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Study investigating targeted drug delivery by focused ultrasound for pancreatic cancer opens

University of Oxford researchers have begun recruitment to a study looking at whether chemotherapy medication can reach pancreatic tumours more effectively if encapsulated within a heat-sensitive shell and triggered with focused ultrasound.

The Phase I PanDox study, which is supported by the NIHR Oxford Biomedical Research Centre (BRC), aims to learn if using thermosensitive liposomal doxorubicin and focused ultrasound (FUS) results in enhanced uptake of doxorubicin in pancreatic tumours, compared to doxorubicin alone.

PanDox is being carried out as a multi-disciplinary collaboration between the Oxford University Institute of Biomedical Engineering, the Oncology Clinical Trials Office (OCTO),  Oxford University Hospitals (OUH) NHS Foundation Trust and Celsion corporation, the manufacturer of the proprietary heat-activated liposomal encapsulation of doxorubicin ThermoDox used in the study.

The Oxford BRC’s Co-theme Lead for Cancer, Prof Mark Middleton, Head of the university’s Department of Oncology at is the chief clinical investigator on the trial. Prof Constantin Coussios, Director of the Institute of Biomedical Engineering, is the lead scientific investigator.

The trial will recruit 18 patients; ThermoDox will be administered intravenously in 12 patients with a pancreatic ductal adenocarcinoma tumour that cannot be removed with surgery; the drug will then be released by gentle heating produced by focused ultrasound outside the body. This will be compared to conventional systemic delivery of doxorubicin without FUS in the other six patients.

As well as assessing whether uptake of doxorubicin is improved with FUS, the team will compare how the tumour responds to the treatment, examine the impact on patient symptoms and assess the safety of the treatment.

The study, which is expected to be completed by December 2022, is similar in design to Oxford’s 10-patient TARDOX study, which demonstrated that ThermoDox plus focused ultrasound increased doxorubicin tumour concentrations by up to 10-fold and enhanced nuclear drug uptake in patients with liver tumours. The findings were published in Lancet Oncology.

The lead oncology clinical research fellow on the PanDox study, Dr Laura Spiers of OUH, said: “Pancreatic cancer has a low five-year survival rate of approximately 10% and drug-based treatments remain less effective than in other cancers, in part due to the unique challenges presented by the stroma surrounding pancreatic tumours.

“Therefore, finding innovative and effective means of delivering high concentrations of anti-cancer agents such as doxorubicin may lead to a breakthrough for this difficult-to- treat cancer.”

Dr Michael Gray, lead biomedical engineering research fellow, said: “Based on the patient-specific treatment planning approaches developed and validated during the TARDOX trial, PanDox will deliver focused ultrasound mild hyperthermia without either MR-based or invasive thermometry. The ultimate goal is to develop a cost-effective and scalable approach that can be rapidly deployed for the benefit of pancreatic patients.”

T-cell landscape mapping identifies new targets for pancreatic cancer immunotherapy

Pancreatic cancer has one of the worst prognoses of any cancer, with pancreatic ductal adenocarcinoma (PDAC) patients having an average survival rate of 7%.

T-cells (the lymphocytes that play a wide range of roles in shaping the body’s immune response to cancer) are known to be less active in pancreas tumours. So far, checkpoint therapy trials, a type of immune-therapy that targets T-cells and have curative properties on other cancer types, have had minimal effect on pancreatic cancer with a response rate of only 5-10%. Furthermore there has been no lasting impact on a patient’s survival chance and current approved checkpoint therapies are focused on only targeting only two T-cell checkpoints, known as PD-1 and CTLA4.

In order to better understand checkpoint treatment has had a minimal impact on pancreatic cancer, and how to improve their efficacy, there is a need to understand the specific sub-populations of T-cells that are involved in pancreatic cancer. Even though we know T-cells exist in the microenvironment of pancreatic cancer, not much is known about why they are less active. There is also a need to identify new checkpoint therapy targets, beyond the two currently used, so that new, more impactful drugs may be developed.

A new study from researchers in the PancrImmune network at the University of Oxford, has characterised the immune landscape, and specifically the different T-cells, in pancreatic cancer patients, in the hope of understanding the features to aid drug development and novel therapeutics for this disease. This is the first comprehensive characterisations of T-cells in primary human pancreatic ductal adenocarcinoma.

