well, I want to be the one to do it.

Wai-Kwan Alfred Yung, MD:

“I want to be the one to do it. I don’t want to work with you.” Or “I think my idea is good.” Even though it’s really trash. You know, this --- the third person looks in and say,s “This is trash, don’t do it.”

Tacey Ann Rosolowski, PhD:

Interesting. I was thinking too about you know the --- an issue that’s come up in several conversations I’ve had about just the sheer volume of information now that people have to handle. Is there something in that as well you know that I mean you need an organization like this to kind of keep track. I mean it’s almost like this committee is --- is monitoring the groups that are producing information.

Wai-Kwan Alfred Yung, MD:

:2Well the steering committee doesn’t really --- cannot deal with all proliferation of big data. That’s a separate issue. That’s a separate issue. All this big proliferation of data.

Tacey Ann Rosolowski, PhD:

When did you start working with this committee?

Wai-Kwan Alfred Yung, MD:

Well, the committee was formed in 2011. So I was appointed co-chair because the committee covered adult and pediatric. I’m co-chair for adult and Dr. Ian Pollock from Pittsburgh, Neurosurgeon, he is co-chair for pediatric. So basically the two of us started as the committee was formed. It’s a three year term. We’re just --- I’m just going in my second.

Tacey Ann Rosolowski, PhD:

Secondterm. Is there anything that --- Is --- Are there any ways in which serving on this particular committee has, you know, changed your perspective at all or, you know, lessons learned from it? It sounds like a --- kind of a unique experience.

Wai-Kwan Alfred Yung, MD:

Well I mean it gives me a nat --- gives me a chance to look at the national level is --- but on the other hand, it is a new experience in terms of kind of changing the mindset of how big group is working together or whether they can work together.

Tacey Ann Rosolowski, PhD:

That’s the question.

Wai-Kwan Alfred Yung, MD:

It is very difficult. I mean like I said it’s --- it’s a lot of self-interest even in a --- in a government funded group. “Well you fund me to be in charge. So I should be able to tell what science is good. Why --- Why are you creating another group on top of me to tell me I’m not doing the right thing?” Right? So a lot of this kind of thinking is still there. The --- The government funding for a big group or more than four company and then you have this size group. So each disease has many groups working, several cooperative groups and --- and trying to get these groups so each group has a certain amount of resources so now a level of consistency managed with medical school and center working together in this group, the other group work together and there is this competitive spirit. And now you say, “Well guys work together” and one group may say, “Gee why are you saying that my level of science is not good enough?” You have to really get people really able to break down the sides and start looking at the big picture together. It’s --- It’s an interesting process.

Tacey Ann Rosolowski, PhD:

How --- How do you do that? I mean, tell me about that process. How do you work with that?

Wai-Kwan Alfred Yung, MD:

You know we have a lot of meetings together you know and some retreats, but it’s the --- I think it is still too new. It’s only two or --- about a three year process and to change the mindset takes more than two or three years.

Tacey Ann Rosolowski, PhD:

Right. I mean it’s kind of interesting when I was talking to Gabriel Hortobagyi [Oral History Interview] about just putting together the multidisciplinary reviews of cases in breast cancer and I said, “Oh well how long did it take you know before people really accepted that process?” and he said “Well about a decade.” And I thought wow. It’s not easy.

Wai-Kwan Alfred Yung, MD:

It’s not easy. Changing mindset is not easy.

Tacey Ann Rosolowski, PhD:

Not easy at all. Especially you know with big egos. You know big talent, big egos.

Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee

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