Developing and integrating multi-modal techniques to predict oesophageal and gastric cancer behaviour

Mr John Findlay is a Registrar in his final year of training in Upper Gastrointestinal Surgery at the Churchill Hospital (Oxford University Hospitals NHS Foundation Trust) and an Honorary Clinical Lecturer at the Department of Oncology. John’s clinical and academic interest is cancer of the oesophagus and stomach, into which he is currently undertaking postdoctoral research in the Department of Oncology. This focusses on developing new imaging, pathological and molecular metrics and how these can be integrated and used to better predict cancer behaviour and patient outcomes from treatment.

Patients with oesophageal and gastric cancer are usually treated with neoadjuvant therapy followed by surgery. A range of treatment options is available, but all carry substantial risks and implications for patient quality of life. Furthermore, despite optimal treatment cancer recurrence remains common, suggesting the way we assess cancer burden and make decisions about treatment is overly simplistic, and does not represent what is increasingly understood to be very complex underlying biology. The success of these therapies is therefore very variable, however, in the absence of mechanisms to predict this, a ‘one size fits all’ approach needs to be taken. As a result, in hindsight many patients receive ultimately futile and morbid treatment (e.g. chemotherapy and then surgery), whilst others do not receive treatment which would benefit them.

John and his team are looking into ways of understanding why the success of treatment is so variable, and how it could be predicted better. Key to this is the philosophy of integrating data on cancer from different angles and at different time points, rather than viewing modalities, time points and markers in isolation. John is trying to generate and refine new markers of treatment success and outcome with an emphasis on integrating imaging, pathology and molecular techniques in conjunction with machine learning. John hopes this enhanced understanding of the underlying mechanisms will accelerate more personalised patient management, and the development of decision support tools for patients and clinicians to make better and more informed decisions.

In Oxford John is collaborating with the Department of Oncology (Prof Mark Middleton and Prof Fergus Gleeson), the Ludwig Institute for Cancer Research (Oxford Branch) (Prof. Xin Lu), the Big Data Institute (Dr David Wedge), and the Radiology Department of the NHS Foundation Trust Oxford University Hospitals (Dr Kevin Bradley).

Within the UK John’s collaborators are Prof Tim Underwood (University of Southampton), Mr Andrew Davies (Guy’s and St Thomas’), Dr Sheraz Markar (Imperial College London) and other fellow members of the Association of Upper GI Surgeons of Great Britain and Ireland and Royal College of Surgeons Upper GI Research Collaborative.

International collaborators include Dr Don Low  and Dr Fredrik Klevebro (Virginia Mason Medical Centre, Seattle), Ms Jessie Elliot (University College Dublin) and other fellow members of the European Society for Diseases of the Esophagus, Young Investigators Division.

John’s research is funded by the Oxford Biomedical Research Centre and CRUK.