Optimise: Make cancer treatments more effective
The wealth of information now available to help characterise tumours provides potential to optimise treatment for each individual patient.
We need to get the most out of new treatments that we develop and those we already have. It is likely that combination approaches will ultimately prove most effective.
Ideally patient treatment decisions will be made on a truly individual basis, both at the initiation of treatment and at the point of recurrence, utilising a more complete understanding of the nature of the tumour and its surrounding microenvironment.
We will support more experimental medicine studies, through Experimental Cancer Medicine Centres (ECMCs) and our extensive clinical trials portfolio to realise our aspiration of making precision medicine a reality in the UK.
New technologies, including genetic sequencing and molecular imaging, tell us that each person’s cancer is as unique as their fingerprints, creating an opportunity for more precise treatment. Personalised, minimally invasive surgery and radiotherapy combined with molecularly targeted agents for diagnosis, imaging and therapy, focusing particularly on patients with early stage disease, will dramatically improve our chances of delivering long-term survival.
Professor Gillies McKenna, Director of the CRUK/MRC Oxford Institute for Radiation Oncology
Recent studies have revealed extensive intra- and inter-tumour heterogeneity, which evolves over time – either as part of natural disease progression or accelerated by therapeutic intervention. Developing our understanding of this evolutionary process and how it links to the development of patient relapse will underpin future therapeutic discovery and development and will ensure we can make better use of the treatments we already have.
Building understanding of these areas will require greater insight into the underlying biology, using in vivo and in vitro models and integrating biomarkers into both early- and late-phase trials. This will depend on new models of collaboration, highquality tissue samples associated with clinically annotated data and a variety of technologies and capabilities (e.g. functional imaging, deep sequencing, repeat biopsy, liquid biopsy).
We will encourage and facilitate further research in this area.
While we don’t yet fully understand drug resistance, it is likely to be the result of redundancy in signalling pathways and rapid evolution of tumours fuelled by genetic instability. Combinations of therapies, including radiotherapy or surgery as well as different drugs, work by attacking cancers through different modalities or at multiple points in the same pathway. We will support approaches to investigate novel therapeutic combinations in the lab and in the clinic.
We will continue to develop an understanding of how, and in which patient populations, new therapeutic combinations might be used most effectively. We will also work with pharmaceutical companies to explore access to experimental drugs from their pipelines, to enable clinical investigation of such combinations.
Biomarker-based tests present an opportunity to radically improve our ability to tailor treatments to individuals. Stratification of patients ‘out’ of treatments to which they will not respond will prevent potential harmful side effects. Recent advances in detecting circulating tumour cells (CTCs) and circulating free DNA (cfDNA) as well as improvements in functional imaging, provide the promise for decision-making based on genetic and phenotypic aspects of the tumour, without the need for invasive procedures.
We will ensure that the required capability to perform robust biomarker discovery and validation exists to translate the discovery of new biomarkers into changes in clinical practice. We will play a lead role in the global effort to discover and develop imaging, CTC and cfDNA technologies into clinically viable diagnostics. We will also invest in efforts to establish standardised readouts for immune therapies.
We will continue to support stratified trials and seek to fund innovative trial designs, such as adaptive multi-arm, multi-stage trials and window trials, in partnership with others.
Precision medicine is increasingly recognised as the future of cancer therapy. Many questions remain to be answered in order to make it a widespread reality. Through phase 1 of our Stratified Medicine Programme we have demonstrated the feasibility of embedding large-scale molecular analysis in the NHS, to inform treatment decisions across a wide patient population.
As more targeted therapies become available, there will be an increasing need for clinicians to routinely perform diagnostic testing and interpret complex data sets – and to do all this in a way that can benefit therapeutic choices in real-time.
We will support the NHS in understanding the routes to embedding precision approaches. We will build on our current work to provide the evidence base which enables the long-term adoption of precision medicine in the NHS, including the development of future phases of the Stratified Medicine Programme.
Opportunities for your research
We have an extensive portfolio of funding, infrastructure and partnership opportunities to support your research optimising cancer treatments, whether you're an academic researcher, clinician or working in industry.