Cross-border collaboration is crucial in cancer research because it fosters knowledge-sharing, accelerates innovation, and maximises the impact of research by leveraging diverse expertise and resources. However, it also comes with many challenges.
In this episode of The Cancer Researcher Podcast we’re joined by four renowned experts — the Director of EMBO, the Director of Research and Partnerships at Cancer Research UK, the Past President of the European Academy of Cancer Sciences, and the Past President of the EACR.
The guests discuss the complexities and benefits of cross-border collaboration in cancer research, emphasising the need for careful planning and understanding diverse funding models. They also explore the balance between discovery science and translational research, the importance of investigator-initiated and pragmatic clinical trials, and how such approaches can drive innovation and reduce healthcare costs.
Listen here, scroll down for the transcript and subscribe now via Spotify, Apple Podcasts, Amazon Music/Audible, Deezer or YouTube so you’ll never miss an episode. You can find all episodes and their transcripts here.
Our guests in this episode:
- Fiona Watt, Director of the European Molecular Biology Organisation
- Catherine Elliott, Director of Research and Partnerships at Cancer Research UK
- Anton Berns, Past President of the European Academy of Cancer Sciences
- Rene Bernards, Past President of the European Association for Cancer Research
And our host: Alexandra Boitor, EACR Scientific Officer.
Episode transcript
Alexandra: The topic we plan on discussing today is cross-border collaborations in cancer research and how they could be encouraged, facilitated, and managed. I’d like to begin by acknowledging the incredible progress done in the EU in the past 20 years in this respect, from the formation of the European Research Area in 2000 to having a dedicated Mission on Cancer in Europe in 2021.
I’d like to highlight to our listeners that they can find out more about the lessons learned and implications of the actions taken in the Molecular Oncology article published earlier this year, written by Professor Julio Celis and Professor Ulrik Ringborg, which we will link to in the show notes.
This being said, despite the incredible effort put in by various organisations, and despite the progress made in bringing researchers together with clinicians and unifying the cancer research and cancer care communities across Europe, the research community is still fragmented and there are still disparities that need addressing.
I’d like to start this conversation with the following question. What are, in your opinion, the key challenges in cross-border coordination and communication today?
Fiona: I think you’re right to highlight that there are some challenges. And these challenges aren’t necessarily specific for cancer research, but my reply is from a cancer perspective. So, one thing which is frustrating is that it can be difficult for researchers in different countries to obtain visas to go and visit one another. And that is disappointing. Another issue is that there can be restrictions on moving tumour samples between countries. And then a third issue I would highlight is that different scientists in different countries have very different attitudes to data sharing. So the issue of whether data should be freely available, or has some kind of national value that needs to be protected.
Alexandra: Thank you, Fiona. Is there anything else, other challenges, that anyone would like to highlight?
Catherine: I just wanted to pick up actually on your first point, Fiona, about visa costs. And I think as countries, sadly maybe the UK especially, are trying to reduce migration in a very broad-brush way. Visa costs definitely are an issue. So Cancer Research UK funds four research institutes. So we looked at the cost of those visas for our institutes. Just across one year they will go up by about 44% to £700,000 annually. And for us alone, that’s about 17 PhD students. So those visa costs are really significant for research institutes.
And I think, as you say, we need more global movement of researchers. Research is a very international effort, as I’m sure we’ll talk about a lot. So that mobility matters a lot and when I completely agree about the regulatory side of things, whether that’s clinical research, particularly clinical trials, data, tissue sample movement, you know the different jurisdictions really impose challenges on arranging that.
And then I think sometimes there’s a challenge, particularly on the clinical research side, around our different healthcare systems and what’s accepted as a standard of care, how the pathways work. So, when you get into the detail of how you deliver a trial or ethics approval or just the sort of pathway through a trial, different care pathways can be very challenging as well. And different resources, of course, which I think we’ll come on to for healthcare systems.
