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EXPIRED


CHEMOPREVENTION OF TOBACCO-RELATED CANCERS IN FORMER SMOKERS:  CLINICAL 
STUDIES
 
Release Date:  March 28, 2002

RFA:  CA-03-006   
 
National Cancer Institute (NCI)
 (http://www.nci.nih.gov/)

LETTER OF INTENT RECEIPT DATE:  June 21, 2002

APPLICATION RECEIPT DATE:  July 26, 2002

This RFA is a reissue of RFA-CA-02-009, which was published in the NIH Guide 
on 04/20/2001.

THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanism of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements 
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE

The purpose of this initiative is to fund clinical research to develop 
effective chemopreventive strategies that reduce the risk of tobacco-related 
cancers in former smokers.  This initiative will fund pilot clinical trials 
(phase I/II or phase II) evaluating the efficacy of chemopreventive agents in 
specified cohorts of former smokers with or without a prior history of a 
tobacco-related malignancy and translational studies performed on specimens 
(such as tissue, blood, urine, etc.) derived from these clinical trials.

RESEARCH OBJECTIVES

Background 

An efficient way of identifying clinically useful chemopreventive agents is to 
perform short term pilot clinical studies examining the effect of 
interventional agents on molecular, imaging, and histologic endpoints in 
populations at high risk for developing invasive cancer.  These studies serve 
to establish the safety and preliminary efficacy of the interventional 
strategies ("proof of principle") in high risk populations, including 
phenotypically normal cohorts as well as cohorts with 
dysplasia/intraepithelial neoplasia, and are crucial in determining which 
agents/strategies are safe and effective enough for further development in 
phase III clinical trials.  

Since phase III cancer prevention trials require large patient cohorts, major 
resources, and many years to give a definitive answer, it is imperative to 
prioritize promising agents before embarking on such trials.  The purpose of 
this RFA is to stimulate phase I/II or phase II clinical trials that will 
identify agents suitable for definitive testing in the phase III trial context 
for tobacco-related cancers in cohorts of former smokers.

It is estimated that smoking is responsible for more than thirty percent of 
all cancers, particularly cancers arising in the lung, head and neck, bladder, 
esophagus, kidney, pancreas, and cervix.  While the risk of developing cancer 
(i.e., of the lung) in people who quit smoking decreases substantially 
compared with the risk in people who continue to smoke, former smokers 
continue to have significantly elevated cancer risk compared to never smokers 
and this increased risk is maintained for the remainder of their lives.  
Recent data show that genetic damage in tobacco-exposed tissues, such as the 
bronchial epithelium, persists for decades after stopping smoking.  Currently 
almost one-half of all new cases of lung and bladder cancer occur in former 
smokers.  Therefore, the identification of molecular and imaging markers of 
risk and early neoplasia, and the testing of agents that can prevent the 
development of clinical cancer in this group are of high public health 
importance.

Increasing understanding of the lengthy process of human carcinogenesis is 
providing many new opportunities for prevention and early intervention.  The 
identification of genotypic and phenotypic abnormalities that occur frequently 
during tobacco-induced carcinogenesis in the aerodigestive or urothelial 
epithelia, for instance, provides markers for risk of developing cancer as 
well as potential targets for intervention in the process of carcinogenesis.  
For instance, the epidermal growth factor receptor (EGFR) and cyclooxygenase-2 
(COX-2) are frequently expressed in tobacco related malignancies as well as in 
preneoplastic lesions associated with these malignancies, thereby representing 
novel, mechanistic targets for intervention. Similarly, loss of heterozygosity 
at chromosomal loci such as 3p and 9p are frequent early changes occurring in 
lung and upper aerodigestive carcinogenesis, suggesting that the tumor 
suppressor genes found at these loci  (i.e., FHIT at 3p) may have important 
roles in these early phases of carcinogenesis and thereby be reasonable 
mechanistic targets.

