Benefits of partnership: The Christie perspective
Director of Research at The Christie NHS Foundation Trust, Professor John Radford, tells us how team science is transforming patient outcomes and how personalised medicine can provide the solutions for cancer challenges in the next decade.
Manchester is the ideal cancer research testbed because we have The Christie; Europe’s largest single-site cancer-specific hospital, which treats 14,000 new patients every year and 40,000 patients that require ongoing treatment.
Manchester is dealing with a huge patient population, many with rare disease types, so we’ve got the opportunity to build a mass of expertise in how to manage these patients. We undertake research, even in difficult-to-access populations, into rare or molecular sub-types of more common diseases, and we’re increasingly using personalised medicine to focus down onto highly uncommon molecular sub-types of diseases.
Within this large population, the chances of picking up rarer cancers are obviously increased and so we’re an ideal environment for research companies interested in testing and developing new molecules. We're also attractive to pharmaceutical companies who want to develop new molecules for us to undertake early and later phase trails.
“In the past, we’ve taken a pragmatic approach and treated all cancers in same way but now we’re in an era of personalised medicine.”
Size and scale
Because we’re so big and we encompass so much of cancer, it’s not just about access to new molecules or cells; it also gives us access to new types of techniques. In radiotherapy for example, the new proton beam centre that we’re opening is the first in the UK. We’re in this position because we’ve got the expertise and strength in our medical professionals and other professions, including nursing, physiotherapy, pharmacy, pathology and radiography to name a few. All of these areas can offer their own expertise and create a network of expertise across The Christie, Cancer Research UK (CRUK), the University and other partners. We’re setting up a lung cancer screening trial for survivors of a first cancer and are also investigating heart disease in these people, working with academics in cardiovascular disease.
All of these discipline areas offer their own expertise and such a collective breadth of knowledge only adds to the existing network of expertise across the partnership. It’s this collective brilliance that allows us to really gain traction on cancer.
Looking forward, there are going to be a number of different challenges including the affordability of new treatments. However, this is where personalised medicine comes to the fore as it means that expensive targeted therapies will only be used in patients where we are confident that it will work and will be beneficial.
The need for personalisation
Managing the burden of disease will also become a challenge but if we could shift away from managing advanced disease to screening, prevention and early detection, this will be a much better approach, in terms of lives and monies saved.
This is something Manchester, as a research community, is really focusing on and we’ve got the expertise to achieve great things.
For example, the biomarker research that Professor Caroline Dive is leading, which demonstrates the ability to measure something in the blood that may signify early relapse of disease so that intervention can take place before the patient becomes symptomatic, is a great example in terms of screening and prevention. I think this is the future because of the costs saved in unnecessary treatments.
Prevention and earlier detection strategies will aid cost saving so we can shift our resources and our focus away from exclusively being on advanced disease, and how we treat it at an advanced stage, to how can we detected it earlier or prevent it altogether.
As a collective research community, these are the key challenges we’ll need to face, along with how we manage the survivor population.
Advances in treatments and detection are resulting in increasing numbers of cancer survivors, a great news story, but these survivors haven’t been returned to an absolute normal risk level for other problems. They’re at high risk of secondary cancers, of cardiovascular disease, of osteoporosis, fractures, infertility and psychological issues. We need to decide how we can best manage this survivor population; something that my research team is currently looking at.
We’re looking at developing new therapies in two ways. We’re evaluating new molecules and seeing how they fit into the current mix and also taking older, existing treatments and using them better and differently.
We’re using imaging and other biomarkers to guide the treatment so that we can stop treatment earlier, thereby reducing toxicity and the likelihood of treatment-induced secondary cancers. To help us, we need to continue developing biomarkers that can tell us what’s going to happen with any particular treatment or what is happening and what the outcome is likely to be.
The final challenge is how we can minimise late toxicity with those areas of second cancers, cardiovascular disease bone health, infertility and screening for second cancers.
Team science agenda
The challenges and opportunities for delivering this research, I believe, will derive from pursuing a genuine team science agenda which will see professionals from different disciplines, working collectively to realise a shared aim that is relevant to a cancer patient. In other words, at the very outset we need to define what is the problem that patient needs solving and then construct a multidisciplinary team around meeting that need.
The opportunities that will flow from this way of working will include enabling very precise diagnostic techniques, developing treatments that can focus on the molecular abnormalities in any given patient, being able to screen, prevent and earlier detect. These will all be absolutely key, as will dealing effectively with the survivor population.
In the past, researchers have worked in small, siloed research groups comprised of different individuals. Increasingly, these groups are now focusing on the achievements that can be made over a relatively short period of time (two to five years), as a wider team instead. We’re implementing a genuine team science approach.
It’s becoming increasingly recognised nationally and internationally that Manchester is leading the way in cancer research and in the past year alone we’ve been awarded CRUK major centre status and become an NIHR Manchester Biomedical Research Centre (BRC). Over the next year I predict that increased national and international recognition of our leading research outputs across a number of areas will increase, and it’s not overdue.
Manchester is home to Europe’s largest cancer hospital where its 14,000 new patients every year benefit from the new treatments and drugs developed by the city’s cancer research community.