Over the last 15 years, scientific and technological breakthroughs have changed the face of cancer research.
The mapping of the human genome, improvements in both computer power and data analysis, and breakthroughs in understanding the immune system have made it possible for scientists to take great strides forward.
But over this period, it has also become clear that collaboration is needed between academics, hospitals, charities and the pharmaceutical industry if the pace of discovery is to continue.
With everything moving at such a pace, patients’ groups and charities have also begun to ask the question, if we truly want to beat cancer, why isn’t all this research data shared freely?
For academics in the UK, collaborating is key to the war on cancer. At University College London Cancer Institute (at UCLH), Professor Charles Swanton is leading a groundbreaking project mapping the genetic changes that occur during the lung cancer disease course – a disease that has traditionally seen little improvement in survival rates.
The TracerX trial is enrolling 850 patients in ten centres around the UK, regularly collecting biopsies that will provide new insights into the course of the disease – and common targets for treatment.
“We are absorbed by the idea of collaboration because one lab together with my clinic at UCLH keeps me very busy, and there is a lot of expertise we are not set up for and a lot we cannot do to interrogate cancer genomes exhaustively,” says Professor Swanton. “We need expertise from across the UK and so have ten hospitals recruiting patients and many senior UK research scientists helping.
“This study is sequencing spatially and temporally separated lung cancer genomes changing constantly in the same patient and it’s a huge undertaking when scaled to 850 patients. But we need these sorts of big studies to get to grips with how and why lung cancer is incurable.”
It is not only scientists who are collaborating with one another; industry has also begun to see the benefits of greater collaboration to speed up research
Professor Swanton and his collaborators will be analysing on average up to 12 trillion letters of DNA in each patient, across 850 patients over nine years. Although analysing the genomes of cancer patients is getting faster, it remains an expensive and time-consuming business because essential elements still have to be done by scientists rather than computers. Even computational technology is struggling to keep up with the data explosion from cancer studies at a price that is affordable.
But it is not only scientists who are collaborating with one another; industry has also begun to see the benefits of greater collaboration to speed up research.
Angela Kukula, director of enterprise at the Institute of Cancer Research, says: “In recent years the pharmaceutical industry has contracted and consolidated, and their research and development departments are often smaller. So nowadays we see independent researchers funded by charity doing the early, innovative, blue-sky work and, once something looks promising, we partner back with pharmaceutical firms for the next stage.”
Dr Kukula says that this approach has benefits for patients as it means the drugs that are developed are not “me too” drugs similar to ones already on the market, but are often targeting rare and under-represented forms of disease.
Robin Jones, a sarcoma oncologist at London’s Royal Marsden Hospital, has been working on some of these trials looking into immunotherapy for sarcoma. This disease is complex and hard to treat, and patients currently have few treatment options. He says this type of research, in this case involving a biotechnology firm working with scientists, can produce important results.
“Immunotherapy is a big player in the cancer field now,” says Dr Jones. “As a sarcoma oncologist, it can be difficult when you see patients who should have more treatment options and better survival rates. But some of the immunotherapy treatments that are currently in trials look promising and there is very exciting work in hand.”
There are other forms of collaboration too, involving big data. Researchers and industry are finally starting to see the benefits of sharing information about the trials they work on.
In addition, there is a push to put more raw data – or anonymised health information about patients in a trial – on to websites for researchers to mine, as long as patient confidentiality is retained.
Last year, a number of projects for sharing this sort of big data were announced by pharmaceutical firms. One of these, the Project Data Sphere, involves AstraZeneca, Bayer, Celgene, Janssen, Pfizer, Sanofi and Memorial Kettering Sloan Cancer Centre all agreeing to share the raw data from cancer trials.
In Europe, the hotly anticipated European Clinical Trial Regulation will also require all types of trial, including those on cancer, to be publicly registered and for their results to be published. The largest registration site in the world is currently ClinicalTrials.gov.
European campaigners want this to go even further and have set up the All Trials campaign. This calls for both the pharma industry and researchers to publish previous trial results, a sentiment that was recently backed by the World Health Organization.
So far, GSK has agreed to do this for all trials dating back to 2000. Step by step, other pharmaceutical firms and some researchers are signing up to the initiative, but campaigners say more still needs to be done to improve the sharing of clinical trial information.
The future of cancer research will not only be affected by the sharing of past trial data, but also by the way in which future trials are carried out. The advent of genomics, personalised medicine and immunotherapy has meant that clinical trials are now smaller and faster than ever.
As scientists pinpoint the molecular changes that fuel cancer growth they can hand-pick the drugs to interrupt the disease. It means patients can be matched with the best medicine for them from the outset or benefit from drugs made using their cells, including cancer vaccines.
Dr Navid Malik, an industry analyst and non-executive director at Northwest Biotherapeutics, which is working on new cancer vaccines, says: “In the United States last year, the Food and Drug Administration approved 41 new drugs, nine of which were ‘breakthrough therapies’ and two were approved based only on phase I trials. Things are now happening very fast in cancer research and it’s an incredibly exciting time for researchers, industry and for patients.”