Phase II clinical cancer prevention trials depend on intermediate endpoints, 
whether they be histologic preinvasive lesions or molecular endpoints, to 
determine preliminary interventional agent efficacy.  Since these trials are 
intended to evaluate efficacy quickly, it is necessary to identify surrogates 
for cancer incidence/mortality to serve as trial endpoints.  Examples of such 
surrogate or intermediate endpoints include, but are not limited to: 
preneoplastic lesions at high risk for progression to invasive cancer (e.g., 
oral leukoplakia, bronchial dysplasia, urothelial dysplasia, superficial 
bladder cancer, etc.), abnormalities in expression of various proteins 
associated with cancer development and progression (e.g., proteins involved in 
the control of growth, differentiation, and/or apoptosis), and distinct 
genetic or epigenetic abnormalities (e.g., microsatellite alterations, FISH 
abnormalities, mutations/deletions in tumor suppressor genes or oncogenes, 
aberrant promoter methylation).  The incorporation of newer imaging 
technologies, such as spiral CT, PET, MRI, light scatter spectrophotometry,  
or combinations, into chemoprevention trials could also provide novel and 
important information.

Several promising agents are already available for chemoprevention studies in 
lung, head and neck, bladder, and other tobacco-damaged organ sites.  For 
example, members of the non-steroidal anti-inflammatory drug family (NSAIDs) 
have shown efficacy in animal models for multiple tobacco-related 
malignancies, including cancers of the lung, upper aerodigestive tract, 
esophagus, and bladder.  Furthermore, the highly specific COX-2 inhibitor 
celecoxib, which has minimal gastrointestinal toxicity compared with other 
NSAIDs, has already been shown to be effective in reducing colorectal polyp 
number in patients with familial adenomatous polyposis.  Thus, COX-2 may be 
one reasonable target for chemopreventive strategies, and numerous studies 
evaluating NSAIDs for chemoprevention are already ongoing.  Many other targets 
also exist.  Based on preclinical animal studies and limited human studies, 
the list of other potential agents to consider includes, but is not limited 
to, glucocorticoids, lipoxygenase inhibitors, farnesyl transferase inhibitors, 
EGF receptor inhibitors, other novel tyrosine kinase inhibitors, immune 
modulators, angiogenesis modulators, soy isoflavones, vitamin D analogs, 
perillyl alcohol, and lycopene.  Investigators are strongly encouraged to 
propose novel agents.  Given that the same carcinogenic exposure (tobacco) is 
operational in a variety of target organs and that several of these agents 
have potential efficacy in multiple organ sites, clinical studies assessing 
chemopreventive efficacy in multiple tobacco-damaged organs would also have 
great appeal.  Alternatively, regional drug delivery to minimize systemic 
toxicity (such as by inhalation, mouthwash, or intravesical installation) 
would constitute another important chemopreventive strategy.

Prevention trials employing agent combinations targeting various biochemical 
pathways that are relevant to tobacco-induced carcinogenesis represent yet 
another important experimental approach.  For example, preclinical studies 
support the use of both cyclooxygenase and lipoxygenase inhibitors for 
chemoprevention in various organs, suggesting that the combination of these 
inhibitors may prove more efficacious than either one alone by blocking both 
major pathways of arachidonic acid metabolism.  A second example of such a 
strategy would be the concurrent use of inhibitors of polyamine synthesis and 
cyclooxygenase inhibitors for bladder cancer prevention.  The use of 
combinations of agents should, however, be based on a strong scientific 
rationale.  Furthermore, the feasibility of such an approach (e.g., the 
ability to obtain each agent from a pharmaceutical supplier for the specified 
purpose of a combination trial, as well as the feasibility of obtaining FDA 
permission for a combination trial) must be addressed prior to application.  
Multiple new agents are also expected to be identified by the companion 
preclinical RFA addressing chemopreventive agent development using animal 
studies that is being issued simultaneously with this RFA 
(http://grants.nih.gov/grants/guide/rfa-files/RFA-CA-03-004.html).  The 
appropriate preclinical screening of agents and targeted early clinical trials 
to identify the most promising agents are the crucial foundations for a 
chemopreventive strategy that should ultimately lead to a reduced cancer 
burden for our society.

Objectives and Scope

The purpose of this initiative is to establish multiple pilot short-term 
clinical trials (phase I/II or phase II) evaluating the efficacy of 
chemopreventive agents in specified cohorts of former smokers.  These studies 
should integrate the evaluation of multiple biomarkers and surrogate endpoints 
into the clinical trial design.  Given that a significant long-term goal of 
the NCI is the identification and validation of intermediate endpoints to 
replace cancer incidence and mortality as endpoints in clinical trials (and 
thereby significantly shorten the duration of such trials), investigators are 
strongly encouraged to collect and save relevant specimens (tissues, blood, 
urine, etc.) and to use appropriate processing and storage modalities to 
preserve them for future translational studies.  It is anticipated that 
reissuance of this RFA in the future will include funds for independent 
translational studies performed on specimens collected before and after 
chemopreventive intervention in former smokers.

