Research Support and Progress in Cancer Control

Dr Sullivan reviewed the areas of research, starting with institutes such as the Beatson in Glasgow and the Paterson in Manchester, which are promoting basic science and biology into patient benefit. The Translational Research Committee is the bridge for the two. The Clinical Trials Committee oversees the single point of entry of all publicly-funded cancer clinical trials in UK. Then there is the Population and Behavioural Sciences Committee, which spans psychosocial, behavioural and epidemiological studies.

Clinical trials translation and basic research is part of CRUK's work. It spends about 170 million pounds in cancer research, yet there are many more high quality research projects that CRUK cannot afford. The CRUK strategy is to encourage mobility of funding and a balanced portfolio of research projects. People are hugely important, so funds are spent on recruitment and training, clinical centres, basic research priorities, service provision and technology transfer.

There are 'Alliances' - partnerships between MRC and CRUK, Wellcome Trust and Marie Curie - brought together in the National Cancer Research Institute (NCRI). The National Cancer Research Network (NCRN) has supported the infrastructure for cancer clinical trials, with CR-UK and MRC supporting the Clinical Trial Units. The National Translational Committee (NTRAC) co-ordinates therapies against cancer in the UK. A National Cancer Tissue Resource is also being set up, but there are ethical and legal problems to be overcome. International Alliances include the European Organisation Research and Treatment of Cancer. Where appropriate CR-UK collaborates with major European Institutes such as INSERM, and in the USA, the NCI, IARC, UICC and American Cancer Society.

In the UK we are spending 41% of the total cancer research budget on basic biology, and perhaps too little of it on prevention (2%), aetiology (16%), and early detection and spread 8%. Supporting and training people (clinicians and scientists) is vital and will continue to be a major focus for CR-UK's scientific strategy.

One example of how vital this fellowship support is translated into real patient benefit is work on the protein Mcm2's involvement in the cell cycle. This turns out to have potential as an identifier of bladder cancer. However, including the clinical trial it will have taken 15 years to prove whether this science is a diagnostic agent.

CR-UK supports many domains of scientific endeavour. For instance, many anti-angiogenesis agents are under study. There are many targets to inhibit angiogenesis, but it will take time to determine which are the ones that are important clinically. Non-invasive imaging must be developed further, as will how to integrate new drugs into other therapy.

Already localisation of radio-labelled antibody can be used to detect liver metastases, and there are new techniques combining radiochemistry with PET. Research into signalling pathways, which are much more complex than was previously thought, is under way. Also, can targeting of survival pathways kill tumour cells but not normal cells? Tumour cells may be very reliant on one or two survival pathways, and normal cells may use more. Novel drugs to remove these key survival signals may leave cancer-transformed, but not the normal cells, with a balance of pro-death signals. New signal transduction inhibitors may eventually be brought into clinical practice.

Cancer research is the biggest user of publicly funded clinical trials, many of which are also funded by industry. Large randomised controlled trials are mainly with existing drugs.

Prevention and early diagnosis.
This can be broken down into the funding of tobacco control and obesity. Obesity is an increasing problem here in the UK and is massive in the USA. Chemoprevention is a question of whether we should treat the 'healthy ill'. It is hugely expensive. The wide range of agents to choose from includes aspirin. Early detection is mainly through screening of breast and cervix. Evidence of the effectiveness of bowel screening is complete but using PSA screening for prostate cancer screening remains controversial.

The current political situation is a threat to progress. Other threats are a lack of money, and failing to develop research into real patient benefit. There are orphan research areas because of lack of interest. Socio-political threats include lack of leadership and failure to manage risk properly. The rising bureaucracy will kill research if it continues.

Finally, the establishment's resistance to new ideas must be overcome. A referee once commented that a report was 'a wild speculation based on faulty logic' - it later won the author the Nobel Prize. 'An outrageously expensive exercise in vanity' was the way one editor described the Human Genome Project.

Professor McVie suggested talking to non-medical scientists such as those in the British Aerospace Industry about medical research, because they are the people in the forefront of nanotechnology. Dr Sullivan replied that it is difficult to couple the two things and to peer-review the results. There is also the problem of getting people interested in prevention. Recruiting the required numbers is time consuming.

Dr Hannah Farmer, of the Institute of Cancer Research, London, then spoke of her work in the lab of Professor Alan Ashworth, in collaboration with Professor George Mosialos's group in Athens, into familial cylindromatosis, yet another form of tumour that might respond to aspirin treatment.