Abstract
As one of the major health issues in Europe, cancer was a research priority in the 6th Framework Programme (2002–2006). About €485 million were devoted to this theme, which allowed funding of 108 multidisciplinary transnational projects. A significant part of them was large‐scale initiatives addressing complex issues through a broad combination of competences. All major types of cancer were covered, as well as the three dimensions such as prevention, diagnostic and treatment, with a particular emphasis on translational research aiming at bringing basic knowledge on medical practice. This approach will be continued in the 7th Framework Programme (2007–2013), together with a strengthened effort to improve the coordination of European cancer research, which is fragmented and in which EU action represents only a small part. EU cancer research will also be addressed within the reinforced efforts in the areas of pharmaceutical and technological developments as well as common aetiological mechanisms of diseases that the 7th Framework Programme will undertake.
Keywords: Cancer research, European Union, 6th Framework Programme
1. Introduction
Cancer remains one of the major public health issues and challenges in Europe. According to an estimate (Boyle and Ferlay, 2005), in 2004 alone, 2.9 million people were diagnosed with cancer in Europe and 1.7 million died from it. Due to the strong association between age and the risk of cancer, these numbers are expected to increase further as the European population ages.
Major efforts and investments in cancer research over the last decades have resulted in a decrease in the age‐standardised mortality rate for cancer by 9% (Boyle et al., 2003), in particular thanks to better prevention, earlier diagnosis and more effective treatments. It has even been speculated that lasting improvements at these three levels mentioned could make cancer a manageable chronic disease in the future (Von Eschenbach, 2003; Sikora, 2006).
Yet, in the foreseeable future, cancer will remain a formidable social and economic challenge worldwide, and further investments are therefore required to combat this disease and limit its devastating consequences.
2. Cancer research under the 6th Framework Programme
Therefore, building on earlier achievements, the European Union made cancer research a priority in its 6th Framework Programme (2002–2006). Whereas in the previous 5th Framework Programme (1998–2002) cancer research focused mainly on molecular mechanisms underlying the disease, the 6th Framework Programme has taken a step forward by implementing a decidedly patient‐oriented, “translational” research approach, aiming at bringing basic knowledge into medical practice more rapidly. Pioneered in cancer research, whilst other areas kept a more focused approach on genomics, this translational concept will be applied throughout the whole field of Health research in the 7th EU Framework Programme.
Some €485 million were devoted to cancer research in FP6, leading to the support of 108 projects and involving nearly 1500 research groups. Approximately 66% of the entire budget was spent on large‐scale initiatives (“Integrated Projects” and “Networks of Excellence”), addressing complex issues which require the combination of resources and capacities, while helping to better integrate and structure the cancer research community in Europe. The remaining third of the budget was spent on more focused small‐ and medium‐sized research projects, and on complementary networking activities and support actions.
3. An all‐encompassing effort
It has been postulated that more than 80% of cancers in western populations can be attributed to the environment in the largest sense (Boyle et al., 2003). Up to 40% of cancers might be preventable altogether, whilst better ways of screening, earlier diagnosis, appropriate treatments and follow‐up measures might have the potential of curing another 30% of cancers (source: WHO Cancer Fact Sheet). In addition, palliative care can improve significantly the quality of life for those patients for which the manifold treatment options have been exhausted. However, achieving these medical promises will require a deeper understanding of the biology and molecular mechanisms of cancer.
All these issues have been covered in FP6 (see Figure 1) and the scientific community's positive response involving leading academic teams, small and medium‐sized enterprises (SMEs) as well as larger industrial partners, has allowed to establish a substantial portfolio of multidisciplinary projects in these areas. The following offers a brief overview of the projects funded. More information about the individual projects is available online (Manoussaki, 2006) (see also Figure 1) 1 .
Figure 1.
Spending on cancer research under FP6. (a) Total spending (€485 million) of the European Commission in FP6 (2002–2006) according to the five different areas described in the text (in million Euro). (b) Total spending (in million Euro) according to various subgroups in each of the five areas. The same colour codes apply in (a) and (b).
3.1. Causes and mechanisms of cancer
Nearly half of the total FP6 funds for cancer were committed to research on the causes and mechanisms underlying cancer. The 47 projects supported covered a wide range of topics, from the molecular causes of cancer to its development and progression, through molecular mechanisms relevant to preclinical drug discovery.
A first group of 16 projects went further in the elucidation of molecular mechanisms in cancer aetiology, investigating signal transduction pathways and cellular processes, infectious agents such as cancer‐causing human viruses and bacteria, and carrying out genomic screenings for the identification of unknown cancer genes.
A second group of 21 projects addressed molecular pathways and mechanisms controlling cancer development and progression: identifying genes involved in organ‐specific metastasis, key regulatory molecules of tumour angiogenesis, the role of extra‐cellular proteases in tumorigenesis, or isolating and characterising cancer stem cells.