The clinical trials should focus on specified target organs, well defined 
cohorts of former smokers, and particular chemopreventive agents or strategies 
as reflect the interests and expertise of the investigators.  Should they so 
desire, investigators will have access to agents that the Division of Cancer 
Prevention (DCP) already has in supply and for which Investigational New Drug 
(IND) support is available.  Alternatively, DCP will work with investigators 
to provide IND support for agents of their choice.  Investigators must, 
however, demonstrate access to specific interventional agents in their 
applications.  

Investigators are strongly encouraged to integrate studies of relevant 
molecular and biologic markers into their clinical trial design.  Assessment 
of various molecular markers associated with regulatory mechanisms controlling 
malignant transformation, proliferation, differentiation, apoptosis, and/or 
angiogenesis may be appropriate.  Investigation of molecular profiles (mRNA-
based or protein-based) could be included in a proposed study if the 
investigations are hypothesis-driven.  Assessment of markers of drug efficacy 
in target tissues may also provide valuable information.  Investigators are 
encouraged to utilize various types of specimens (e.g., tissue biopsies, 
brushings, lavage fluid, serum, sputum, urine, buccal smears, etc.) to 
investigate biomarkers and to perform relevant correlative studies.  The 
choice of markers should be dictated by the hypotheses being addressed by each 
study and the relevance of each marker should be adequately addressed in each 
application.

Examples of clinical studies that would be appropriate for this initiative, 
for the purpose of illustration only, might include the following:

1.  Former smokers (30 or more pack year smoking history) with bronchial 
dysplasia on fluorescence bronchoscopy and random bronchial biopsy might be 
randomized to chemopreventive treatment or placebo.  In addition to the 
primary endpoint of treatment (number of sites and grade of bronchial 
dysplasia), investigators might include assessments of multiple biomarkers, as 
appropriate, in biopsied abnormal and histologically normal tissues, 
bronchoalveolar lavage, and induced sputum.  Subjects may also be asked to 
undergo spiral CT with appropriate follow-up if abnormalities are present.

2.  Former smokers with oral leukoplakia might be randomized to 
chemopreventive treatment or placebo.  The primary endpoints of treatment 
would be the size and grade of leukoplakia, but investigators might also 
include assessments of multiple molecular markers performed on biopsied normal 
and involved tissue, as well as on sputum and buccal smears.

3.  Former smokers with superficial bladder cancer (Ta, T1, Tis) who have 
undergone resection and remain at high risk or who received intravesical BCG 
treatment might be randomized to chemopreventive intervention or placebo.  The 
primary endpoint would be recurrence of bladder cancer (superficial versus 
invasive), but investigators might also include assessments of multiple 
intermediate endpoints in the resected superficial bladder cancer as well as 
in normal-appearing mucosa pre and post treatment and in urine.  Surveillance 
could also include marker analysis in serum, urine and bladder washings using 
one or more of several FDA-approved biomarkers.

The NCI will conduct a safety and protocol review of the studies prior to 
their initiation.  This review is required to assure that all safety, conduct, 
monitoring, and reporting conform to FDA IND guidelines.  The awardee 
institutions and Principal Investigators must agree to comply with the 
recommendations of the review.

MECHANISM OF SUPPORT

This RFA will use NIH U01 award mechanism.  The NIH U01 is a cooperative 
agreement award mechanism in which the Principal Investigator retains the 
primary responsibility and dominant role for planning, directing, and 
executing the proposed project, with NIH staff being substantially involved as 
a partner with the Principal Investigator, as described under the section 
"Cooperative Agreement Terms and Conditions of Award"

The total project period for applications submitted in response to the present 
RFA may not exceed 5 years.  The anticipated award date is April 1, 2003.    

Because the nature and scope of the research proposed in response to this RFA 
may vary, it is anticipated that the sizes of awards will vary also. 
 
Awards and level of support depend on receipt of a sufficient number of 
applications of high scientific merit.  Although this program is provided for 
in the financial plans of the Division of Cancer Prevention, awards pursuant 
to this RFA are contingent upon the availability of funds for this purpose. 
 