The team looked at 32,000 T-cells from 8 cancer patients, to see if there were any unique T-cell subtypes in the tumour microenvironment. First, this data confirmed that the microenvironment of pancreatic cancer is extremely suppressive and could be a major driver of poor prognosis. Secondly, they have also identified important genetic components of these T-cell subtypes that may be driving this immunosuppression, which could be potential targets for future immunotherapy drugs.

Specifically, their observations showed an activated regulatory T-cell population, which was characterized by a highly immunosuppressive state with high TIGIT, ICOS and CD39 gene expression. The exhausted CD8 T-cells had lower PD1 levels but high levels of TIGIT and tim3. As well as the presence of a significant senescent T-cell population – this is when cells have gone down an irreversible cell cycle arrest and are no longer responsive to antigen stimuli.

This means that new potential checkpoint immunotherapy avenues in TIGIT, ICOS, CD39 and Tim3, that target these populations, may have more potential to improving the prognosis of pancreatic cancer.

The next step in this research is to take the newly-identified immunotherapy target and begin clinical experiments using targeted immunotherapy drugs. This may eventually lead to clinical trials to test these drugs in patients.

Mapping the immune landscape in PDAC patients is a huge step in pancreatic cancer research, as PDAC tumours represent 50% of all pancreatic cancer diagnoses. So new targets identified in this study has the potential to generate novel drugs that could benefit a large range of patients.

About the study

This study was co-authored by researchers in the PancrImmune Network, including  Dr Shivan Sivakumar (Dept of Oncology), Dr Enas Abu-Shah (Kennedy Institute of Rheumatology, Prof Mark Middleton (Dept of Oncology), Dr Rachael Bashford-Rogers (Wellcome Trust Centre for Human Genomics),  Prof Michael Dustin (Kennedy Institute of Rheumatology), Mr Michael Silva (University Hospitals NHS foundations Trust) and Mr Zahir Soonawalla (University Hospitals NHS foundations Trust).

New partnership enables access to state-of-the-art radiotherapy machine

The first NHS patient has received treatment on the cutting-edge ViewRay MRIdian technology, thanks to a new partnership between the University of Oxford, Oxford University Hospitals (OUH) NHS Foundation Trust and GenesisCare.

The partners, with the support of the John Black Charitable Foundation, have collaborated to establish a ten-year programme of clinical treatment for NHS patients, with further research into improving cancer treatment using the Viewray MRIdian.

Due to the natural, unavoidable movement of soft tissue inside the body, normal tissue around the cancer can be exposed to radiotherapy treatment, particularly when targeting soft-tissue tumours deep within the body. It can be challenging to visualise these organs during radiotherapy with routine radiotherapy delivery.

The ViewRay MRIdian machine is the only one of its kind in the UK, with only 41 machines worldwide. It allows doctors to see the normal soft tissue and the tumour in real time by combining MRI scanning with targeted radiotherapy. Incorporating MRI scans will allow doctors to then tailor doses in real time to the specific internal anatomy of the patient on the day of treatment.

MRIdian technology also minimises the damage to surrounding healthy tissues by switching off when tumour tissue moves outside of the targeted beam. This could mean less side effects for patients and increased dosage of treatment delivered directly to the tumour.

GenesisCare, the University of Oxford and OUH will also partner in research collaborations to develop real-world evidence which will inform future utilisation of the MRIdian technology in hard-to-reach tumours, such as pancreatic cancers. The research partnership will assess the benefits of the MRIdian technology in terms of improved cancer outcomes and reduced toxicity.

Elizabeth Rapple, from South Oxfordshire, is the first patient to use the machine to treat her renal cancer, as part of the new partnership. She says:

“I feel very fortunate to be able to access this machine as part of a new Oxford-wide partnership. Any operation to remove my tumour would have been highly invasive, so it’s lucky that my cancer was suitable for MRIdian radiotherapy. I am so grateful that this unique machine has been made accessible through the NHS, and that I can be the first of many to benefit from this partnership going forward.”

Project leader Professor Tim Maughan, from the University of Oxford, said:

“Treating patients on the MRIdian is like a surgeon putting on their spectacles for an operation – for the first time we can see exactly what the cancer is doing during treatment and adapt to change accordingly.  This accuracy allows us to reduce side effects and we hope to improve cancer outcomes in hard-to-treat cancers.”

Dr James Good, Clinical Oncologist at GenesisCare, said:

“The MRIdian machine is at the cutting-edge of what is possible in radiotherapy technology. The ability to visualise the tumour more accurately, to follow it while it’s being treated and to adapt the plan every day means we can deliver the best possible outcomes.