Finally, the EU Programme supported 10 translational projects unravelling molecular mechanisms to develop novel anti‐cancer drugs, e.g. studying apoptotic signalling or targeting oxygen‐sensing pathways.
Overall, these projects covered the major molecular pathways involved in the formation of cancers, comprising all six hallmarks of cancer (Hanahan and Weinberg, 2000, see Figure 3).
Figure 3.
FP6 projects on molecular targets. Numbers of projects funded on molecular targets according to the six hallmarks of cancer (Hanahan and Weinberg, 2000). Forty‐six out of the 108 total cancer research‐related projects in FP6 fall in these six categories.
3.2. Early detection and diagnosis
The outcome of cancer critically depends on the stage at which the disease is detected, and on the diagnostic tools and information available to the clinician to decide on the most promising therapy for each patient. Given its importance for cancer survival the European Commission supported 17 projects in this area with a total budget of approximately €60 million.
On one hand, projects concentrated on the study of molecular signatures from patient samples (e.g. genes, proteins, glycans or low molecular organic compounds), so as to improve diagnosis for major cancer types, such as prostate, ovarian, lung, pancreas, gastrointestinal and head‐and‐neck cancers.
On the other hand FP6 dealt with the refinement of state‐of‐the‐art imaging devices and technologies for cancer diagnosis, from high resolution X‐ray imaging to molecular imaging mammography, through to molecular imaging based on positron emission tomography combined with computed tomography (PET–CT). These technologies will be used for the diagnosis of all major tumour types and other major diseases.
3.3. Cancer treatment research and palliative care
FP6 focussed explicitly on the development of improved patient‐oriented strategies. In total, a €163 million was invested to address major research opportunities as well as gaps in emerging areas, concentrating funds on drug discovery, clinical trials, and the development of therapeutic tools and technologies.
The Programme supported drug discovery and development through a total of 22 highly innovative research projects focussing on novel assays against specific targets for cancer therapy. Topics ranged from investigating cAMP signalling networks or epigenetic modulators to focusing on the generation of a humanised genetically modified mouse model for the screening of anti‐angiogenic molecules, through to screenings to identify compounds interfering with protein–protein interactions involved in cancer, such as p53‐Mdm2 or beta catenin‐TFC4. Another group of projects dealt with translational studies on novel therapies, such as the development of therapeutic cancer vaccines based on patient‐derived dendritic and regulatory T cells, the development of innovative viral and non‐viral oncolytic or gene therapy vectors, or the development of therapeutic antibodies for anti‐cancer therapies.
€22 million went to three projects implementing clinical trials, investigating amongst others (1) the potential use of gene expression signatures from individual tumour samples to determine the optimal treatment for breast cancer patients; (2) innovative treatment options for a particular lymphoma subtype with an especially poor prognosis; and (3) more effective cancer vaccines, with the ultimate goal to make immunotherapy an additional standard cancer treatment.
In addition, the EU supported the development or improvement of treatment‐related tools and technologies, such as advanced radiotherapy equipment or the creation of a web‐accessible system to support clinical decision‐making.
Side effects of cancer can be relieved in over 90% of patients using palliative care (source: WHO Cancer Fact Sheet). €5 million went to two research projects focusing on the improved management of pain, depression and cachexia suffered by still too many advanced cancer patients, with a view to improve their quality of life.
3.4. Prevention and epidemiology
Understanding the role of nutritional, genetic, environmental and socio‐economic factors involved in cancer aetiology should allow to develop approaches to predict the risk of certain cancers and to prevent their occurrence. €19 million was spent to support five projects in this field. Particular topics addressed the role of nutrition and other socio‐economic factors in the risk of developing cancer, and the identification of genetic and environmental risk factors. Moreover, one consortium aimed in particular at improving cancer control by linking biobanks and cancer registries with the goal to create research facilities for large‐scale population‐based cancer research.
3.5. Better coordinating and integrating cancer research efforts in Europe
Based on a recent survey (Eckhouse and Sullivan, 2006), the average annual investment made in cancer research by the EU in FP6 – slightly more than €121 million – would correspond to approximately 8.5% of the annual spending on cancer research by public organisations in Europe, showing that the bulk of research in this field is supported at the national level.
The European cancer research field is characterized by its fragmentation and diversity (multiplicity of support mechanisms, funding bodies, etc.). Consequently, one of the EU's key policy objectives is to improve the coordination of cancer research activities throughout Europe, in line with the spirit of the European Research Area (ERA), which endeavours to bring together EU, national as well as regional research programmes, activities and policies.
Surveying and documenting the way cancer research funding is structured across the EU Member States is a necessary first step to achieve such an objective. A second step is to carry out in‐depth reviews of current cancer research activities in all Member States, in order to identify and clarify issues of fragmentation, redundancy and lack of efficiency.
