Facilitate a major shift in early diagnosis research: our progress
Earlier diagnosis of cancer offers the greatest potential to transform patient outcomes. The UK has a growing, active research community focused on the role of patients, healthcare professionals and healthcare providers in early diagnosis, and, together, we have a strong track record in policy research and development in this area.
Research we funded provided evidence that underpinned the introduction of bowel scope as a national bowel cancer screening programme, which is already saving lives. Our input also informed the new five-year cancer strategy for England, which has early diagnosis central to achieving ‘world class’ cancer outcomes.
Yet, there remains a pressing need to increase the focus of research on early disease biology and the accurate detection of early cancers, as well as to drive innovation in existing areas of strength such as behavioural science and epidemiology. We are currently faced with a very low baseline of research capacity in early detection and hope that increasing our focus in this field will accelerate progress.
We plan to tackle this in three ways: working closely with the emerging early detection community to understand how best to shape our activity, launching new funding calls to address specific knowledge, technological and/or skills gaps identified, and developing international networks to attract talent to the field and forge new strategic partnerships.
We said we would...
The emphasis of basic cancer biology towards later stage or metastatic disease limits the identification of new approaches to early detection. To build capacity and drive efforts to understand the biology of early cancer development, our Major Centre in Cambridge has launched an Early Detection Programme. Although its primary focus will be on the biology of cancer initiation and progression to invasion, the programme covers a broad spectrum of early detection research, from clinical studies to the broader psychological, legal and economic implications of early detection strategies. The programme is already funding several research projects and in January 2017 held its first Early Detection Annual Symposium.
In partnership with the Dutch Cancer Society, we are co-funding an international team, led by Dr Jelle Wesseling, to interrogate the biology of one of the earliest stages of breast cancer – ductal carcinoma in situ (DCIS). Armed with a Grand Challenge award of £15 million and samples from the world’s three largest clinical studies of DCIS in the UK, US and the Netherlands, the team hopes to determine the differentiating characteristics of DCIS that progresses to invasive cancer, and that which does not, to address its significant overtreatment.
In addition to increased focus on early tumour biology, our aim is to support a wide range of disciplines from population studies to health policy research, and to support innovation and collaboration in the early detection field.
Our £5 million Catalyst Award provides international scientists in population research with an opportunity to team up and work together. We were excited to award the first Catalyst Award to CanTest – an ambitious international programme that aims to transform the GP office into a hub of diagnostic excellence for cancer, by assessing the accuracy, cost effectiveness and suitability of diagnostic methods for use in primary care. It also aims to leave a legacy – an International School for Cancer
Our Early Diagnosis Innovation Awards support multidisciplinary teams looking at ways to harness new technology to detect cancer earlier. We invited early-to-mid career researchers and healthcare professionals to a three-day ‘sandpit’ – an interactive, facilitated workshop where they formed new teams and developed novel research ideas. Five teams have been awarded with up to £20,000 seed-funding to conduct 12-month feasibility pilots of their groundbreaking ideas, which include using audio-technology to detect lung cancer earlier and using video-technology to raise awareness of paediatric cancers in healthcare professionals.
The challenge of early detection is a global one, and to accelerate progress we have joined forces with the Knight Cancer Institute at Oregon Health and Science University, a leader in precision cancer medicine. The partnership aims to address some of the barriers to studies of early cancer biology, such as a lack of early-stage disease models, shortage of tissue samples and the need for new technologies that can detect the earliest stages of cancer development. In 2016, we held a joint international Early Detection of Cancer Conference – a collaborative forum for international experts to come together and shape this priority research field.
We are delighted to be the US Cancer Moonshot Initiative’s first international partner, focusing on detecting early signs of cancer. In this joint endeavour, Professor Caroline Dive from the CRUK Manchester Institute will collaborate with Professor Peter Kuhn’s team at the University of Southern California to apply their combined expertise and technology in analysing circulating tumour cells to the study of patients with early-stage lung and bowel cancer. Evidence already suggests that circulating tumour cells and circulating tumour DNA could provide early warning signs of cancer relapse before it is detectable on scans in lung cancer, and if similar hallmarks are found in early disease, these markers could hold promise for the detection of primary cancer too.
The Sondland-Durant Early Detection of Cancer Conference
As part of our partnership with the Knight Cancer Institute at Oregon Health and Science University, in June 2016 over 100 researchers working in biomedicine, technology and engineering, from all corners of the globe, attended a three-day meeting in Oregon to discuss the complex challenges of early cancer detection.
The full potential of precision cancer medicine will only be realised when it is coupled with a sophisticated early-detection effort. We are committed to uniting researchers worldwide and ensuring the next generation of cancer detection becomes a reality.
Dr Brian Druker, Director, OHSU Knight Cancer Institute.
The programme included world-renowned researchers presenting overviews of the current state-of-play in their field, alongside opportunities for discussion and debate. Topics were wide-ranging within the early detection theme – from circulating tumour cells to the role of the immune system and microbiome in early disease. Academic scientists were joined by those at the frontier of commercial development of new diagnostic tests for early cancers, providing diverse perspectives on the challenges.
The breadth of speakers, strong scientific content and the intimate, highly collaborative atmosphere of the first meeting laid a solid foundation for what will now be an annual international event, jointly hosted by CRUK and the Knight Cancer Institute. The location for meetings will alternate between the UK and US, the next being held in Cambridge in autumn 2017, and have the aim of identifying new opportunities in the field and building on the relatively small early detection research community.
We are making full use of previously funded patient sample collections, through a partnership with Abcodia, a biomarker validation company that focuses on developing new blood tests to detect cancer early. The partnership makes use of one of the world’s largest prospective collections of serum samples available for biomarker research, from the UK Collaborative Trial for Ovarian Cancer Screening (UKCTOCS), which comprises more than five million samples curated at University College London and supported by CRUK and other organisations.
Our new Clinical Research ‘Statement of Intent’ outlines our plans to prioritise hypothesis-driven, data-rich, sample collections that support the discovery, validation and qualification of valuable biological information, ensuring we learn as much as possible from the patients on our trials. The pioneering UK TRACERx study, the first of its kind, is an elegant example of this. The study is following 850 people diagnosed with non-small-cell lung cancer from their diagnosis through treatment, and in some cases, immediately after their death. Six samples from different regions of a patient’s tumour, plus healthy lung tissue samples, pulmonary blood and three-monthly peripheral blood samples will be collected as part of this study, allowing analysis of individual lung tumours from early-stage disease through to local recurrence and metastasis.