“This collaboration with the University of Oxford and Oxford University Hospitals will be truly beneficial for cancer patients in the UK. Not only will it provide patients who otherwise would have limited, or sadly, no options with a really viable treatment option, but we can also help demonstrate the effectiveness of this treatment, with the ambition to make it available for all NHS patients in the future.”

Carol Scott, Lead Therapeutic Radiographer & Deputy Clinical Director at Oxford University Hospitals , said:

“OUH are excited to be part of this collaboration offering NHS patients the opportunity to take part in these clinical trials. The use of daily advanced imaging that clearly shows us the tumour and normal soft tissue around it will enable us to take the next step in making our treatments even more personalised and effective”

“The Oxford Classic” classification system uncovers new information about ovarian cancers

In 2020, using single cell RNA sequencing, Oxford cancer researchers made a breakthrough by identifying  new types of Fallopian tube cells that are the cells of origin for the majority of ovarian cancers. They showed that that the types of these newly-discovered non-cancer cells are “mirrored” into different ovarian cancer subtypes. These subtypes correlated well with survival.

Discovering the new subtypes of cells have allowed Oxford researchers to classify and categorise tumours based on their origin in the body, and determine which ones can lead to more severe cancer outcomes – an approach which has been dubbed the ‘Oxford Classification of Carcinoma of the Ovary’ or ‘Oxford Classic’ for short. The Oxford Classic will provide much more accurate predictions for disease outcome in patients, as well as helping researchers to develop targeted therapies for each type of cancer

Professor Ahmed Ahmed, Nuffield Department of Women’s and Reproductive Health and originator of the Oxford Classic, has how published a paper in collaboration with Imperial College, demonstrating the applications of the Oxford Classic approach. As well as shedding light on some previously unknown information about ovarian cancers.

Professor Ahmed says:

“Our group is very excited that we were able to confirm the predictive role of the Oxford Classic. This work highlights that it is now important to identify new personalised therapies for the Oxford Classic-defined EMT-high ovarian cancer subtype. The finding that there is a strong connection with abundant M2 Macrophages already offers a good hint as to where we could find good treatment options for patients with this type”.

Serous ovarian cancer (SOC) is the most common cancer subtype, but is challenging to classify and predict its prognosis. Using the Oxford Classic, researchers found that specific SOC subtypes, known as EMT-high types, were associated with a lower survival rate in serous ovarian cancer patients.

Professor Christina Fotopoulou of Imperial College London says:

“This has been a very fruitful collaboration between two major UK gynaecological cancer centres; Oxford and Imperial College. We have generated very promising results towards an individualisation of care of our ovarian cancer patients. Our data will help clinicians to stratify patients to the right treatment pathway based on features of tumour biology of their disease. I hope we can continue to work together on that basis and expand and validate our data further also on a larger scale.”

EMT stands for epithelial-mesenchymal transition, it is the process by which epithelial cells change and become more mobile. This mobility provides the cells with the opportunity to spread leading to cancer progression. EMT-high subtypes are tumours that have a high number of cancer cells with greater mobility.

Researchers also found that EMT-high subtypes were associated with abundance of a type of immune cells called M2 macrophage. M2 macrophages possess immunosuppressive properties, and can lead to poorer treatment responses if they are found in high quantities within a tumour. It has previously been observed that patients with high-EMT tumours had a poor immune response. This study confirms that the EMT-high subtypes are associated with an immunosuppressive environment (and so poor patient responses to treatment) due to their association with more M2 macrophages – a link that has not previously been identified.

Whether M2 macrophages induce the EMT level or the EMT level results in higher levels of M2 macrophages will be an important question to be addressed by Prof Ahmed’s future work. However, this study has demonstrated the Oxford Classic’s strong ability to predict a patient’s prognosis.

Classifying the EMT status of a tumour, using the Oxford Classic, could potentially become a valuable part of future cancer stratification methods. This will ensure that appropriate treatment methods and attention are given to patients with a poorer overall prognosis.

Ovarian Cancer Action’s CEO, Cary Wakefield, says

“While other cancers have achieved major improvements in treatment outcomes, ovarian cancer continues to go unrecognised, underfunded, and misdiagnosed. The Oxford classic is an exciting breakthrough that will help to identify new treatment options for ovarian cancers that have a lower chance of survival. Funding important research like this will bring us closer towards a shared goal of more women surviving ovarian cancer”.

