Engineering better outcomes
Advances in our understanding of genomics, imaging, novel therapeutic technologies and targeted drugs have dramatically improved our ability to treat cancer patients in the last 40 years. During this time, cancer survival rates have doubled to a point where 50% of diagnosed patients survive. Despite this progress, we have come only part of the way to supporting CRUK’s goal of curative interventions for over 75% of patients.
Decades of genetic analysis tells us that each patient’s tumour is both unique and dynamic, presenting the tantalising opportunity of delivering bespoke treatments which target the specific molecular abnormalities of an individual’s disease. Clinically, we believe the potential of this strategy has not been realised in terms of patient benefit because the cancer research community has focused too narrowly on;
- the testing of many of the targeted drug therapies in late stage disease, when the maximum degree of tumour diversity will be present, and the likelihood of cure is smaller;
- a focus on drug interventions based on only the genetic context of tumours;
- the lack of integration of novel agents with other interventions that hold significant potential to cure (interventional radiology, minimally invasive surgery and radiotherapy);
- reliance on a minimal range of diagnostic indicators prior to and during treatment to assess efficacy.
Our vision is to deliver better outcomes focussed on cure, through a transformation of the current clinical research paradigm. We are focusing on early stage disease; stratifying patients to select the combinations of therapies that give the best chance of cure and testing these prior to, or in the context of, first line curative therapy. Recognising the importance of the interaction between cell intrinsic and micro-environmental drivers of the malignant process, we have expanded the definition of personalised treatment to interlink multiple molecular and morphological data types, with functional imaging, to select the most effective combinations of novel interventions. Finally, we are applying these stratified approaches to monitor response throughout treatment and adapt treatment accordingly.
Drug and Cellular based therapies
We believe to effectively treat cancer we must embrace the inherent complexity exhibited by the range of diseases it encompasses. This means extending far beyond our enhanced understanding of the genetics of driver mutations, tumour evolution and redundancy in signalling pathways. The development of molecularly targeted therapies needs to exploit not only the particular genetic vulnerabilities of cancer cells, but also combine them with immunotherapies which hold the potential for curative treatments for many patients. Small-molecule drugs have proven a crucial tool in combatting cancer, but as our strategies and methods for targeting cancer cells increase, the use of biotherapeutic (e.g. antibodies and IMCgp100), cell therapies (e.g. DCvax) and viruses, offer potential for future development. Oxford’s strategy is to look for unique opportunities to derive insight drawing on existing, but historically not cancer focussed, expertise. Our philosophy is to provide an integrated route to clinic for all novel interventions and this enables us to develop and run combination studies and to look for synergies for multi-modal therapies.
Technology based intervention
We view integrating localised therapies as a cornerstone of delivering comprehensive precision medicine. These therapies are responsible for 90% of all cured cancers, and the development of both novel interventions and better strategies for use of existing technologies is essential to drive step changes in the quality of care cancer patients receive. These interventions however must also be effectively used in combination with advances in early detection, stratification and drug based treatment to ensure that the full patient journey is considered when delivering comprehensive precision medicine.
We have established a pipeline of interventional radiological, surgical and radiotherapy projects to ensure that these curative treatment modalities continue to evolve and deliver precise technical interventions that can further enhance the number and range of cancers cured.
Activity in this theme is led by Professor Constantin Coussios, the Director of the Institute of Biomedical Engineering, which is a focal point for interdisciplinary working between engineers, imaging scientists, biologists and clinicians.