Cancer futures

Rob Bristow is the Cancer domain lead and University Professor of Cancer Studies at The University of Manchester and Director of the Manchester Cancer Research Centre (MCRC). He explains what it was about Manchester that lured him from Toronto, Canada.

Why did you pursue a career in cancer research?

My initial training in Toronto was heavily weighted around mentorship by translational researchers who closely linked basic science and the clinic. The questions being posed to me and fellow doctoral students in the early 1990s centred on the tumour biology and genetics relating to resistance to chemotherapy and radiotherapy.

I had started to think about oncogenes such as ras and tumour suppressor genes such as TP53, and focused on trying to understand how these abnormalities led to cancer by placing these abnormal genes into model normal cell systems. This was hugely exciting to me during my PhD and concurrent medical specialty training.

Now we’re in a whole other realm – the era of the genome – which is also terribly exciting given the possibilities to link specific genetic changes to a patient’s outcome.

Across the planet, teams of scientists have utilised incredible technology to sequence many, if not all, of the major genes involved in the major cancers. I was lucky enough to be involved in the International Cancer Genome Consortium. The idea now is to put these findings into a clinical context so that we can understand who has an aggressive versus less aggressive disease to place patients into individual treatment pathways: a more precise way of cancer treatment with potentially less side effects overall. The same information can be used to understand how we can prevent cancer based on their bloodline (germline) DNA that gives signal as to whether an individual will be at risk for a specific cancer during their lifetime.

Knowing this, we can prevent cancers earlier on. Harnessing correctly all the information that genomics can bring to bear on a patient’s cancer and co-existing diseases (co-morbidities) will drive forward a new approach to patient care in Greater Manchester and indeed, the world.

Why did you choose to come to Manchester?

The University of Manchester is home to world-leading research led by experts spanning the full cancer spectrum, from work on cancer prevention and early detection through to molecular classification of patients into innovative clinical trials using radiotherapy, drug therapy or immunotherapy.

There is also important research on living with cancer with links to survivorship and preventing long-term complications of therapy. Of great appeal to me was the University’s strong links with local NHS trusts which means our researchers work side-by-side with clinicians, quite literally taking our research from the laboratory bench to the bedside and back.

The MCRC with its partners the University, Cancer Research UK and the Christie and other Manchester-based NHS trusts, together allows for collaborative programmatic approaches to genomics. We have a Genomics England hub that will in time link novel genetic tests to each patient when they come to clinic anywhere in the Greater Manchester Cancer Plan (GMCP) encompassing more than 3 million people.

Also at The Christie NHS Trust, there is a new collaboration with SAP, the applied business solutions company, to create a live clinical database where every patients genomics is linked to how they are doing with treatment and their side effects uploaded using their mobile-all being connected in time to the NHS clinical record. This will be a first real-world outcome protocol for the UK and a global lead in electronic data married to a patient’s genetic make-up.

When you are thinking about your own personal research strategy and having maximum impact, you ask yourself: where are the best environments to achieve what you want with your research? Manchester also leads numerous early phase trials at The Christie which tests the latest targeted therapies and increasingly uses molecular profiling to maximise patient benefit.

As a prostate and bladder cancer specialist, my personal ambition is to try and use a patient’s bloodline and tumour genomic secrets to provide information to access these novel trials for a bespoke treatment that fits them best. There are very few places globally that have married the genomics using both solid tumour and liquid (blood) biopsies before and during treatment to track success of a treatment.

The liquid biopsies can also be used within the GMCP to detect cancers quite early. This is a game changer, and we have a real ambition to build this into a world-renowned programme and collaborate worldwide to prevent cancer.

And so, the groundwork to realising my ambitions has already been laid out by the high ambitions of the fantastic basic and discovery scientists and clinical researchers in the city. Therefore, for my personal research programme, Manchester provided an opportunity to activate all concepts of genetic sequencing that we were doing in Toronto and bring it into the clinical realm of “real world outcome” in the NHS to directly impact patient care.

What were your first impressions of Manchester?

It’s a smaller city than Toronto, but a really exciting city to live in with the Northern Quarter and music scene, and the surrounding Lake District, Cheshire, Peak District and Wales within one to two hours’ drive. I can honestly say that I made many visits before I decided to take the role of MCRC Director, as the healthcare and research culture was different from what I was used to in North America.

What I wanted to understand was whether there was a willingness and ambition among colleagues here to embrace new models of research and new models of change in clinical practice.

You can’t just simply put in place what you want to enact based on your previous jurisdictions. Instead, what happens over time with continual questioning in the new environment is that you find novel ways to leverage your new role to achieve even more than was attainable in your previous environment.

What sold me on Manchester was the concept of building effective cancer research teams with a line of sight to the clinic, and a shared set of goals and roadmaps to get there. Best research is best clinical care and the best research can come from any jurisdiction.

In my final visits prior to joining Manchester, I realised that many people in different disciplines and from varied training backgrounds were open to creating dynamic research teams, which was fantastic.

What differentiates Manchester from other cancer centres?

Undoubtedly, Manchester is a global powerhouse of basic, discovery and applied research. Within the University’s cancer research beacon, the MCRC is branding itself as the virtual space in which the collaborative research is added value to current strategies.

I think we are collectively changing the way we think about cancer biology to either prevent, diagnose, treat, or minimise the side-effects of treatment. To my knowledge, there’s nowhere else in the world where cancer research is elevated and activated to such a high level based on the tripartite commitment of the University, Cancer Research UK and The Christie.

The senior leadership have aligned their goals to allow us to create something quite novel here and together embrace an ambition that breakthroughs will happen because Manchester wants to be the place to do it first. A little bit of positive competition never hurt anyone.

What are the immediate opportunities for cancer research in Manchester?

The replacement of the Paterson Building next to The Christie, which was home to a number of cancer researchers until destroyed in a fire in April 2017, affords us the opportunity to create one of the world’s top five translational cancer research centres.

All the research teams and synergies will have a new home, an exciting home for new ideas and new ways for patients to be involved in research. It will be the place to be for cancer team science in the UK and we know it will attract outstanding cancer research trainees to Manchester.

This multi-million pound development is being led by The Christie on behalf of the partners within the MCRC. The new building will be a magnet for attracting international researchers and building partnerships with other academic institutions and the pharmaceutical and biotechnology industries.

We know that by having doctors, nurses, researchers and scientists, all working together in one building, will accelerate the development of cancer research through to patient care on the ward.