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Big Ideas - Poor Outcomes Cancers

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10 October 2018
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In August, academics and clinicians with an interest in Poor outcomes cancers came together to workshop development of BIG Ideas for the Cancer CAG. The goal of this workshop was to identify major, ambitious projects and demonstrate their capacity to work together to deliver outcomes. The aim of the BIG Ideas initiative is to build 2-3 large, strategic projects for the SPHERE Cancer CAG to pursue over a 5-year horizon.

A summary of the discussion is below, including expert tips for developing BIG Ideas and bringing them to fruition.

BIG Ideas – Poor Outcomes Cancers
Members of the Cancer Clinical Academic Group ‘Poor Outcomes Cancers’ Area of Focus came together to workshop opportunities to drive positive change through BIG Ideas. The key questions for discussion were:

  1. What would you spend $10 / $50 / $100 million on?

  2. How would this save lives?

  3. Who is the best person in the world to lead this?

Introduction

BIG Ideas are something that will capture people's imaginations. They need to include some ‘romance’ to become long-term viable enterprises. They should leave a long-term landmark on our research environment. BIG Ideas need multiple funding sources. These often arise with short notice and can be via government, philanthropy, university or other sources. The Cancer CAG therefore needs an ‘ideas bank’ to roll out as spade-ready when opportunities become available.

Funding sources
Dr Alison Butt, Director Research Strategy Office at UNSW, provided an overview of key funding sources and considerations to be competitive. National and international programs support multidisciplinary, collaborative research including the Medical Research Futures Fund (MRFF), Cancer Research UK Grand Challenges and Stand Up To Cancer.  
The full PowerPoint presentation from Research Strategy is available here.

Philanthropy
Daniel Martin, Director Development for Medicine and Science at UNSW, gave an overview of how research can engage with philanthropy to achieve a shared vision.
The full PowerPoint presentation from Philanthropy is available here.

External and internal expertise

Prof Tim Shaw is Professor of eHealth and Director of the Research in Implementation Science and eHealth Group (RISe) in the Faculty of Health Sciences at the University of Sydney. He is the Health Systems lead on a recently successful Digital Health CRC bid. Tim gave an overview of his experience and considerations for others in developing and delivering BIG Ideas.   Tim Shaw’s PowerPoint presentation is available here .

Prof Chris Heeschen recently joined UNSW Medicine from the Barts Cancer Institute in London. He outlined his contribution to several international research consortia with funding ranging from $18 – 27 million. This experience brings significant expertise to the Cancer CAG Poor Outcomes Cancers area of focus and pancreatic cancer research specifically.

The Cancer CAG Executive leadership includes Prof David Thomas, Director of The Kinghorn Cancer Centre and Division Head – Cancer for the Garvan Institute. David spoke about his experience developing national  and international collaborations to improve outcomes for young adults with cancer and those diagnosed with rare cancers.

There were several take-home messages that featured in the presentations of all three speakers:

  • Start with the patient voice and a tractable area of unmet need that is hard to ignore,
  • Begin with a working prototype and develop a staged program with early surrogates for success,
  • Champions are needed who can focus on entity development and maintain momentum (over years) as well as a powerful advisory board,
  • Develop a compelling set of relevant, balanced and cash-contributing partners with international anchors,
  • Construct a public narrative (hope is an important driver) and early and professional marketing and
  • web presence

Existing strengths
Within Poor Outcomes Cancers our main strengths are in pancreatic and brain cancer research. The 
workshop identified differences in the level of workforce maturity and capacity between the two sub- groups. Pancreatic research is well positioned to initiate development of BIG Ideas at this time with an appropriate balance and critical mass of disciplines. Additional workforce capacity, particularly in the basic sciences, is needed to support brain cancer research. Through the SPHERE alliance, the Cancer CAG covers approximately half the patient population in NSW. This positions us well to initiate state-based programs as a pilot to bring impact to the local population and then scale nationally and internationally. An overarching and ambitious aim is to develop framework/s to allow 100% of pancreatic and brain cancer patients to be given the opportunity to take part in research. For pancreatic cancer patients, currently only 7% of patients are enrolled on a clinical trial.

BIG Idea #1: Brain Cancer time machine
Overview:

Pipeline to accelerate the delivery of the best therapies available now with integrated discovery

  •  Framework
    • Integrated and research-ready supporting data platform
    • Tissue, blood, imaging over time
    • Entire SPHERE footprint (and beyond!) for recruitment
    • Build capacity in basic science for brain cancer
  • Innovation areas
    • Therapeutic decision making
    • Tumour heterogeneity
    • Temporal change
  • Patient journey
    • Multi-disciplinary supportive care
    • Integrated treatment and contribution to discovery over the ‘lifetime’
    • Complete understanding - from atom to population

The next 12 months:

  • Work together to build a visible track record
  • Internally build capacity in platforms
  • Build upon a small clinical model – test feasibility and show that it really works

BIG Idea #2: Integrated Pancreatic Cancer Treatment and Research Centre
Core problem:

  • Poor long-term survival
  • Lack of early biomarkers
  • Chemoresistance
  • Immune microenvironment
  • Clinical trials need to be the drivers

What is needed:

  • One-stop-shop for longitudinal, preclinical models encompassing tumour initiation, metastasis and adjuvant settings to aid understanding of clinical observation / response
  • Comprehensive ‘omics’ (including metabolomics, radiomics, pathomics) and investigation of what predicts poor outcome
  • Investigate strategies to change the tumour microenvironment
  • Manipulation of the microbiome
  • Rationalisation and optimisation of treatment
  • Build in patient care/how people feel about cancer/psychosocial research

The next 12 months:

  • Further explore development of a Pancreatic Cancer Research and Treatment Centre
  • Identify clinical and basic science leadership
  • Build critical mass and strengths
  • Incorporate partners from QIMR, Melbourne, Uni Sydney and UNSW

Next steps
The BIG Ideas put forward for each sub-group will be further explored over the final quarter of 2018. This will start with development of a proposal outlining the BIG Idea and pathway that will then be further developed in meetings with a broader stakeholder group. 

Interested in contributing?
If you are interested in contributing to one of the BIG Ideas we have in development (or have others you think we should consider), we would love to hear from you.  Please contact us:

Prof Michael Barton
Principal, UNSW Medicine Cancer Theme
Lead, SPHERE Cancer CAG
michael.barton@unsw.edu.au (link sends e-mail)

Dr Tanya Ward
Executive Officer, Cancer Theme and Cancer CAG
tanya.ward@unsw.edu.au (link sends e-mail)
0478 492 184

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