To this end, FP6 supported initiatives designed to help establish a strong, harmonised collaborative framework for cancer research in Europe. With approximately €3 million two actions were launched in this spirit, which seek to identify the needs and potential benefits of a pan‐European coordination of national cancer research activities.
4. The future
The necessity to better coordinate cancer research at all levels in Europe, which requires a strong commitment from the scientific community, is now largely recognised. To this aim, several EU Member States have established national cancer institutes aimed at providing a strategic oversight of cancer research and care, facilitate collaboration between funding bodies, identify gaps and opportunities and monitor progress. The support to this co‐ordination at EU level should represent a major feature of cancer research activities in the new 7th EU Framework Programme (see http://cordis.europa.eu/fp7/home_en.html for further details of FP7).
This new Framework Programme is equipped with an increased budget for health research. Again, a strong emphasis is put on cancer, pursuing FP6's efforts in translational research in this area while reinforcing the focus on clinical aspects.
Several new elements are introduced that benefit cancer research. The Innovative Medicines Initiative (IMI), a pan‐European public and private sector collaboration between patient organisations, universities, hospitals, regulatory authorities as well as small and large biopharmaceutical and healthcare companies, endeavours to support the faster discovery and development of better medicines. According to a recent study, only 3% of oncology drug candidates entering phase I clinical trials will make it to the market (Desdouits et al., 2006). IMI aims at overcoming this situation by funding research into the prediction of suitability, safety and efficacy of therapies, including cancer therapies. In addition, a dedicated FP7 Infrastructures Programme will support the establishment of clinical trials facilities and bio‐banking, so as to pave the way to a harmonised framework for genuine pan‐European initiatives.
In addition to cancer‐specific activities, cancer research will also benefit from increased efforts to investigate common aetiological mechanisms of diseases, as well as from further development of imaging and other technologies that are highly relevant to several different diseases. Moreover, under FP7 an entirely new part of the Programme – public health‐related research – will complement efforts in cancer research and will carry activities forward even further towards clinical practice.
By both building on FP6's achievements and introducing important novelties of particular relevance to health‐related research, including cancer, the 7th Framework Programme will demonstrate the sustained commitment of the European Union to improve the health and quality of life of its citizens.
Acknowledgements
Stefan Jungbluth and Olaf Kelm contributed equally to this report. Stefan Jungbluth has been seconded to the European Commission as a National Expert by the Centro Nacional de Investigaciones Oncológicas, Madrid, Spain. We are grateful to many colleagues in the Health Directorate of the European Commission for providing us with additional information in relation to the funded projects. The authors declare to have no financial conflict of interest.
Figure 2.
Relation of different cancers funded in FP6 projects and their incidence in Europe. Numbers of projects funded on particular cancer sites in relation to 5‐year median survival rates and incidence in Europe (Boyle and Ferlay, 2005; Desdouits et al., 2006). Grey circle shows only cancer type currently not covered (testicular cancer) in FP6. Numbers in blue circles indicate the number of projects dealing with a particular cancer type.
Table 1.
Funding allocation in EU FP6 Cancer area vs. US National Cancer Institute
| Relative budget per activity | FP6 % budget | NCI % budget |
|---|---|---|
| Cancer causation | 19.6 | 23.0 |
| Cancer biology | 22.9 | 16.4 |
| Treatment research | 33.6 | 22.3 |
| Detection and diagnosis | 12.4 | 7.7 |
| Prevention | 3.9 | 10.7 |
| Other | 5.2 | 19.1 |
Percentage spending on cancer research according to different research activities by the European Commission in FP6 (2002–2006) compared to the spending by the NCI for fiscal year 2005. Total budget amounts referred to are: €485 million for cancer research spending by Directorate Health, European Commission, during the 4‐year period of FP6; and €3.64 billion for the NCI for Fiscal Year 2005.
Jungbluth Stefan, Kelm Olaf, van de Loo Jan-Willem, Manoussaki Elengo, Vidal Maria, Hallen Manuel, Trias Octavi Quintana, (2007), Europe combating cancer: The European Union's commitment to cancer research in the 6th Framework Programme, Molecular Oncology, 1, doi:10.1016/j.molonc.2007.01.002.
Footnotes
FP6's portfolio of projects covers all relevant cancer types, the only exception being testicular cancer, one of the rarest cancers. Indeed, the total number of projects that deal with a particular cancer type in most cases correlates with the incidence of these cancers in the population (see Figure 2). It is also interesting to note that the US National Cancer Institute's (NCI) budget partition (source: NCI, 2005) is very similar to the one of the EU (see Table 1). Only treatment‐related research, detection and diagnosis – on which the EU spent a higher budget share than the NCI – and cancer prevention – which received a higher percentage of funding at the NCI – were areas that show major differences in budget allocation between the two organisations.
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