About the study

This study was co-led by Prof Ahmed Ahmed of the University of Oxford and Prof Christina Fotopoulou of Imperial College. It was funded by Ovarian Cancer Action, CRUK Oxford Centre and the National Institute for Health Research (NIHR) Biomedical Research Centre.

This study has demonstrated the potential of the Oxford Classic to:

  1. Accurately classify types of serous ovarian cancers
  2. Identify populations of cancer cells that have poorer prognoses (such as EMT high cancers)

Ahmed Ahmed is a Professor of Gynaecological Oncology at the Nuffield Department of Women’s & Reproductive Health at the University of Oxford and a Consultant Gynaecological Oncology Surgeon at the Oxford Cancer and Haematology Centre. His work focuses on surgical, medical and fundamental research into ovarian cancer, its early detection, treatment and screening.

Read the fully study here: http://clincancerres.aacrjournals.org/content/early/2021/01/12/1078-0432.CCR-20-2782

Innovative drug delivery techniques show promise in clinical trials

Pancreatic cancer has a limited response to chemotherapy treatment, due to the movement of anti-cancer drugs from the blood into tumour cells being limited by cellular mechanisms such as poor perfusion, high stromal content and raised interstitial pressure. One way to overcome these challenges and increase the toxic effect of chemotherapy treatment on a tumour would be to increase drug dosage. However, this would result in the damage of healthy non-tumour cells, and would likely result in unacceptable toxicity to patients.

The aim of Professor Constantin Coussios and his team in the Institute Biomedical Engineering is to develop of drug delivery system capable of enhancing drug penetration into and around a tumour, whilst minimising toxicity to the patient. The team has so far found a successful approach, by increasing drug uptake into tumours through warming of the body, which causes vasodilation.

By using focused ultrasound (FUS) to generate heat, only defined areas (approximately the size of a grain of rice) are targeted for treatment. In combination, chemotherapy drugs such as doxorubicin can be encapsulated in a heat-sensitive lipids (ThermoDox®), so that the active drug is only released when a specific temperature is reached at a specified location, as defined by the position of the FUS beam.

Research fellows Dr Michael Gray (Dept of Engineering) and Dr Laura Spiers (Dept of Oncology) have been working with the Department of Pathology in the Oxford University Hospitals NHS Foundation Trust, to help characterise the efficacy of this approach, by assessing thermal and acoustic ultrasound properties of the ex vivo pancreas.

This new knowledge will be directly applied to patients in the new early phase clinical trial, PanDox (targeting pancreatic cancers with focused ultrasound and doxorubicin chemotherapy). This builds on the successful TarDox trial, which already demonstrated FUS-induced heating resulted in improved delivery of the ThermoDox® encapsulated chemotherapy drugs to liver metastases from various primary cancers.

The effect in the TarDox trial was such that a positive response to therapy from the tumour was seen after only a single treatment cycle in 4 out of 7 patients, even in cancers as colorectal adenocarcinoma (which is not known to respond to conventionally administered doxorubicin). These results suggest that if the cytotoxic threshold needed to successfully treat a tumour can be reached, then a positive response may be achieved without unacceptable toxic consequences on the patient.

The upcoming PanDox trial translates this approach to patients with non-resectable pancreatic adenocarcinomas. It will combine focused ultrasound to generate heat with ThermoDox® delivered into the blood.

The main aim of PanDox is to determine whether this novel approach to treating pancreatic cancer can enhance the amount of drug delivered to tumours that cannot be surgically removed. Secondary aims will assess tumour response and procedural safety. The first patients will be recruited from early 2021.

About the PanDox Team

Prof Constantin Coussios, PanDox Priniciple Investigator, is the Director of the Institute of Biomedical Engineering. His area of interest is in the study of drug delivery systems and improvement of delivery into tumours.  He founded and heads the Biomedical Ultrasonics, Biotherapy and Biopharmaceuticals Laboratory (BUBBL), a research group of 4 faculty and some 45 researchers working on a wide array of therapeutic applications. He is also serves as the Director of the Oxford Centre for Drug Delivery Devices.

Dr Laura Spiers is a doctor of Medical Oncology. She is currently undertaking a DPhil in Oncology with the Institute of Biomedical Engineering, investigating ultrasound-enhanced drug delivery.

