We are aware that in the last several weeks there has been a flurry of activity surrounding the ongoing changes and realignment of government funding after the change of administration.

Recognizing that changes will continue to occur, we realize that the path forward will remain murky until many of the challenging issues are settled via the courts.

During this time of uncertainty, NRG Oncology wants first to acknowledge that all of our research functions are currently continuing uninterrupted and that patient safety continues to be monitored despite the Facilities and Administrative overhead that has fallen below 15%. Our research and patients remain at the forefront of our mission, always.

We would also like to take this opportunity to highlight the impact that NCTN cooperative group research has made in the fight against cancer and clear up some misconceptions about the groups’ collaboration with the NCI. Amid the talk of budget slashing and cost-cutting, we fully understand that our research could be impacted and believe it is crucial to share our perspective on clinical research and our many pathways towards improving the lives of those affected by cancer.

• Who is the NCI and what do they do? The National Cancer Institute (NCI) is a part of the National Institutes of Health (NIH). NCI is the federal government’s principal agency for cancer research and training. Although the NCI is a different entity from our NCTN groups, which will be discussed in the next section, the NCI supplies a budget to the NCTN groups to conduct their research in cancer care. Outside of funding, the NCI also provides incentives to help the NCTN keep research costs low for our Cancer Centers. The NCI provides Cancer Centers with standardized trial implementation including uniform databases, quality assurance, auditing, resources for the facilitation of research and any issues that arise, as well as a central investigational review board to ensure our information is clear and concise for our patients. They implement the technological advances that our groups use to conduct our research and help us to provide the necessary training to the future leaders in the oncology field.

• Who are the NCTN groups? The NCTN is a network of six individual, independent research groups focused on cancer outcomes. These groups are legally separate entities from the NCI and the NIH. The groups within this network receive a federal funding budget of $100 million across the six groups. For the many social media posts we have seen suggesting that pharma could provide the same level of research, note that a single pharmaceutical company registration study would cost approximately the same as this $100 million budget that is spanned across these six groups for currently over thousands of active clinical studies. However, this funding does not stop at clinical trials alone. Our NCTN groups’ correlative science program analyzes the biology of specific tumors. This biology informs us of new or different potential treatments and how they could impact specific patients. This type of translational science allows us to get closer to personalized care where we can assess solutions that would not only improve our individual patients’ outcomes and minimize future recurrences, but also alleviate any potential burden of side effects from treatment or long-term impacts of their disease.

• What impact does the NCTN have towards improving cancer outcomes? The definitions above only provide a simple snapshot of the full footprint that the NCI and the NCTN groups provide to the whole picture. We can take a look from the NRG Oncology portfolio at some of the major impacts in cancer care advancement that could have only occurred with the funding we received. The NRG-GY018 phase III trial, for instance, discovered that adding the immunotherapy drug pembrolizumab to standard chemotherapy would significantly lengthen progression-free survival for patients with advanced endometrial cancer. Another trial, OlympiA trial (NRG-NSABP B-55), reduced the risk of death by 32% for patients with high-risk breast cancer who have germline BRCA mutations by adding olaparib as an adjuvant treatment to local treatment and adjuvant chemotherapy. These are only two of NRG’s numerous trials that have challenged and changed current standards of practice. The NRG has taken major strides in improving cancer care, especially in sex-specific malignancies such as breast, gynecologic, and prostate cancers. Even deeper than just our first-hand experience with NRG Oncology’s research, our cooperative group as a whole has undoubtedly been at the helm of the accelerated level of advancements we have seen in cancer care over the last several decades. A Journal of Clinical Oncology article authored from the NCTN cooperative group SWOG in 2023 noted that, in the last 50 years since the NCTN’s inception: “Randomized trials conducted by NCTN groups have contributed substantial gains in life-years for patients with cancer, and the studies have had a marked impact on cancer treatment guidelines and the scientific literature. Collectively, these findings demonstrate how publicly funded oncology research plays a vital role in informing clinical practice and extending the lives of patients with cancer.”. Read the JCO manuscript.

• Why is this so important? There is no question that without the funding we receive from NCI, we would not be able to continue our quest to improve the lives of cancer patients. Cuts to this funding would directly impact the quality and timeliness of our research.

For our policymakers, it is imperative that you understand the deep roots that the efforts of this cooperative network have in strengthening and flourishing local economies. Peter O’Dwyer, MD, and Mitchell Schnall, MD, PhD, Group Co-Chairs of the NCTN group ECOG-ACRIN, noted in a message to the research community:

“Policymakers in this fragmented environment need to know about the contributions of our research to local economies. A guide to this is provided by NIH: in fiscal year 2023, every $1 of NIH funding generated approximately $2.46 of economic activity. The multiplier is well-recognized and is a reason that institutions large and small broadcast their links with one or another Cooperative Group. Policymakers need to know too that our work has a patient-centered focus. We rely on patients and advocates to help set research priorities, and we are committed to following their recommendations on reducing the side effects of treatment in specific trials”.

To our partners in Cancer Centers – we need you. Your support in vocalizing the need for the collaboration between centers and the NCTN helps highlight the significance of the symbiotic nature of this relationship.

An additional note from the ECOG-ACRIN messaged stated, “Cancer Centers contribute to the Cooperative Group research programs by taking on trials at less than what it costs to do them. But in return, the Groups populate the portfolios with trials too large for any one Center to take on; they provide an inexpensive path to multi-institutional studies of cancer center research; they provide national exposure for early-career faculty; they provide the path to the faculty becoming key opinion leaders nationally; and they provide discipline-specific education and review of ideas, making the faculty more likely to succeed”.

We will strive to open up the discussions surrounding the value and importance of the continued funding of clinical research. We need to look to the key leaders of our field to help build momentum behind who we are and what our mission and goals are in this crucial and unprecedented time. The only way we can continue to make these leaps in our understanding of this disease and hope to one day move towards a cure, is to study what makes it work and tackle the many ways this disease can adapt in our bodies. The research of this network is necessary and irreplaceable in this common goal.