Anton: I might add that also the funding of these activities across-border are more complicated. And we know that there are good examples where that works very well. I mean, we have Synergy, ERC, Grand Challenges, and there are also some initiatives of charities that join forces to do things together. But overall that is still rather limited, and transferring funds from one country to the other is rather complicated. And I think what we are missing actually is sort of an overarching NCI, as we see it in the United States, that could sort of control this and also have sufficient funding to support research projects cross-border. And, in that regard, the problem I think Europe has is that there is not a really consistent entity that supports this. NCI has that. We lack that in Europe. We have all the programs, but they last not very long. And so they provide an impulse to research. Very useful, but they are temporary. And only those actions that persist in Europe appear to work.
And whether that’s EMBO, which is of course also a continuing activity, or EMBL, and there are entities in different countries. The ERC and the Marie Curie fellowships, I think that works. And one of the reasons is because they are a more permanent support, largely run by scientists, and that’s the formula that you really need. And I’m afraid that a lot of the initiatives that have been taken in the EU with that program, including the Missions and the Beating Cancer Plan, a lot of that is actually less effective than it could be, simply because it’s temporary.
Catherine: Just to wholeheartedly agree with that. And obviously, as the world’s largest cancer research charity, we do fund quite a large number actually, of those partnerships, but you’re absolutely right Anton, navigating them with different countries and different funding processes is really challenging. So one of the ways we address that is to have dedicated partnerships teams. Each of those initiatives, like say Cancer Grand Challenges or our International Early Detection Consortium, the Accelerate Awards that we ran with European charities. They all require an individual tailored approach to partnerships, contracts and agreements, which is very resource intensive, even for a large funder like ourselves. And I think almost impossible sometimes for smaller funders.
And as you say, every funder has their own restrictions about where they can fund. We can fund internationally, not all funders can. Some funders have to fund in their own countries. We all have different approaches, for example, to indirect costing, different approaches to reporting. And I think for the funders, that makes it quite challenging and long to set things up. And for researchers, I think often very frustrating probably to navigate. But to pick up your final point, I think things that are successful, we co-create with other partners and with researchers from the outset, so we get something that’s right for everybody and sustainable.
Rene: Yeah, I concur with everything that has been said so far. The visa issue is one. We often think of visas when we think about postdocs that want to go and work in a foreign country, but it also applies to postdocs that want to go to conferences in other countries. I have a severe problem with my Chinese postdocs that cannot go to any UK meeting simply because the visa process is very difficult to get them to go to a UK meeting. So very practical exchanges, short term stays, are simply impossible if you’re outside the Schengen zone. So that is a real concern.
And then, when it comes to cross-border funding, Anton already mentioned that there are a number of systems in place, but very often you have a desire to do a one-on-one collaboration with somebody in Switzerland, Italy, Spain, and there is no funding mechanisms to fund these one-on-one collaborations because the EU typically wants larger consortia, not one-on-one. And then you’re in a very difficult spot where I cannot apply to the Dutch Cancer Society or the Dutch government for a collaborative grant with a person in Spain, because they only want to pay the Dutch part, and the Spanish only want to pay the Spanish part, and then there is no system in place.
And I really hope that, for instance, the European Academy of Cancer Sciences, where Anton is part of, could help facilitate these cross-border funding opportunities, because I think science is becoming so much more collaborative, and there is hardly anything you can do just by yourself. We need to work together across-borders and every person you talk to understands that we need to work together and collaborate, but the funding mechanisms really don’t enable us too much to make that happen.
Anton: That’s absolutely true and I think we, the EACS, has been talking to charities and they all agree that they want to help to improve this but, you know, it’s not so simple because of all the regulations. And certainly, when it’s already briefly mentioned in clinical trials that becomes a completely independent problem with all the regulatory issues.
Here again I think, you know, it would be so wonderful if we had an overarching NCI in Europe. We have been talking with representatives of the EU and those that have inside information think that it’s almost impossible to get something going like that. Still, I would think that if you simply look at EMBO, for example, that’s precisely the organisation that has sort of the embedding that would be able to support that, because the EMBC, such an intergovernmental organisation, that’s what you would need to do that. We sometimes wonder whether it would not be possible that the EMBC would take on such an additional task for Europe next to what they do, for example, for EMBO. Is that a crazy idea, Fiona?
Fiona: It’s a great idea. I’m not saying it couldn’t happen, but for our readers, EMBO receives funding from, I think it’s 31 or 32 member states in Europe and also further afield and it’s funding in five-year cycles. But the challenge is that, well it’s not a challenge it’s very democratic. Each country has one vote, but all the countries have to agree on the budget every five years. And if you are representing a small country where your contribution will be small, it’s much easier to say yes, you need a budget increase than if you represent a larger country like Germany or the UK.
