Cancer is at one level a fundamental problem in biology. At another, it is a practical clinical problem that throws up challenges across the whole spectrum of medicine. The approach to both the biological and the clinical problem increasingly requires complex techniques, for example in genomics and in imaging, and behind them, expertise in chemistry, physics and mathematics. The juxtaposition of Addenbrooke’s Hospital, including the Clinical School and Regional Cancer Centre, with the science of Cambridge therefore provides an exciting environment for cancer research.
Recognising this potential, over £70m has been invested since 1998 in the new buildings for cancer research on the Addenbrooke’s site (Strangeways, Hutchison/MRC Research Centre, Cancer Research UK Cambridge Research Institute (CRI) ) and annual peer-reviewed cancer research funding in Cambridge is over £40m (mostly from Cancer Research UK).
The largest concentration of cancer research is in the CRI. CRI opened in 2007 and is still recruiting: when complete it will contain 30-35 groups with some 350 bench researchers. The main ‘basic’ research themes are epithelial cell biology, tumour microenvironment and gene regulation; these are supported by substantial programmes in cancer genomics, molecular imaging, bioinformatics, mouse models and experimental pathology; these programmes in turn underpin several research programmes on specific cancers, that link to the clinic. Currently these are in breast, lung, ovarian, pancreatic and prostate cancer, and in early phase ‘experimental medicine’ clinical trials. The Hutchison/MRC Research Centre, opened in 2001, has 140 bench researchers focussed principally on DNA replication and repair and cell cycle checkpoints, and on early detection of epithelial cancers, notably cancer of the oesophagus. It also houses the Cambridge Molecular Therapeutics Programme, focussed on new approaches to drug discovery. Both CRI and the Hutchison/MRC Research Centre have many clinical scientist group leaders, and many clinical research training Fellows.
Haematological cancers are the focus of programmes within the Cambridge Institute of Medical Research and the Department of Pathology within Addenbrooke’s; there is also significant mainly clinical research into other cancer types including brain, melanoma, kidney and cancers of teenage years.
Cancer epidemiology is strongly represented in the University Departments of Public Health and of Oncology, based in the Strangeways Research Laboratories. There is leading research into genetic susceptibility to breast, prostate and ovarian cancer and an MRC Unit in nutrition and cancer. A component of the Europe-wide ‘EPIC’ cancer and diet cohort (totalling 500,000 subjects in all) is based here.
There are strong interactions with many departments in the University and beyond, including Chemistry (joint PhD programme), Applied Mathematics (joint M.Phil), Physics, Engineering, the Gurdon and Stem Cell Institutes and the Sanger Institute; and with local biotech. These are catalysed through the Cambridge Cancer Centre, an overarching programme which provides an annual symposium, small meetings and pump priming funding for new inter-disciplinary projects.
Successful application of the results of this research requires an excellent clinical service and clinical research environment. These have been built on a strongly multi-disciplinary basis, bringing together not only medical and radiation oncology, but cancer surgery, pathology, imaging, palliative care and organ-specific specialists, for example, in respiratory medicine and gastroenterology. Cambridge is thus a ‘cancer centre’ rather than an ‘oncology centre’. Patient accrual to national phase 3 and phase 2 trials of treatment within the West Anglian Cancer Network based in Cambridge is amongst the highest in the UK. Intensive, small, experimental medicine studies, biology based and with genomics and imaging endpoints, are being built up in collaboration with major pharma companies and with biology input from local researchers. Substantial refurbishment of clinic space has been achieved to accommodate the needs of clinical research, for example the opening in 2008 of a £2m purpose-built clinical research Unit integral to the dedicated clinic space for the Breast Unit. Further developments are planned.