Outlining the challenges

Cancer Research UK Manchester Institute Director, Professor Richard Marais, tells us about the offering of the Manchester Cancer Research Centre partnership and outlines the challenges and opportunities that are generated by the research community’s ever increasing knowledge of this complex disease.

Professor Richard Marais

Professor Richard Marais is the Director, Cancer Research UK Manchester Institute and Professor of Molecular Oncology at The University of Manchester.

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As a basic science institute within a clinical cancer environment, our focus is on translational and clinical research. Our scientists are working on understanding the biology of cancer and how we can use this knowledge to improve cancer care. We bring the ability to work right across the board, from the discovery of cancer biology, the identification of targets and biomarkers, all the way through to the production of new drugs in our Drug Discovery Unit. We implement biomarkers via our biomarker centre all the way through to clinical trials and use the information from these trials to refine our understanding and improve patient care.

Access to patient samples and clinical data is incredibly important in modern research and this is a major benefit of the partnership to us. It means that we can have an improved understanding of how patients are responding to new treatments, drugs and strategies and modify our research accordingly.

Equally important is being aware of the questions which are being asked within the clinical community. It’s the ability to bring the clinical and the basic scientists together and interact so that we can start to find out what basic research questions the clinicians need answering, making sure that we’re in the discussions about this and making sure than any new discoveries feed through to the clinic, as early as possible.

Learning more

Our increased understanding of cancer biology means there are more opportunities globally than ever before to apply this knowledge. Of course you’re always going to be in a position where your understanding today is greater than it was yesterday but we’re now beginning to comprehend just exactly how complex cancer really is.

We’re starting to see the magnitude of the disease’s complexity. While our collective global research community’s understanding of the disease is still quite rudimentary,  we are continually making huge advances in knowledge. The opportunity for us all lies in the advancements made in one disease area feeding into other areas and for us to identify how we can cross-fertilise knowledge across different disease areas. For example, amongst the big four cancers (breast, lung, prostate and bowel) breast cancer incidence has reduced by 10% in the past five years whereas prostate cancer has only seen a 5-6% reduction. Can lessons in breast be applied to prostate?

Whilst increased scientific understanding is leading to improvements in patient care and surgical techniques are resulting in better patient outcomes, at the same time we need to maintain our level of questioning. How we can improve our knowledge of drugs in order to combine different modalities that will achieve better patient outcomes? How do you combine surgery with chemotherapy? How do you improve the new targeted therapy with immunotherapy? How do you get the best out of that? These are the learning opportunities we have.

Understanding our data

Our access to new drugs and increased understanding of cancer is beginning to impact on patient outcomes, with us slowly seeing more people surviving cancer than ever before. But the increased knowledge, treatment options and methodologies bring increased associated challenges;  how can we best harness all this complexity?

New scientific and clinical techniques and drugs mean we’re able to understand cancer better than ever before but all this learning generates enormous amounts of new data, and we’re generating it so quickly that we barely have time to understand it before we have to move to the next stage. We need to become smarter in learning how to simplify this.

To really make an impact for patients we’re going to have to learn how to get the best out of the drugs we’ve got, how to most effectively combine them, and how to do that in individual patients so that we’re personalising their treatment to ensure that we’re treating their specific tumour and nobody else’s.

When I first arrived in Manchester, clinicians in my field, melanoma, were frustrated because they didn’t know which drugs they could put their patients on as the small number available weren’t working.

Now those same clinicians have so many options that they don’t know which of the multitude of drugs to give to which patient. They’re overwhelmed by choice. So we need to concentrate on the idea of precision medicine, which sees us giving every patient the individual treatment they need and don’t just treat everybody the same. This is a technical and clinical challenge but something that Manchester is perfectly suited to tackle.

There’s a huge, untapped expert community here that the cancer community could engage more routinely with and who would bring immense value to the research. For example, we’re starting to bring in the material scientists, physicists, engineers and mathematicians. But alongside this we need to build the basic biology and infrastructure that will allow this to become more routine and allow us to have more people feeding into different areas.

There’s potentially an enormous amount of space to fill and I think there are genuine opportunities to be broader and wider in what we do.

Whilst we are still a relatively small community, it’s worth remembering that Manchester forms the core of the Cancer Research UK investment outside of the south west of England so, in addition to the science, the research and the discovery that we have here, we’ve also got the political clout. This is where we make things happen.