And EMBO definitely can encompass cancer research. If we were to try and make this happen, I think it would be important to define which of those countries would see cancer research as a priority, because I don’t think that you would have a uniform feeling that it’s important. I’d like to jump to something which is a bit different, but outside of Europe, EMBO has partnerships with a number of other countries, notably for example India. We have a lot of EMBO associate members in Japan and it’s interesting, dealing with funders in Japan, because there are different agencies and where it works with the Japanese agencies is to define a problem or a priority for that agency and then work together on delivering that.
So, that’s another way of doing it and I suppose just to wrap up, I would say EMBC is a great example of how different agencies in many different countries can come together, but if we were to push a cancer agenda, I suspect it would have to be a special project of a subset of countries.
Alexandra: From what all of you have said, I think it’s quite clear that there’s interest, at least from the researchers’ side, and a lot of effort has been put into starting this cross-border collaboration, smaller or larger consortiums, and there are indeed organisations like EMBO, Cancer Research UK, and some from the EU, that are helping start this collaboration.
As Anton highlighted, we in Europe probably lack an organisation such as NCI that oversees everything, but my question is, are there any systems in place today to try and facilitate and coordinate the activities that already exist. Are there any plans at least in place to try and unify these individual consortiums and collaborations that have been started. To try and ensure that it doesn’t all go in vain, like four or five years down the line when the funding runs out?
Catherine: On the first part of that, I think there are quite a number of international collaborations and consortia, particularly for looking at priorities and strategies. So for example, there’s the G7 for cancer. Of course, there are many initiatives within the EU. We talked about clinical trials and there’s ITCC for children’s clinical trials. UICC, I mean there’s many things. And in some ways, I think because we’re all trying to wrestle with this challenge, there is almost too many collaborative kind of strategy and priority setting groups, which all really want to achieve the same things. But because then when we get into the detail of how do we fund that, it’s hard to move from that agreement of strategic priorities into a mechanism for funding.
So that’s just my first thoughts on that. But some of those initiatives work very well. So particularly I think where we line up around priorities that all the members have in common, and we understand each other’s constraints and requirements. But as we said before, it takes a lot of time and resource to get there.
Anton: I think important initiatives which are also supported now by the EU is to establish comprehensive cancer centers. All the way through Europe because, you know, cancer research requires so much infrastructure and not a laboratory itself can afford. So you need these rather large entities with a lot of expertise in order to do decent cancer research, certainly when it comes to more clinical associated research. And so, it was already mentioned, but the OECI is one organising entity, but also the EU is now putting quite a bit of funds in getting the CCCs and a proper accreditation system, and also to create networks of CCCs that can work together and, for example, Cancer Core Europe is one of those which have been an initiative of researchers to work together. And why is that important? Because when, especially for clinical trials, more and more we will stratify patients to smaller and smaller groups. So in order to conduct such trials, you need large patient populations.
And that has to be done cross-border, otherwise these trials are never going to end. So, it’s extremely important that these collaborations are established. Unfortunately, there should actually be more oil in the system to support such collaborations. And that’s more or less missing still.
And, like I said, there are now some initiatives from the EU, and that will run for a number of years. But you need some sustainability in that system in order to, first of all, establish those centres and then keep them. And for the EU, it has been very important to establish such centres in less privileged areas in Europe. In doing that, of trying that, it will take many, many years before you have put this together and that way provide equal access to cancer care for a larger population in Europe.
Rene: Isn’t there a way to sort of establish a European Cancer Research Council, an ECRC that would operate along the same lines as ERC, but would in fact fund collaborative research grants.
There is a very interesting initiative from a US private charity called The Mark Foundation, and they fund the Endeavor grants that are clearly small groups, like three people that collaborate on a project, and they can be anywhere in the world. And that type of funding across Europe, I think would be a very much needed addition to our current funding schemes.