In addition to the current RFA solicitation, it is anticipated that this RFA 
will be reissued one additional time next year.  Future issuance will have a 
greater focus on translational biomarker studies on specimens collected during 
the course of the clinical trials supported by this RFA and will include 
independent funding for these translational studies separately from funding of 
clinical trials.  If the Division of Cancer Prevention does not continue the 
program, awardees may submit grant applications through the usual 
investigator-initiated grants program.
 
FUNDS AVAILABLE
 
The NCI intends to commit approximately $4,000,000 in FY 2003 to fund 3 to 5 
new and/or competitive supplement grants to existing cooperative agreements in 
response to this RFA.  An applicant may request a project period of up to 5 
years and a budget for direct costs of up to $1,000,000 per year.  Because the 
nature and scope of the research proposed may vary, it is anticipated that the 
size of each award will also vary.  Although the financial plans of the NCI 
provides support for this program, awards pursuant to this RFA are contingent 
upon the availability of funds and the receipt of a sufficient number of 
meritorious applications. 

ELIGIBLE INSTITUTIONS
 
You may submit (an) application(s) if your institution has any of the 
following characteristics:
	
o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to develop 
an application for support.  Individuals from underrepresented racial and 
ethnic groups as well as individuals with disabilities are always encouraged 
to apply for NIH programs.   
 
SPECIAL REQUIREMENTS

General
 
Applications funded under this RFA will be supported through the cooperative 
agreement (U01) mechanism.  An assistance relationship will exist between NCI 
and the awardees to accomplish the research objectives.  It is expected that 
each submission will describe plans for a clinical trial using a specified 
chemopreventive agent in a tobacco-damaged target organ in a well-delineated 
cohort of former smokers to meet the objectives of this RFA.  As described 
below, the recipients will have primary responsibility for the development and 
performance of the research activities.  However, there will be government 
involvement in clinical studies, with regard to 1) assistance in securing an 
Investigational New Drug (IND) approval from the Food and Drug Administration 
(FDA), 2) coordination and assistance in obtaining the chemopreventive agent, 
and 3) monitoring of study safety and conduct.  The investigator is 
responsible for obtaining access to the chemopreventive agent(s) prior to 
submitting an application to this RFA.  The source of agent must be clearly 
identified in the application, including written documentation of support from 
pharmaceutical companies, if applicable.  If an investigator anticipates 
requiring considerable assistance in obtaining the chemopreventive agent 
and/or in securing an IND permit from the FDA, documentation of such 
assistance from the NCI should be obtained prior to submitting an application.  
Awards will not be made until all arrangements for obtaining the IND and the 
agent are completed.  Cost of agent and necessary formulation should be 
included in the budget.

Definitions

Program Director   the NCI Program Staff official (see INQUIRIES section of 
this RFA) responsible for the stewardship and monitoring of the award.  The 
Program Director may also function as the Staff Collaborator

Staff Collaborator   the NCI Staff official responsible for contributing 
expert advice on the scientific design and conduct of the research

Cooperative Agreement Terms and Conditions of Award 

A.  These special Terms of Award are in addition to and not in lieu of 
otherwise applicable OMB administrative guidelines, HHS Grant Administration 
Regulations at 45 CFR Parts 74 and 92, and other HHS, PHS, and NIH Grant 
Administration policy statements.  (Part 92 applies when state and local 
governments are eligible to apply as a "domestic organization.")
 
The administrative and funding instrument used for this program is a 
cooperative agreement (U01), an "assistance" mechanism (rather than an 
"acquisition" mechanism) in which substantial NIH scientific and/or 
programmatic involvement with the awardee is anticipated during performance of 
the activity. Under the cooperative agreement, the NIH purpose is to support 
and/or stimulate the recipient"s activity by involvement in and otherwise 
working jointly with the award recipient in a partner role, but it is not to 
assume direction, prime responsibility, or a dominant role in the activity.  
Consistent with this concept, the dominant role and prime responsibility for 
the activity resides with the awardee(s) for the project as a whole, although 
specific tasks and activities in carrying out the studies will be shared among 
the awardees and the DCP Project Scientist.
 
B. Awardee Rights and Responsibilities
 
The Awardee is responsible for:

1.  Research design and protocol development, including definition of 
objectives and approaches, planning, implementation, participant recruitment 
and follow-up, data collection, quality control, interim data and safety 
monitoring, final data analysis and interpretation, and publication of 
results.