Dr Michael Gray is a Senior Research Fellow, interested in the clinical therapeutic potential of ultrasound.

Therapeutic potential for breast cancer found in the matrix

Work currently underway in the laboratory of Prof Kim Midwood is investigating the therapeutic anti-cancer potential of tenascin-C, a molecule found in the extracellular matrix of breast cancer

Using DNA & RNA to treat cancers

Cancer research UK Oxford Centre Development Fund Awardees Ysobel Baker and Tom Brown investigate the potential of DNA and RNA molecules as precision cancer treatments

Drug target potential for myelofibrosis

A new paper led by Dr Bethan Psaila, from the Weatherall Institute of Molecular Medicine (WIMM) of the Radcliffe Department of Medicine, has revealed a potential new immunotherapy drug target in the treatment of myelofibrosis.

Myelofibrosis is an uncommon type of bone marrow cancer characterised by gene mutations acquired in blood stem cells that lead to over-production of bone marrow cells called megakaryocytes, development of scarring or ‘fibrosis’ that stops the bone marrow being able to produce blood cells in adequate numbers, low blood counts and a large spleen.

At present, bone marrow transplant is the only potentially curative treatment for myelofibrosis, but this procedure carries high risks and only a small proportion of patients are suitable candidates for this. While drug therapies including JAK inhibitors can improve symptoms and quality of life, none are curative and these do not improve the bone marrow fibrosis. Therefore, there is a need to identify new targets for therapeutic development.

In a paper recently published in Molecular Cell, Beth Psaila and her team investigated a specific aspect of myelofibrosis, which is an increased frequency of bone marrow megakaryocyte (MK) cells. MKs are the bone marrow cell responsible for the production of platelets. While they are rare cells in healthy bone marrow, a pathogenomic feature of myelofibrosis is that they are observed in high numbers, and they are recognised as the key cellular drivers of fibrosis.

In order to better understand the cellular and molecular pathways leading to over-production of Mks and their dysfunction, the team used single-cell analyses, studying over 120,000 blood stem/progenitor cells individually.

This led to two key observations: firstly, that the proportion of blood stem cells that were genetically ‘primed’ to give rise to MKs was 11-fold higher in myelofibrosis patients than in healthy donors, and secondly that MK genes were being switched on even in the most primitive stem cells in myelofibrosis, suggesting massive expansion of a ‘direct’ route for MKs to develop from stem cells in myelofibrosis, a phenomenon that was almost undetectable in healthy bone marrow.

They found that the myelofibrosis stem/progenitor cells, but not the wild-type or normal stem cells, expressed a high level of G6B, a immunoglobulin cell-surface receptor protein. They validated G6B as an exciting potential immunotherapy target that might be utilised to specifically ablate both the cancer stem cell clone and the fibrosis-driving MK cells.

Dr Beth Psaila commented:

“The finding that G6B is markedly increased in the cancer stem cells is very important, as it suggests that targeting G6B in combination with a stem cell marker may be a way of selectively targeting the cancer-driving stem cells while sparing healthy stem cells.

“Identifying ways to knock out the disease-initiating cells is crucial to make progress in this disease, as currently there are no curative treatments available to offer the majority of our patients.”

Going forward, Beth and her team will be working on further validating their targeting strategy to see if it might be translated to the clinic.

About Beth

Beth is a CRUK Advanced Clinician Scientist at the MRC Weatherall Institute of Molecular Medicine. The primary focus of her group is on megakaryocyte and platelet biology in cancer, and the application of single-cell approaches to clarify the cellular pathways by which megakaryocytes arise from haematopoietic stem cells.

She trained at Clare College, Cambridge, Imperial College London/The Hammersmith Hospital, Cornell, New York, and the National Institutes of Health, Bethesda USA, Beth is also an Honorary Consultant in Haematology in Oxford and a Senior Fellow in Medicine of New College, Oxford.

This research was conducted in collaboration with Prof Adam Mead and Dr Supat Thongjuea in the WIMM, including using data that was generated by Dr Alba Rodriguez-Meira. The work was partially funded by a Cancer Research UK Advanced Clinician Scientist Fellowship, a CRUK Innovation Award; a Wellcome Career Development Fellowship and a Medical Research Council (MRC) Senior Clinical Fellowship.

New MSc in Precision Cancer Medicine

Cancer Researchers at the University of Oxford have launched a two-year, part-time, online course in Precision Cancer Medicine. The new course is an exciting opportunity for professionals from across the research, clinical and medical spheres to learn more about how to make precision medicine a reality.