Alexandra: Just to echo Rene’s thoughts, I’d like to add that the EACR has a platform for researchers to find collaborators. We call it the Collaboration Tool, and it’s available to all EACR members. And we noticed a formidable interest from researchers to collaborate across-borders. Reading the calls on this platform often highlights some of the existing disparities, especially in terms of sample availability and resources, but it also highlights the willingness of researchers to help each other, to collaborate. And we managed to initiate a few collaborations through this tool. But, as Rene highlighted, what we lack is the possibility to offer them funding.
We can help them find each other, and we contributed in this way even to the formation of a consortium. But now the researchers need to apply for funding somewhere else. And if the collaboration they wish to establish does not have the size of a consortium, funding opportunities are truly limited, so funding schemes similar to the Endeavor grant that Rene mentioned, from the Mark Foundation, could indeed be very useful.
Anton: Interesting you say that, as it is precisely one of the actions that is being taken by Manuel Heitor. He was previous minister in Portugal, and he is pushing hard in order to do that in the next Horizon program of the EU to create an ERC equivalent for this type of activity. And we all hope and should try to stimulate or help that initiative in order to get it going, because as we know, the ERC is extremely successful and you could precisely do what you just said.
If you have sort of a permanent organisation, run by scientists, that provides that support and, I think if we all help pushing that, that would create momentum, maybe, in the years to come.
Catherine: It’s a really important proposal because we talked about actually the time and effort and challenge of setting up cross-border programs and often that means that we end up looking at big initiatives like Cancer Grand Challenges. But as I said, I think also those collaborations are most successful where researchers co-create and already have strong relationships and collaborations. And we need that sort of project funding to really start to build some of those collaborations and relationships.
So all of those aspects of funding are important, but you’re unlikely to get a group of funders for a short term project awards because, as we’ve talked about, the challenges and efforts involved. So a standing organisation that funds in that way, would be really valuable I think.
Anton: There is not necessarily an enormous amount of money involved. I see how successful some of the cancer center grants in the UK are. You know, they bring people together and this is supported by a few million a year in more local arrangement, but nevertheless, that helps already a lot.
And I have seen in the attempts of Cancer Core Europe to get going, that a few millions every year would have helped enormously to get it off the ground. So I think, you know, it’s not that there’s an enormous amount of money involved.
Fiona: I’d like to pick up on that because one of the schemes that EMBO runs, which cost the least amount of money per grant, is our scientific exchange grants, and they will stimulate cross-border visits for a short period of time. The success rate is very high. We recently evaluated the outcomes for the people we’d funded and they’re spectacular. So, at a level of saying, these two labs would really like to initiate a collaboration and this person will make that visit, it can be fantastic and it can generate the pilot data that you need for a more substantial collaboration.
So, I completely agree with Anton that sometimes the availability of small funding schemes can nucleate huge benefit further down the line.
Alexandra: Just to add on what you mentioned Fiona. We at the EACR are also impressed with outcomes of the travel fellowships that we offer in partnership with Worldwide Cancer Research, which I believe are similar to the scientific exchange grants you just mentioned. We support travel overseas, up to three months, in order for early career researchers to carry out a research project, or develop a specific research skill. In the interest of time, I’m not going to get into more details now, but if anyone is interested, they can check out some success stories in our online magazine, The Cancer Researcher.
I’d now like to move on and bring the conversation back to something we discussed at the beginning of our conversation. That there are some imbalances between different countries in resource allocation and availability of technology, some technological disparities, maybe even talent, resources and obviously medical, ethical issues. And I’m wondering when putting together these sort of systems that try to facilitate collaboration, if there’s a risk that these disparities would accentuate over time and if there are any measures considered to try and promote collaboration across countries, which maybe don’t strike as being equal in research at a first glance, just to try and avoid to deepen these sort of disparities.
Anton: I think there are some spurious initiatives, for example by twinning activities where institutes in, let’s say Western Europe, are connected with institutes in Eastern Europe in order to exchange and bring those centers up to speed. And obviously this is one of the goals of the EU Beating Cancer Plan to establish, let’s say, comprehensive cancer centers in less privileged areas. But again, that takes a long time and the other problem is that you have to incentivise people to go there and stay there. And if you want to build quality, it’s very easy for someone searching one of the Eastern European countries, if he’s very ambitious, to come to Western Europe, or to the U. S., and continue his work there, which might provide him with a better environment. So, one has to build infrastructures of high quality and support that in order to build that.
