To the Editor:

Re “Faltering Cancer Trials” (editorial, April 25):

It is clear that the National Cancer Institute’s clinical cancer research program is in urgent need of repair. The institute and the cooperative research groups it finances are taking action to address costly inefficiencies and burdensome regulations, but they cannot do it alone. Equally important is the need to reverse the systematic underfinancing of the program.

Virtually every important scientific advance in cancer prevention, treatment and quality of life in the last half-century has come from the N.C.I.’s cooperative group program. Yet the program receives less than 5 percent of N.C.I.’s budget. Adjusted for inflation, it actually receives less financing than it did a decade ago.

A recent survey by our organization found that because of inadequate financing, one-third of research centers plan to limit their participation in these trials. And 40 percent of those centers plan to increase their participation in better-financed industry trials, which may be less likely to examine the big, important questions in cancer research.

We support rapid implementation of the Institute of Medicine’s recent recommendations to improve the system and urge the N.C.I. to double financing for the cooperative group program within five years. This will require not only an internal reallocation of resources within the N.C.I., but also an infusion of new dollars to support the program.

Fixing the crown jewel of the nation’s cancer research system is essential to ensuring continued progress against cancer.

Douglas W. Blayney
Allen S. Lichter
Alexandria, Va., April 27, 2010

The writers, both doctors, are president and chief executive, respectively, of the American Society of Clinical Oncology.

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To the Editor:

Your editorial correctly calls attention to the underfinanced and often unfinished trials of the cooperative groups financed by the National Cancer Institute. But you do not mention that industry-sponsored trials, performed in collaboration with academic health centers, represent a much larger segment of the cancer drug evaluation effort, and are thriving.

The rapid growth of the biotechnology industry has produced more than 800 new drugs for cancer currently in clinical trials, with positive results in melanoma, lung cancer, breast cancer and other tumors. The N.C.I.-sponsored trials, while important in refining the use of new and established cancer drugs, are no longer the dominant vehicle for cancer drug development.

The point remains that N.C.I. should make maximal use of the cooperative group program, but it is no longer the exclusive route to drug development.

Bruce Chabner
Boston, April 27, 2010

The writer, a doctor, is director of clinical research at the Massachusetts General Hospital Cancer Center.

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To the Editor:

As a clinical investigator for more than 20 years, I have personally experienced the successes and frustrations associated with the publicly financed clinical trials system.

It is well recognized that clinical trials are critical to improving cancer care. But an important point not mentioned in your editorial is that cancer patient participation in clinical trials is abysmally low. In fact, only a small percentage of all adult cancer patients takes part in clinical trials. This low participation rate comes at a time when scientific discoveries and technologies are providing the opportunity to test an unprecedented number of promising new treatments.

There are many reasons for this low participation rate. As you note, operational inefficiencies in the nation’s clinical trials infrastructure and inadequate financial support for clinical investigation are certainly partly to blame. But as a society we have done a poor job emphasizing the importance of clinical research as an integral component of high-quality cancer care.

Taking part in a clinical trial offers the opportunity to advance cancer treatment, while gaining access to the latest innovations under the careful watch of an infrastructure designed to ensure patient safety. It is time that we take note of the marketing skills that have contributed to the adoption of so many unhealthy behaviors (smoking, fast food), and apply them to a more healthful goal: widespread recognition that cancer clinical trials represent the best treatments we have to offer.

Neal J. Meropol
Cleveland, April 27, 2010

The writer is chief, Division of Hematology and Oncology, University Hospitals Ireland Cancer Center at Case Western Reserve University.

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To the Editor:

Research financed by the National Cancer Institute continues to fail because it is locked into one fruitless approach: detailed study of the tumor process that afflicts patients with cancer. This ignores a critical area.

The immune system is our most powerful protection against cancer. Without its ability to handle carcinogenic cells, mankind would not be around today. Yet research on how to strengthen deficient immune responses is seldom reported — and medications that safely strengthen immunity do exist.

Consider this hypothetical: In a city police department, all members are given total protection using special bulletproof vests, yet each year several police officers die of bullet wounds anyway. Why should the police research the steps involved in how one dies of a bullet wound? Wouldn’t it be more productive to examine the bulletproof vests and learn how to correct the deficient ones?

David Gluck
New York, April 26, 2010

The writer, a retired internist, maintains a Web site that calls attention to the medical importance of existing generic medication that strengthens immunity.