2.  Implementing the data collection method and strategy.

3.  Establishing mechanisms for quality control and monitoring.  Awardees are 
responsible for ensuring accurate and timely assessment of the progress of 
each study, including development of procedures to ensure that data collection 
and management are:  1) adequate for quality control and analysis,  2)  as 
simple as appropriate in order to encourage maximum participation of 
physicians and patients and to avoid unnecessary expense,  and 3)  
sufficiently staffed.

4.  Submitting interim progress reports (twice a year) to the NCI Program 
Director including summary data on protocol performance.  One of these 
progress reports will be the annual awardee noncompeting continuation progress 
report. 

5.  Establishing procedures, where applicable, to comply with FDA regulations 
of 21 CFR Part 312 for studies involving investigational agents and to comply 
with the requirements of 45 CFR Part 46 for the protection of human subjects.  
For INDs sponsored by the NCI, the Principal Investigator is responsible for 
obtaining approval from both the Institutional Review Board and the NCI 
Program Director to enroll patients and to change the protocol.  The Principal 
Investigator is also ultimately responsible for all aspects of investigational 
drug acquisition, formulation, distribution, etc., although the NCI will 
provide aid for drug acquisition, IND support, etc. if requested prior to 
submission of application.

6.  Cooperating in the reporting of the study findings.  The NCI will have 
access to and may periodically review all data generated under an award.  
Awardees will retain custody of and have primary rights to the data developed 
under these awards, subject to Government rights of access consistent with 
current HHS, PHS, and NIH policies. 
 
C.  NCI Staff Responsibilities

It is expected that the dominant role and prime responsibility for the 
activity will reside with the awardee (s) for the project as a whole, although 
specific tasks and activities in carrying out the studies will be shared among 
the awardees and the NCI Staff Collaborator who will provide expert advice to 
the awardee on specific scientific and/or analytic issues as described below.  
The NCI Staff Collaborator will be named later based upon the subject matter 
of the award.  However, the NCI Program Director will retain overall 
programmatic responsibility for the award and will be the contact point for 
all facets of interaction with the awardee related to stewardship and 
monitoring of the award.

NCI Staff responsibilities will include:

1.  Interacting with the Principal Investigator on a regular basis to monitor 
study progress.  Monitoring may include:  regular communications with the 
Principal Investigator and staff, periodic site visits for discussions with 
awardee research teams, observation of field data collection and management 
techniques, quality control, fiscal review, and other relevant matters.  The 
NCI retains, as an option, the right to act as Sponsor for an IND filed to 
support the clinical research and conduct periodic external review of 
progress.

2.  Serving as a resource with respect to other ongoing NCI activities that 
may be relevant to the protocol to facilitate compatibility and avoid 
unnecessary duplication of effort.

3.  Involvement assisting in the design and coordination of research 
activities for awardees as elaborated below:

     a.  Assisting by providing advice in the management and technical 
performance of the investigations, coordinating clearances for investigational 
agents held by NCI.  The NCI reserves the right to crossfile or independently 
file an Investigational New Drug Application form with the FDA.

     b.  Reviewing and approving protocols to insure they are within the scope 
of peer review and for safety considerations, as required by Federal 
regulations.  The NCI Program Director will monitor protocol progress, and may 
request that a protocol study be closed to accrual for reasons including:  a) 
accrual rate insufficient to complete study in a timely fashion,  b)  accrual 
goals met early,  c) poor protocol performance,  d) patient safety and 
regulatory concerns,  e) study results that are already conclusive, and f) 
emergence of new information that diminishes the scientific importance of the 
study question.  The NCI will not permit further expenditures of NCI funds for 
a study after requesting closure (except for patients already on-study).

     c.  Reviewing and providing advice regarding the establishment of 
mechanisms for quality control and study monitoring.

     d.  Making recommendations for continued funding based on:  a) overall 
study progress, including sufficient patient and/or data accrual,  b) 
cooperation in carrying out the research  (e.g., compliance with the terms of 
the award and reporting requirements).

D.  Arbitration

Any disagreement that may arise on scientific/programmatic matters (within the 
scope of the award), between award recipients and the NCI may be brought to 
arbitration.  An arbitration panel will be composed of three members -- one 
selected by the awardee, a second member selected by NCI,  and the third 
member selected by the two prior selected members. This special arbitration 
procedure in no way affects the awardee"s right to appeal an adverse action 
that is otherwise appealable in accordance with the PHS regulations at 42 CFR 
Part 50, Subpart D and HHS regulation at 45 CFR Part 16.