And, you know, it’s the only way to finally get also equal access to high quality care. If one assumes, which I think is the case, that comprehensive cancer centers, which combine basic and translational research with clinical care, is the right sort of environment in order to get optimal care development.
It’s a big challenge, and it’s absolutely true that that’s difficult to achieve. There’s only one thing though. Once you have these centers at a certain level, they can participate in clinical trials. As we said earlier on, it might be quite difficult to stratify patients and to get enough of them. And if those centers can participate and have sufficient infrastructure to do, let’s say, the work that is needed to enter patients in those trials, then they can become a very active participant. And so, in that regard, I think there are options to do this, but it’s a challenge.
Fiona: At an individual level, one thing I think is really important is to make sure that, as far as possible, an applicant from a country which may not have a big science base, has a good chance of writing a good application. Because, certainly within EMBO with the postdoctoral fellowship scheme, which is really competitive, we know that if you are in a lab that already has an EMBO fellow, chances of sponsoring another one, you know, the applicant is going to get a lot of help. So, we’re really trying to make sure that if you’re applying from another country, you have access to the practical advice that you need on how to write a good application. So, I think being aware of the advantages that you have by virtue of where you trained and where you want to go. We should really do our best to flatten that disparity.
Alexandra: On that note, the EACR has recently started a new initiative. I mean, new for us, but seems similar to what EMBO offers for their fellowship applicants. We have started mentoring EACR members from low and middle income countries that have a strong but not quite there application for the travel fellowships that I mentioned earlier.
Where previously these applications would have been rejected, now researchers are offered advice on how to make a stronger application and are invited to resubmit.
Catherine: I think even within single countries, like the UK, we have a lot of disparities and differences, for example, in success rates. One of the approaches we’ve used is to open up an observer scheme for our funding committees. And I’m just thinking actually, even internationally, there’s always hybrid access now to meetings. And I think, as you say Fiona, support with how you write applications, and some lens into how things get reviewed, what the committee discussion is about, can be really useful as well.
I think to your question at the start Alexandra, it’s also about, going back to my point about co-creation, meaningful engagement across countries, but also recognising what each country or center can bring to that co-creation. And you talked about the smaller countries in EMBO Fiona, and I think recognising as well that budgets of different countries are different. But then actually giving countries an equal voice, even when you recognise their budgets are different, or they may not have budget to support, but there’s in kind support. Through Cancer Grand Challenges, we support the SAMBAI challenge, which is based the UK, led from the US, but also involving Ghana and South Africa.
And I think that’s a really good example of that co-creation. Building on strengths in each country, not expecting each country to contribute the same, but also I think we’ve moved a long way from the model, particularly in Africa, where Western researchers go in, use samples, make findings, and then leave. And I think that’s absolutely wrong, and it’s about the capacity building, co-creating, but also recognising strengths and experiences that other countries will have that, for example the UK and US may not have. So, I think there are some really good models, but again it’s about being really mindful at the outset of what we’re trying to achieve and how we equally value and respect everyone’s contributions.
Rene: There is of course a lot of movement across Europe, east to west and south to north. More than half of my lab is from southern Europe, so we train a lot of highly talented people in northern Europe. I think the problem is that once these people are here, they don’t tend to go back, because the infrastructure for research is simply not up to par to what they get used to when they are here, and that is a big problem.
In fact, I saw that in the last round of ERC advanced grant allocations, that in Britain, there were a lot of ERC advanced grants allocated. But only a minority of those grants were by British citizens, mostly foreigners that got funded to work in the UK. So there you see how unsuccessful we are in training people in the North and then have them go back to their residence countries. And that is also a problem because there’s a lot of talent out there.
Catherine: I’m pleased to hear people still want to come to the UK and work with us.
Anton: But there is a solution to that, you see some examples. If you look at the CNIO in Madrid when it was established, which attracted a lot of Spanish people back. So, as soon as you establish an infrastructure and a funding environment that is attractive, then many of them are interested to go back to their country. I spent a few in vain years in Moscow to try to set something up before disaster started. And I thought it will be extremely difficult to get people there. But Russians would come back to Moscow very quickly as soon as you would provide the right environment because it’s still a population with their own culture and so on.
