Research Opportunities in NRG Oncology

Walter J. Curran Jr., MD, and Mitchell Machtay, MD, FASTRO

NRG Oncology (NRG) is one of five national cancer cooperative groups currently funded by the National Cancer Institute (NCI) as part of the National Clinical Trials Network (NCTN). NCI’s support was launched in March 2014 following the NCI-directed reorganization of its cancer cooperative group system conducted between 2011 and 2014. This reorganization reduced the number of groups from 10 to five and enabled three of the legacy groups to form NRG. These groups were the National Surgical Adjuvant Breast and Bowel Project (NSABP), the Radiation Therapy Oncology Group (RTOG) and the Gynecologic Oncology Group (GOG).

NRG’s mission is to improve the duration and quality of life of adults with specific cancers by conducting science-driven, NCI-supported multi-institutional clinical trials. NRG is particularly concerned with patients with gender-defined malignancies, including gynecologic, breast and prostate cancer, and in research affecting management of patients with a broad variety of localized or locally advanced solid tumors. This mission and the focused approach to specific patient subgroups is based on the strengths of NRG’s members and leaders and build on the strengths of NRG’s three legacy cooperative groups.

NRG’s work is supported by several NCI grants, including a group operations grant, a statistical and data management center grant, a biospecimen bank award and an award supporting cancer prevention, control and care delivery research through an NCI Community Oncology Research Program (NCORP) award. NRG has seven cancer disease site committees that actively develop therapeutic clinical trials: Brain Tumor Committee, Head and Neck Cancer Committee, Lung Cancer Committee, Breast Cancer Committee, Gynecologic Cancer Committee, Genitourinary Cancer Committee and Gastrointestinal Cancer Committee. The NCORP and a Developmental Therapeutics Committee also lead clinical trials. NRG benefits from strong core and administrative committees, such as its Radiation Oncology/Advanced Technology team. Additional support for NRG infrastructure and trial execution is provided by partnerships with industry, foundations, cancer centers and other peer-reviewing organizations.

When NRG submitted its competitive renewal applications for these grants in 2018-2019, substantial progress in fulfilling its mission was clearly demonstrated. The best evidence of this was the publication of at least 51 NRG manuscripts or abstracts that defined or redefined standards of care in just three-and-a-half years of operation. Overall, 302 peer-reviewed manuscripts and 365 abstracts were published by NRG during this time. This outstanding work supported the position of NRG as the major platform for conducting transformative multi-institutional trials for patients with those malignancies in which the group has world class expertise. The competitive renewal of NRG’s group operations grant in 2018 received an “Exceptional” score as further evidence of the quality of the group’s work. Another example of the group’s success is the broad engagement of almost all major academic cancer centers and many community centers across the United States and Canada. Almost 16,000 patients were enrolled by more than 200 full-member NRG institutions and their affiliates onto NRG trials or NCTN partnership trials in its first three-and-a-half years of activity. Among enrolled patients in the United States, 12.7% self-identified as of African descent and 8.0% as Hispanic or Latino. This level of minority representation is higher than previously seen in cooperative group trials.

NRG has continued its activities of protocol design and development, protocol activation, study enrollment, quality assurance, data analysis and publication during the pandemic, with great engagement from its members and staff and with proactive support from the NCI. While there was a significant decline in patient accrual at its member sites in the second and third quarters of 2020, there has been a significant rebound since August 2020. Remote work practice has been in place for NRG staff for several years, and this practice facilitated a high level of efficiency during the pandemic. Fourteen new clinical trials were activated by NRG in 2020, a number that compares favorably with previous years.

How can I participate more in NRG Oncology?

You can learn more about NRG and its clinical trials at www.nrgoncology.org. NRG has semi-annual meetings, which are open to all oncology professionals and are a great environment to learn about the group. The last two meetings were virtual, and this format provided an opportunity for hundreds of first-time attendees to participate. If your own organization participates in NRG research, seek out the engaged physicians and research associates to understand how to get more involved. If your group does not participate and is interested, you can download an application at https://www.nrgoncology.org/About-Us/Membership. NRG and its committees actively solicit and seek out new members and junior investigators to participate in all aspects of the group’s activities.

Walter J. Curran, Jr., MD, is the global chief medical officer for GenesisCare, NRG Oncology Group chair 2014-2021, professor emeritus and Lawrence D. Davis Chair Emeritus of Radiation Oncology, Emory University, and Georgia Research Alliance eminent scholar and chair emeritus in Cancer Research.

Mitchell Machtay, MD, FASTRO, is associate dean for Clinical Cancer Research and professor in the Departments of Radiation Oncology and Medicine at Penn State College of Medicine and interim NRG Oncology group chair 2021.