3 Boys Searching for Life – Part 2

After visiting The United States in October, the next visit was scheduled in Cambridge UK. The three boys Peter Kapitein, Jan Gerrit Schuurman and Coen van Veenendaal ‘did’ Cambridge in just one day. The city of Cambridge is famous for its old University and the discoveries that were made on its grounds. One of the most famous is the discovery of the double helix structure of the genome by Francis Crick and James Watson, with the help of, not to forget, Maurice Wilkins and of course Rosalind Franklin, who was never properly rewarded for her crucial role.

We are invited to the CRUK Cancer Research Institute, located in the Li Ka Shing Centre. The very polite taxidriver drops us off right at the gate, and she wishes us good luck. We are again looking for the remnants of the impossible. Cambridge is a good place to continue our search for life.

Bruce Ponder’s secretary planned two meetings, one after the other. The first is with Carlos Caldas, who heads the Breastcancer lab. Then we meet Bruce Ponder and David Lane.

Carlos Caldas is head of the Breast Cancer Research Group of the Cambridge Research Institute of Cancer Research UK. Professor Caldas is educated in John Hopkins Medical Centre.

Sir Bruce Ponder was appointed Professor of Oncology, University of Cambridge in 1998 and appointed Li Ka Shing Professor of Oncology, University of Cambridge in 2007. In 2008 he received the Knighthood for ‘Services to Medicine’. From 2005 till present he is the Director of Cancer Research UK Cambridge Research Institute

Sir David Philip Lane is a Britisch Oncologist. He is best known for his work on the P53 tumour suppressing-protein. He was made a Knight Bachelor in 1999. In April 2007, Cancer Research UK has appointed Professor Sir David Lane as its first Chief Scientist. He is currently serving his 2 year sabbatical from the University of Dundee as the Executive Director of Singapore’s A*STAR Institute of Molecular and Cell Biology (IMCB) where he was appointed from 1 August 2004.

What follows is an intense debate, lead by Lane and Ponder, and intermittently clarified or illustrated by Caldas. The Brits are very conversational and the more we probe, the more enthusiastic they become. And we concur, of course.

As in the US, we ask four questions:

• How to proceed with cancer research?
• How to improve cancer research?
• How can we speed up to bring the knowledge from the laboratory to the clinic?
• How to judge the quality of cancer research?

We need not ask the questions. All they need is a signal, beginning with the how… questions.

The Cambridge turn
The conversations did not go as they went in the US. There is the platitude that Brits are more concerned with tradition than the Northern Americans are. And there is truth in this platitude. Not only do Lane and Ponder recount the stories of discovery, they converge on a set of interrelated themes:

• Education: a new breed of scientist-clinicians must be shaped. This is done so far in just a few places in the world. In the CRI of Cambridge, the Memorial Sloan Kettering Cancer Centre, Dana Farber Cancer Institute in Boston and The John Hopkins Hospital in Baltimore.

• Status: the future breed of professionals will need adequate support, to gain status and influence regarding both the direction that research should take, and to initiate new forms of patient-oriented treatment.

• Environment: Ponder, Lane and Caldas speak of a stable environment that enables the new breed of professionals to deliver new forms of high quality care (a hospital within a hospital, so to speak). In fact, they see that this environment permeates to publicity as well. Publishing ones work in the top notch Academic Journals is insufficient. What is needed is an outpour of research reports that tell the story from the lab to the bed and back!

At some point in the conversation, the remark is made that cancer research and treatment will require a different sociology. Hence the idea that we should focus on education, status and the working environment, including publishing about ones work.

The Brits love scandals-for the good!
Another element in the conversation did not turn up so far in the US conversations. It turns out that there are examples of treatment that show dramatic improvement compared to existing forms of treatment. But the way of working is so different from current clinical standards, that acceptance is low. Now comes the punch line: once you have shown that this new form of treatment (involving a more intense collaboration between patient, clinician and lab) is feasible, you cannot withhold it from the patient. Or you will risk severe criticism from the public! As Sir David Lane put it: ‘If we don’t execute what we already know, it’s a scandal!’

A cost paradox
What can be done now was virtually impossible 5 years ago (Lane). And what is crucial is that with more knowledge of the patient itself, treatment can be way more targeted. And very often, no new medication is needed! All you need is a detailed picture of biology of the cancer in one particular patient. This is complex, but with the present means, it can be done. Apart from the fact that you cannot withhold new forms of therapy that definitely benefit the patient, if the costs/benefit ratio goes up, there is little reason to keep working the old way. However, there is a paradox. At the beginning of the treatment, costs will definitely rise. The diagnosis and impact monitoring will be much more knowledge intensive. But the results are based on knowledge of the individual, not based on the effect-seizes determined by statistical samples, with little knowledge of the responsible biological processes in the individual.

Molecular management of cancer
A point made often and not to be missed is the following: the current breed of clinicians thinks in terms of Randomised Controlled Trials. Very few have sufficient understanding of the molecular networks of interaction that give rise to and feed the cancer. Remember this: unless the molecular basis of the cancer of an individual is understood, there is no way we will get cancer in control. This is exactly why the convergence of research and clinical practice is so crucial. No two cancers are the same and no two patients are the same. Its expression is different from patient to patient. Lane: ‘And your timing is fabulous: we have now very strong reasons to believe that cancer is becoming a manageable illness.’

The funding umbrella
Ponder makes one point with much force. Lane and Caldas reinforce his point several times. Put the funding of the research and the related treatment beneath one funding umbrella. Moreover, make sure that no funding substitution takes place. This is common anywhere. Some charity brings in money and next the traditional sources of funding are removed. The net effect is that the innovation does not benefit the patient, because all that happens is a systematic shift of costs to charities.

Conference Understanding Life!
We leave the gentlemen with an invitation for our conference Understanding Life! In januari 2011. Ponder, Lane and Caldas are pleased to be invited, express their support and say they will attend.

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