So, it’s out of necessity that they, sort of, stay outside their own area and it can be repaired quite quickly if you would take good action.
Rene: Agreed. You see that in Milan as well, where there’s good research centers where people want to go back to, and there’s a good infrastructure.
Alexandra: One of the other challenges that you’ve mentioned is funding and getting, and managing, research funding for multinational research projects. And I was wondering whether you could get into a bit more detail in what exactly are these challenges and how the organisations tackle these challenges.
Fiona: I could start with that. So the EMBC model is that the different countries agree on a budget, which is allocated to EMBO, and we spend it. And it’s important that it’s clear that everybody is putting money into agreed programs. It’s not putting this much money in to get this much money out.
I think that is one model. But if I go back to our experience with one of the Japanese government funders where we have a memorandum of cooperation. And then we say these are our priorities at this time. And we run the competition, but the Japanese funding agency specifies who is eligible and the topics to be covered.
Of course, that is more labour intensive for us, but it is a way of showing how this is stimulating cross-border collaboration. But it’s about defining what that particular funding agency wants, agreeing to it, and then moving forward. And I think both ways work.
Catherine: Yeah, and Rene alluded to this as well, it does depend which funders you have and what you’re trying to do. So again, it’s about that really careful planning at the outset and really understanding your partners a funder like EMBO doing this. I don’t think we can overemphasise how important those early discussions are, because particularly when there’s a great scientific idea, it’s quite easy to just think, let’s get on quickly and get everyone on board.
But it’s so important to understand some of those really detailed kind of logistical things. As Fiona said, one model is that you say, well everybody puts money into a single pot that flows out to researchers. And in some ways that’s an attractive model, probably easier for researchers because they get their money from one route, one report, hopefully fairly non onerous. But there can often be reasons why that’s just not possible. So, for example, talking about the NCI, you know, it’s often much easier for the NCI funds to stay inside the US. The approach to indirect costs is very different, for example, within Grand Challenges, across the different funders involved.
As we’ve alluded to already, some funders can only fund in their country, so they can’t put money into a single pot, even if some of that money will come back to their country. So there’s a lot of complexity in setting up those consortia, that’s well worth persisting through. And the more we work together, again, we all have different ways we’ve done this.
So there’s a lot of experience about how to do it. You don’t have to start from scratch, we have a lot of experience across different funders, that we can bring to play in that. But it’s often, I think, for some of the researchers we work with, it’s frustratingly complex, but organisations, particularly publicly funded organizations, have constraints that they can’t move beyond because they’re imposed by US federal government or the different European governments.
Anton: The other advantage of ERC, over some of the other activities, is that there is not a specific demand on an area. I think, you know, how basic research or ideas develop, don’t necessarily match with what is a specific goal. And it’s an increasing malady, I would say, that funding organisations start, more and more, to specify what area researchers should ask funding for because they think it’s important.
But frankly, funders don’t know what is important because the most important advances are made by accidental inventions or very smart ideas, and it’s very frustrating for investigators when you have a great idea that they have to hear from their funding agents, well if you had had this idea last year that would have fit in our program, and maybe in five years we have again such a call.
And we see this increasingly happening with different funding organisations, and it would really be great if we would primarily look at the quality and expect that that will be most profitable in the long run, rather than putting all these demands on what areas should be explored. I think all charities should take that message in and think about it, how valuable it is to put these restrictions on calls.
Fiona: I completely agree with what you’re saying, but I would like to give a shout out for Cancer Research UK because, in the many years when I was funded by them, I really appreciated the stability of the staff.
The problem in government is that people will move between agencies all the time. So they might be doing cancer research one minute, and it might be genetically modified plants the next. But if you have a situation where you know people working for the funding organisation are committed to the same thing. They’re not going to be experts, but they’re going to be field experts. It really makes for a good partnership. And otherwise it’s incredibly difficult if you’re dealing with a lot of turnover in the funding agency and massive shifts in government priorities. Scientists really struggle in that sort of situation.
Catherine: Another issue I would highlight is turnover of staff. When you’re working in partnerships, it’s all about personal relationships as well, isn’t it? I do agree with you, probably up to a point, as a large charity funder. I think our perspective would be that, in particular when we’re looking at discovery research, I couldn’t agree more.