About precision medicine

Precision medicine is a novel approach to patient care, which allows medical professionals to select specific treatments that are most likely to help with their cancer.

It considers the genetics of the cancer, the patient’s biology, environment and lifestyle, in order to guide disease diagnosis and treatment. It is also known as personalised or tailored treatment.

Most cancer treatments take a ‘one-size fits all’ approach, such as using chemotherapy drugs across the whole body to kill cancerous cells. Often these drugs do not differentiate between cancer and non-cancer cells in the body, which may cause unpleasant side effects that can have long-lasting implications.

By creating tailored treatments that target the specific cancer cells we can improve patient experiences of cancer treatment and reduce these side effects.

About the course

The new Masters course hopes to equip graduates with a multi-disciplinary understanding, beyond their own area of expertise, and prepare them for roles at the forefront of cancer medicine.

It will touch on areas such as cancer genomics, pathology, omics techniques, diagnostics, experimental therapeutics, onco-immunology, bioinformatics, ethics and health economics.

For more information about the course, see here.

New Era in Precision Medicine for Pancreatic Cancer

The development of new treatments for pancreatic cancer is set to be transformed by a network of clinical trials, aiming to find the right trial for the right patient, after a £10 million investment from Cancer Research UK today.

The investment will support the PRECISION Panc project which aims to develop personalised treatments for pancreatic cancer patients, improving the options and outcomes for a disease where survival rates have remained stubbornly low.

A team of researchers from across the UK, including Oxford Centre member Dr Eric O’Neill, aim to speed up recruitment and enrolment of pancreatic cancer patients to clinical trials that are right for the individual patient.

Dr Eric O’Neill said: “the overall goal for PRECISION Panc is to personalise cancer treatment for Pancreatic cancer patients based on their particular genomic background. Oxfords role is to assess whether radiotherapy offers a therapeutic advantage to molecularly targeted approaches for some of the more common pancreatic cancer subtypes. We will be working closely with our partners in PRECISION Panc to ensure findings are expedited into clinical trials to bring advantages to patients as soon as possible”

The researchers will use the molecular profile of each individual cancer to offer patients and their doctor a menu of trials that might benefit them. The first wave of research will establish the best way to collect and profile patient tissue samples. Each patient will have up to five samples taken from their tumour at diagnosis for analysis at the University of Glasgow. The results will guide clinical trial options in the future.

The three trials planned as part of this initiative will recruit a total of 658 patients from a number of centres across the UK – with the scope to add more trials in the future. Patients may also be helped onto suitable clinical trials that are already up and running.

Professor Andrew Biankin, a Cancer Research UK pancreatic cancer expert at the University of Glasgow, said: “PRECISION Panc aims to transform how we treat pancreatic cancer by matching the right treatment to the right patient. Because the disease is so aggressive, patients may receive no treatment at all or if they are given an option it will be for just one line of treatment, so it’s essential that the most suitable treatment is identified quickly. It’s important we offer all patients the opportunity to be part of research alongside their standard care.”

The programme will ensure discoveries from the lab rapidly reach patients, and that data from clinical trials feed back into research of the disease. Cancer Research UK’s investment will support two of the three clinical trials, preclinical work, assay development, biomarker work and the huge amount of molecular sequencing. The charity’s funding will also provide overarching support though project management, funding staff, and a steering committee.

Professor Biankin added: “PRECISION Panc has been developed over the course of three years through the unwavering commitment of pancreatic clinicians and researchers who see that the patients deserve much more than is currently available to them. I’m fully committed to this project and I believe we’re on the cusp of making some incredible advances which will provide therapeutic options to help people affected by this terrible disease. Without Cancer Research UK and their vision for cancer precision medicine, and the commitment of the other stakeholders, we couldn’t get PRECISION Panc up and running.”

Dr Ian Walker, Cancer Research UK’s director of clinical research, said: “This ambitious project marks a new era for pancreatic cancer. Little progress has been made in outcomes for pancreatic cancer patients over the last 40 years, and we believe that PRECISION Panc will reshape how we approach treatment development. Cancer Research UK is determined to streamline research, to find the right clinical trial for all pancreatic cancer patients and to ensure laboratory discoveries have patient benefit.”

Image copyright Dr Eric O’Neill, CRUK / MRC Oxford Institute for Radiation Oncology