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues:

o Direct your questions about scientific/research issues to:

Eva Szabo, M.D.
Division of Cancer Prevention
National Cancer Institute
6130 Executive Blvd., Room 2132, MSC 7341
Bethesda, MD  20892
Phone:  (301) 435-1595
FAX: (301) 480-3924
Email:  szaboe@mail.nih.gov

o Direct your questions about peer review issues to:

Referral Officer
National Cancer Institute
Division of Extramural Activities
6116 Executive Boulevard, Room 8041, MSC 8329
Bethesda, MD 20892-8329
Telephone: (301) 496-3428
FAX: (301) 402-0275 
Email:  ncidearefof@mail.nih.gov

o Direct your questions about financial or grants management matters to:

Ms. Eileen Natoli
Grants Administration Branch
National Cancer Institute
6120 Executive Blvd., EPS, Room 243 
Bethesda, MD  20892 
Telephone:  (301) 496-8791 
Fax:  (301) 496-8601
Email:  natolie@gab.nci.nih.gov
 
LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows NCI staff to estimate the potential review workload and plan 
the review.
 
The letter of intent is to be sent by the date listed at the beginning of this 
document.  The letter of intent should be sent to:

Eva Szabo, M.D.
Division of Cancer Prevention
National Cancer Institute
6130 Executive Blvd., Rm 2132, MSC 7341
Bethesda, MD  20892
Phone:  (301) 435-1595
FAX: (301) 480-3924
Email:  szaboe@mail.nih.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 710-0267, 
Email: GrantsInfo@nih.gov.
 
USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  Failure to use this label 
could result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA title and 
number must be typed on line 2 of the face page of the application form and 
the YES box must be marked. The RFA label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of 
the application, including the Checklist, and three signed, photocopies, in 
one package to:
 
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)
 
At the time of submission, two additional copies of the application must be 
sent to:

Referral Officer 
Division of Extramural Activities 
National Cancer Institute 
6116 Executive Blvd., Room 8041, MSC-8329
Rockville, MD 20852 (express courier)
Bethesda MD 20892-8329

APPLICATIONS HAND-DELIVERED BY INDIVIDUALS TO THE NATIONAL CANCER INSTITUTE 
WILL NO LONGER BE ACCEPTED.  This policy does not apply to courier deliveries 
(i.e. FEDEX, UPS, DHL, etc.) 
(http://grants.nih.gov/grants/guide/notice-files/NOT-CA-02-002.html) 
This change in practice is effective immediately.  
This policy is similar to and consistent with the policy for applications 
addressed to Centers for Scientific Review as published in the NIH Guide 
Notice http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-012.html.

APPLICATION PROCESSING: Applications must be received by the application 
receipt date listed in the heading of this RFA.  If an application is received 
after that date, it will be returned to the applicant without review.
 
The Center for Scientific Review (CSR) will not accept any application in 
response to this RFA that is essentially the same as one currently pending 
initial review, unless the applicant withdraws the pending application.  The 
CSR will not accept any application that is essentially the same as one 
already reviewed.  This does not preclude the submission of substantial 
revisions of applications already reviewed, but such applications must include 
an Introduction addressing the previous critique.

PEER REVIEW PROCESS  
 
Upon receipt, applications will be reviewed for completeness by the CSR and 
for responsiveness by the NCI program staff.  

Applications that are complete and responsive to the RFA will be evaluated for 
scientific and technical merit by an appropriate peer review group convened by 
the Division of Extramural Activities (DEA) at NCI in accordance with the 
review criteria stated below.  As part of the initial merit review, all 
applications will:

o  Receive a written critique
o  Undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score
o  Those that receive a priority score will undergo a second level review by 
the National Cancer Advisory Board.
 
REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments, reviewers will be asked to discuss the following aspects 
of your application in order to judge the likelihood that the proposed 
research will have a substantial impact on the pursuit of these goals: 

o  Significance 
o  Approach 
o  Innovation
o  Investigator
o  Environment
  
The scientific review group will address and consider each of these criteria 
in assigning your application"s overall score, weighting them as appropriate 
for each application.  Your application does not need to be strong in all 
categories to be judged likely to have major scientific impact and thus 
deserve a high priority score.  For example, you may propose to carry out 
important work that by its nature is not innovative but is essential to move a 
field forward.