I think that funders, and as Fiona said, we have some field expertise, but we’re not deep experts. And in discovery science, it is very much about broad, long-term funding. And that’s, for example, why we fund research institutes to enable very broad response mode discovery portfolio. Because I think that’s a very broad funnel, or hopper, that we shouldn’t be directing and saying here’s where the next ideas are going to come from. I think the flip side of that is there is a point sometimes, and Grand Challenges I guess is an idea where perhaps funders do add value by bringing people together and saying well actually what are the big questions. So we’re not going to dictate how you answer those questions, we want to see the best ideas, but we do have a sort of line of sight of what do we really think we need to address, whether that’s through the Grand Challenge type approach, or perhaps when we look at specific, questions. You know, how would we develop lung cancer vaccines where we’re partnering with other funders to work on that.
In fact, children’s cancer is a good example, where we see a real lack of effective, kind treatments, and we do need to re-focus and say, well, how can we build that? And we’ve just started a partnership called See Further, to try and develop therapeutics. I think as you get into that therapeutic development and clinical trial, maybe it does pay off for funders to be a little more directive about what we actually want to achieve. I think rightly not dictating how it’s achieved because we’re not the experts in that.
Anton: I agree with that and also when certain areas are underdeveloped, I think it can be helpful to stimulate those. I think Grand Challenges are a great idea because it brings together so much enthusiasm and focus. As long as one keeps this basic funding support in place, it’s fine. But that basic funding platform should be very substantial and not suffer too much from these, let’s say, directed actions.
Catherine: Yeah, and our strategy is very much focused on discovery at the heart of all we do. And we’ve really explicitly emphasised that to commit to the importance of that discovery science. But I guess it’s a charity focused on cancer outcomes. It’s about how do you bring that discovery into prevention, detection, and treatment. Often they can be a bit siloed actually, this world of discovery science and more translational into those outcomes. So we need to do more to bring them together and to do that internationally.
Rene: One of the problems that Anton mentioned, this sort of top down telling us what is important, is a real problem and I often see calls from the EU where I wonder where did that come from, who told them that this was important. And, again, I want to give a shout out to Cancer Grand Challenges. I’m on the scientific committee, but what we do is that we have consultation sessions with everyone in the field, right?
First of all, the Cancer Grand Challenge Committee is of course a committee of scientists that are working at the bench or direct labs. So we are in the middle of the field, but we also consult with all of our colleagues and then come up with the important questions that the field thinks need an answer, right?
It’s not a top down type of approach where some policy makers tell us you need to look at this, that, or the other. These are the concepts that the field feels are important. And, I think people can all relate to that because they were part of the challenge setting consultation rounds. Everybody is heard and that is, I think, how you should do anything that you do top down. You want to hear what the field has to say, and what the field wants to do, and where the opportunities are. And that’s exactly where I think Cancer Grand Challenges does an exceedingly good job.
Anton: I think that’s absolutely true and it’s a great mechanism to bring up important questions that have the support of the field.
Alexandra: Let me try and turn the question around a little bit. Do you think there’s still enough attention paid to promoting fundamental research, at the moment. Do you think there’s still enough effort paid into this from a political and financial perspective? It looks to me that in the past maybe 20 years, a lot effort has gone towards translational research and trying to implement basic research into the clinic, which is great and it was absolutely needed.
But, do you think there’s still enough attention paid to that basic, fundamental research to make sure there’s a continuous income of new ideas and new research for translational research?
Fiona: We will all agree, and I think we’re right, obviously, that both are important. So, as I said, we want to see that discovery, understanding of biology, pulled through into how might we prevent, improve detection, or treat cancer. And we would definitely recognise that that’s important, but at the same time, as I said, you’ve got to keep filling up the pipeline. I think one of the challenges can be for organisations that fund, or people that fund, on a slightly shorter timescale. So I’m not being pejorative, but there are different perspectives. So for governments, for example, who might be working on electoral cycles, or who are impatient to see improvements in health care. Perhaps sometimes for donors who’ve come from worlds where outcomes are seen very quickly, discovery science can seem slow and a bit frustrating, and people may think, well I’d rather fund the trial that gets the outcome that gets to patients.
