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Military Medical Research Leads to 18 New Cancer Drugs, other Devices

a patient prepares for a PET scan Michelle Pribble, Naval Medical Center San Diego's lead nuclear medicine technologist, prepares a patient for a positron emission tomography (PET) scan in the hospital's Nuclear Medicine Department Oct. 6. A PET scan is used for revealing or evaluating conditions including brain disorders (Photo by: Navy Mass Communication Specialist Seaman Luke Cunningham)

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In just the past year, they've been working on new, high-tech treatments for major health problems like cancer, severe hearing loss and genetic diseases like muscular dystrophy.

While the Congressionally Directed Medical Research Programs, known as CDMRP, is not really a household name that is immediately familiar to many people in the military community, it is well known among medical researchers around the world.

The CDMRP is essentially a Department of Defense funding organization that has been a hub of cutting-edge healthcare innovation financing since the early 1990s and has impacted health care development inside and outside the military for decades.

"Certainly, when CDMRP research leads to Food and Drug Administration-approved treatment, it is a big win for the entire community," said Army Col. Sarah Goldman, CDMRP's director.

"Research from CDMRP's cancer programs alone has led to 18 FDA-approved drugs and devices that are currently being used, as well as significant changes in clinical practice."

Based at Fort Detrick, Maryland, the CDMRP is officially a part of the U.S. Army Futures Command, Medical Research and Development Command.

In just the last year, the FDA approved drugs developed through CDMRP-backed research to treat neurofibromatosis (a genetic disorder of the nervous system); Duchenne muscular dystrophy; and a blood cancer called multiple myeloma.

The CDMRP originated in 1992 via a single Congressional appropriation to encourage novel approaches to breast cancer research. Since then, it's grown to include funding for about 5,000 research projects investigating an array of medical issues.

"Our programs work hard to gather a lot of information to help identify research gaps and determine how to make key investments," Goldman said. "We gather different stakeholders at the table, to include representatives from the DOD. Many of our programs have NIH representation as well as experts from the VA (Veterans Administration) ... really all of the major federal and non-federal research funders. We also include scientists and clinical experts in a particular area, and it's extremely important that we have the consumer perspective at the table. Integrating consumers into CDMRP's panels is one of our hallmarks and their input is absolutely critical.

"Our programs conduct a funding landscape analysis, where we figure out what's been funded so far, and where the gaps are."

Teams then develop strategies on how to fill those research gaps. Certain funding mechanisms seek out "innovative, high-impact, high-risk, and high-gain projects, where we're willing to take a chance on some research" and where other agencies may not be willing to tread, Goldman said.

Some of the research may be exploratory in nature, she said. Sometimes reviewers of the research do not know who the principal investigator is, or even the organization behind it, to avoid bias toward some of the larger, more well-known performers.

"They can really focus on the idea, and help determine if it's innovative and potentially impactful or not," Goldman said.

Air Force spouse posing for a photo during her battle with cancer
Heather Souders, an Air Force spouse, poses for a photo during her battle with cancer after her diagnosis in 2018. The CDMRP has funded numerous research studies to develop new treatments for breast cancer (Photo by: Audra Flanagan)

In this context, "consumers" could be patients, survivors, family members, or advocates representing an entire community affected by the disease or condition that's being studied.

"Integrating the consumer viewpoint is really one of the central tenets of the CDMRP," said Rebecca Fisher, the organization's deputy director for program management. "It's something that CDMRP pioneered many, many years ago, and I think others are now starting to see the tremendous value in that. We worked with the VA a few years back to share CDMRP approaches to help with their efforts to integrate more veteran input into VA research. Consumers are active in every part of our process."

That includes patients or advocates helping to set strategies, helping with peer and programmatic reviews, and even participating in research projects with investigators. The CDMRP has a training program and a mentoring process for those consumers who participate and provide input.

"CDMRP is not here to fund research for research's sake," said Fisher, who has managed complex biomedical research programs within the DOD for more than 15 years. "We are focused on accelerating solutions that will better people's lives. Even if it's earlier stage work that we're supporting, we're always looking to that horizon and how we can get there faster."

Fisher said that CDMRP-funded open research awards currently number about 5,000. With so many highly promising areas being studied, it is difficult for her to pick just a handful of the most exciting prospects. But one that was cited by both Fisher and Goldman is a study of the drug known as Ruxolitinib for the possible prevention of breast cancer.

"If this drug is successful, it could have a major impact for women who are diagnosed with early benign breast lesions, when they don't know which ones are actually going to transition to cancers," Fisher explained. "Right now, the current standard of care is an anti-estrogen therapy, which has a lot of side effects and is very difficult, so some women discontinue or don't even take it.

"If you have a better preventative you can offer, it's a sea change in treatment. That's a huge, exciting project that's been developing over many years with different award mechanisms for these investigators through CDMRP's breast cancer program."

There is also a relatively new hearing restoration program underway that is funding pioneering research in treatment of auditory injuries and the restoration of hearing, including novel human 3D stem cell models of the inner ear, Fisher said.

"The inner ear is just really hard to get into and one of only a few organs for which biopsies are not possible," she said. "It's very difficult because of the bone structure around it. Having a way to test the effects of therapeutics on regenerating important sensory cells in the ear and perhaps restore hearing, down the road ... this technological development may open up those avenues. This could be a huge change in this field."

In 2019, the Nobel Prize in Physiology or Medicine was awarded to two doctors, Gregg Semenza and William Kaelin, Jr., who previously received funding from the CDMRP. They shared the award with another scientist for discovering how cells sense and adapt to oxygen availability. Their work has implications for treating a variety of diseases, including cancer.

"It was so exciting for CDMRP be a part of their journey on to winning the Nobel Prize, and to see how their research has led to tremendous innovative breakthroughs," Goldman said recently.

Previously, two other scientists who were CDMRP-funded during their careers went on to become Nobel laureates, one in 2008 and another in 2009.

"We have the opportunity to realize a vision for very specific areas of medical research need, and hopefully accelerate the achievement of products and outcomes that will help to improve the lives of service members, veterans, and the American public, and really make a difference," Fisher said.

"That's what CDMRP is here for. While we fund the whole spectrum of research, we're looking at that impact. That is number one in our book."

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