The annual number of worldwide cancer diagnoses is expected to rise from 14 to 22 million by 2030. In addition to the human cost, cancer imparts a heavy financial burden, amounting in the UK to ~£16bn/year in health care, economic and other costs. Therefore, the overarching goal of the Cancer theme is to reduce the morbidity and mortality of patients with cancer by translating the wealth of laboratory research ongoing across Cambridge University into better ways to diagnose and treat cancer.
The NIHR Cambridge Biomedical Reseearch Centre (BRC) is comprised of 13 research themes and four cross-cutting themes. The cross-cutting themes of Capacity building, Clinical Research Facilities, Imaging, and Inflammation, infection and immunotherapeutics are embedded into the research, facilities and diagnostic work within each theme. Between them, the cross-cutting themes provide specialist knowledge and expertise across the whole of the NIHR Cambridge BRC, helping researchers to undertake and deliver the best research possible, while training and academic support is provided by the cross-cutting resource of Capacity building. This theme focusses on developing the next generation of clinical scientists and currently supports those clinicians wishing to pursue a career in biomedical research through PhD placements and research fellowships. Find out more about the NIHR Cambridge BRC research themes.
Our strategy will be to invest in key personnel and core infrastructure to underpin translational research in our four focus areas, while ensuring integration across related NIHR Cambridge BRC themes.
(a) Innovative diagnostics: Early detection technologies developed by Cambridge scientists and clinicians will be employed in collaborative trials involving primary care and cancer clinics. Examples will include: a 1:1 cluster randomisation of current care versus cytosponge among 4,000 patients with symptoms of heartburn suggestive of Barrett’s/oesophageal cancer; CAMPROBE, a device allowing novel integration of fusion imaging with out-patient local anaesthetic perineal biopsy for prostate cancer; and a study to detect tumour DNA in cervical smears of patients with early ovarian cancer. (b) Inherited cancer risk and its management: Together with our partners (e.g., Manchester Cancer Centre) we will continue to improve genomic testing and associated downstream clinical care pathways for families with increased cancer risk e.g. the ‘Tier one’ study. (c) The biology of early cancer: We will continue to advance understanding of the biology of early cancer formation by investing core support in the new ‘Capella Building’ adjacent to the CRUK Cambridge Institute. ‘Capella’ will unite scientists and clinicians studying normal and malignant human stem cells to decipher mechanisms that drive cancers.
Cambridge scientists have led the world in the development of molecular imaging. We will translate these approaches from the imaging lab to clinical trials in our Molecular Imaging Centre by focusing on four specific areas: (a) Innovative PET/MRI: Use of PET-MRI and hyperpolarised 13C MRI to better image and track cancer. (b) Fluorescence endoscopy: Detection of dysplasia in superficial epithelial cell layers e.g. in the oesophagus and colon. (c) Photoacoustic imaging: Real time imaging of tumour oxygenation e.g. in the breast. (d) Molecular Imaging Pharmacy: GMP-grade manufacture of imaging probes. The CCC has the only pharmacy in Europe capable of producing clinical grade 13C-labelled substrates for hyperpolarized MRI; we will supply ours and other sites in the UK.
We will continue to translate new cancer treatments from preclinical research to clinical trials through two main mechanisms: (a) Partnership with pharmaceutical/biotech industry: Leading biotechnology and pharmaceutical industrial partners are locating to Cambridge, e.g., AstraZeneca is building its new R&D world headquarters next to the CRUK Cambridge Institute with the express purpose of engaging the CCC in its drug development efforts. We will support ongoing strategic collaborations with this and other partners to rapidly advance novel therapies to the cancer clinic. (b) Innovative clinical trials: Novel cancer drugs developed in the CCC will be brought to patients through a programme of investigator-initiated early and late phase trials run from the NIHR Cambridge Clinical Trials Unit (CCTU), with a view to changing practice and improving outcomes.
This ambitious program is assessing, longitudinally, cancer cell clonal evolution and dynamics in individual cancer patients to capture heterogeneity in space and time and across interventions. The programme leverages the expertise and knowledge acquired through our other three focus areas to guide the use of molecular targeted therapies and provide critical insight into the mechanisms of treatment failure and resistance in cancer patients: (a) Dedicated support for Longitudinal Studies: We will invest in ‘core’ study support staff, based in the NIHR-accredited CCTU, to manage these complex, longitudinal studies. We will prioritise acquisition of repeat tissue biopsies for molecular characterisation, imaging correlations and single cell analyses and also crucially to obtain viable tissue that can be expanded in vitro and in vivo. (b) Cancer Molecular Diagnostics Laboratory (CMDL): We will further establish our BRC-supported CMDL that is generating CPA-standard, clinically actionable, genetic data including 250-350 gene panels in solid and haematological cancers as well as 15-25 gene panels of ctDNA to monitor tumour burden and response to targeted therapies. (c) Enhanced Blood Processing Capability: We will invest in high-throughput plasma processing for ctDNA and CTC technologies to allow expansion of these innovative studies to all common cancers. (d) Clinical Single Cell Analysis: We will use serial samples from studies in patients undergoing cancer therapy to profile at single cell level tumour cells, CTCs and immune cells. (v) High Performance Hub for Informatics: We will participate in a strategic partnership between the School of Clinical Medicine and the High Performance Computing Service to provide computational power for these longitudinal studies, and support for clinical pull-through of individual patient records in the NHS.