And you talk to people, sometimes you’ll say, what’s going to happen? I want to see patient benefit within three years or within five years. And that discussion about, well you won’t necessarily get that from the sort of research that we do in the institutes, and across Europe and internationally, but you’ve got to have that research.
Anton: I think we have great examples why it’s important. And that’s illustrated by immunology. You know, when immunology was considered not to contribute anything to cancer, funding substantially diminished. It nevertheless went on and finally appeared to be a very substantial promise for better treatments of patients.
And then suddenly everybody realised we have sort of ignored that field and we need more immunologists. And so, yes it is important to maintain very substantial support for blue sky research because the most unexpected advances come from that and we all know numerous examples in the recent past that illustrate that.
So, it’s very important to maintain very substantial basic research funding, but also to think about how we do the translation, because we have not talked much about clinical research, but there we see major issues. And, you have to realise that 80% of the research budget in cancer comes from pharma and that mostly goes into clinical trials.
And I think that system is not working very well for a number of reasons. And I think what we are desperately missing is societal funding for academic, research clinical trials, so that there is more independent development of treatments and also a more careful assessment of their values in real world circumstances.
Rene: I think there is an opportunity across Europe to do multinational investigator initiated trials that could also deliver tremendous savings to the healthcare system. As one example, there was an investigator initiated trial that asked, do we really need to give one year adjuvant receptin to breast cancer patients? And there was a randomised trial between six months and one year. And the answer was six months was as good as one year, but you have less toxicity, right? But, that is not a trial that typically pharma would want to sponsor, but imagine the amount of funding that European healthcare providers would save. Now, across Europe, you use six months receptin instead of one year, and you can ask the very same question for one year adjuvant immunotherapy, right?
We don’t know whether that is required. It is now the standard and nobody challenges that standard. And the cost of this is like horrendous. So, if we could across Europe ask more questions that pharma would never want to ask, can we do less with the same benefit? There is a tremendous opportunity to save on healthcare costs.
Anton: Actually, the trial you refer to paid for itself because of that. And so it’s quite appealing. Drug dosing reductions or drug reduction trials are very promising, but also a lot of the trials that pharma supports are also a little bit Me Too trials, right? And so, what you would like to see is that there is more commitment from health insurance companies, because they pay for all the drugs. So if they would take a small percentage of their funding, or their resources, to fund these trials, that would be tremendously beneficial. And so the question is, how do you get these different systems and health insurance companies to join forces and put together a fund from which these European trials could be, supported. As Rene said, you don’t get support from pharma for that because it cuts in their income, right? So, it has to be an independent activity. A similar thing applies to drug combination trials. It’s extremely difficult sometimes to achieve that because of the ownerships of the different drugs. And here again, more European action in which there would be a resource of, different, drug compounds that could be accessed for academic trials would be very beneficial.
Catherine: Yeah, I think that’s a great thought. And those pragmatic trials are an area of great interest and, actually in reality, much cheaper than the sort of standard trials, because they can be done with a much more simple methodology and statistical design. And obviously the drugs are available, they’re not innovative products.
So, actually they don’t need the scale of funding that the phase three trials of new innovations do. I think there are some initiatives across Europe, Gustave Roussey involved in one, and some of the Dutch funders, which I think we should really look at whether we could scale those up.
Alexandra: Thanks for bringing that up. I think it’s a great food for thought that we can leave our listeners with, alongside other aspects and challenges of initiating and developing cross country collaboration that you’ve highlighted during the conversation. I think our discussion highlighted the need for improvement in some areas, but I think it’s reassuring that we’re all aiming for a well rounded global strategy. As you’ve stressed on a few occasions, cross-border coordination is crucial for promoting a culture of innovation and knowledge.
And this collaboration, especially in the last part of the conversation, should extend not only across-borders, but also across different sectors and industries involved in cancer research and cancer care. So thank you so very much for joining me on The Cancer Researcher Podcast and for giving our listeners so many important ideas to consider for the way that they prepare for their research in the future.
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References
Celis, J. and Ringborg, U. (2024), From the creation of the European research area in 2000 to a Mission on cancer in Europe in 2021-lessons learned and implications. Mol Oncol, 18: 785-792. https://doi.org/10.1002/1878-0261.13632