(1) SIGNIFICANCE:  Does your study address an important problem? If the aims 
of your application are achieved, how do they advance scientific knowledge?  
What will be the effect of these studies on the concepts or methods that drive 
this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 
support?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o PROTECTIONS:  The adequacy of the proposed protection for humans, animals, 
or the environment, to the extent they may be adversely affected by the 
project proposed in the application.

o INCLUSION:  The adequacy of plans to include subjects from both genders, all 
racial and ethnic groups (and subgroups), and children as appropriate for the 
scientific goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated. (See Inclusion Criteria included in the 
section on Federal Citations, below)

o BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:   June 21, 2002
Application Receipt Date:        July 26, 2002
Peer Review Date:                November/December, 2002
Council Review:                  February, 2003

Earliest Anticipated Start Date: April, 2003

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
 
REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD:  Research components 
involving Phase I and II clinical trials must include provisions for 
assessment of patient eligibility and status, rigorous data management, 
quality assurance, and auditing procedures.  In addition, it is NIH policy 
that all clinical trials require data and safety monitoring, with the method 
and degree of monitoring being commensurate with the risks (NIH Policy for 
Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

Clinical trials supported or performed by NCI require special considerations.  
The method and degree of monitoring should be commensurate with the degree of 
risk involved in participation and the size and complexity of the clinical 
trial.  Monitoring exists on a continuum from monitoring by the principal 
investigator/project manager or NCI program staff or a Data and Safety 
Monitoring Board (DSMB).  These monitoring activities are distinct from the 
requirement for study review and approval by an Institutional review Board 
(IRB).  For details about the Policy for the NCI for Data and Safety 
Monitoring of Clinical trials see: 
http://deainfo.nci.nih.gov/grantspolicies/datasafety.htm.  For Phase I and II 
clinical trials, investigators must submit a general description of the data 
and safety monitoring plan as part of the research application.  See NIH Guide 
Notice on "Further Guidance on a Data and Safety Monitoring for Phase I and II 
Trials" for additional information:
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-038.html.  
Information concerning essential elements of data 
safety monitoring plans for clinical trials funded by the NCI is available:  
http://www.cancer.gov/clinical_trials/

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH:  It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of the 
research. This policy results from the NIH Revitalization Act of 1993 (Section 
492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-
files/NOT-OD-02-001.html), a complete copy of the updated Guidelines are 
available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.  
The amended policy incorporates: the use of an NIH definition of 
clinical research, updated racial and ethnic categories in compliance with the 
new OMB standards, clarification of language governing NIH-defined Phase III 
clinical trials consistent with the new PHS Form 398, and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable, and 
b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:  
The NIH maintains a policy that children (i.e., individuals under the age of 
21) must be included in all human subjects research, conducted or supported by 
the NIH, unless there are scientific and ethical reasons not to include them. 
This policy applies to all initial (Type 1) applications submitted for receipt 
dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy 
requires education on the protection of human subject participants for all 
investigators submitting NIH proposals for research involving human subjects.  
You will find this policy announcement in the NIH Guide for Grants and 
Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.  A 
continuing education program in the protection of human participants in 
research in now available online at: http://cme.nci.nih.gov/

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) cited 
publicly and officially by a Federal agency in support of an action that has 
the force and effect of law (i.e., a regulation) may be accessed through FOIA.  
It is important for applicants to understand the basic scope of this 
amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the application. 
In addition, applicants should think about how to structure informed consent 
statements and other human subjects procedures given the potential for wider 
use of data collected under this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.   Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving 
the health promotion and disease prevention objectives of "Healthy People 
2010," a PHS-led national activity for setting priority areas. This RFA is 
related to one or more of the priority areas. Potential applicants may obtain 
a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/

AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal 
Domestic Assistance No. 93.393, and is not subject to the intergovernmental 
review requirements of Executive Order 12372 or Health Systems Agency review.  
Awards are made under authorization of Sections 301 and 405 of the Public 
Health Service Act as amended (42 USC 241 and 284) and administered under NIH 
grants policies described at http://grants.nih.gov/grants/policy/policy.htm 
and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. 

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, Public 
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain 
facilities (or in some cases, any portion of a facility) in which regular or 
routine education, library, day care, health care, or early childhood 
development services are provided to children.  This is consistent with the 
PHS mission to protect and advance the physical and mental health of the 
American people.




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