Working out how to tackle hard-to-treat cancers is a real challenge.

Cancer survival has doubled in the last 40 years, but progress hasn’t been equal across all types of the disease. For some forms of cancer, survival has lagged behind – they’re hard to treat successfully and there has been little improvement for decades.

If you look at survival figures by cancer type, four types of cancer stand out in which survival has barely improved: lung, pancreatic and oesophageal cancers, and brain tumours.

In 2014 we launched our strategy – the plan for how we are going to reach our goal of 3 in 4 people surviving cancer by 2034. And a key element of this was tackling these hard to treat cancers, with a commitment to boost funding by two- to three-fold over five years.

But while increased investment is necessary for future progress, it’s not sufficient. Simply writing a bigger cheque isn’t enough. Progress also relies on a strong research community to join forces and come up with research ideas, based on an increasing understanding of the biology of these diseases. So tackling hard-to-treat cancers means understanding how these factors affect each other, and spending wisely to make the biggest possible impact. And that’s what we’ve set out to do.

Understanding the biology

One shared feature of all these hard-to-treat cancers is that there are some big practical difficulties in studying them.

For instance, they’re generally very fast-growing, so patients are often diagnosed at an advanced stage, when they’re very unwell. At this point, the cancer is likely to have spread. Combined with the fact the tumours are often in tricky locations (like the brain), surgery is often not an option, and so tissue samples are hard to come by.

And for researchers, this translates into a lack of tumour samples they can study to discover more about the faulty genes and molecules driving the disease.

In particular, the scarcity of tissue from patients with early-stage disease makes it difficult to untangle how each disease develops.

It also makes it harder to study the diseases’ genetic landscape, which is often diverse and complex, and the important role of the immune system and the surrounding tissue. And it leads to a lack of good ways to replicate human disease in animals.

And even when potential new treatments are identified, getting patients on clinical trials can also be problematic. The aggressive nature of hard-to-treat cancers all too often means that, by the time doctors have found a potential clinical trial and carried out the necessary tests, patients can be too unwell to join. Without enough people taking part in trials, doctors have no way of finding out if new treatments are more effective.

As well as these over-arching challenges, each of these four hard-to-treat types of cancer presents its own unique challenges, which we’ll be covering in detail in future blog posts.

A small, fragmented research community

For many researchers, these daunting practical challenges can make hard-to-treat cancers seem unattractive to work on. And this presents a further barrier to progress: compared with other cancer types, there’s only a relatively small community of research scientists focusing on lung, pancreatic, oesophageal cancers and brain tumours.

The small numbers of researchers means expertise is often thinly spread out around the world, reducing opportunities to work together and share ideas. There aren’t large conferences for them to attend to hear about the latest studies and network with each other, further slowing down progress.

And coming back full circle, the lack of funding and opportunities deters many young researchers from starting a career in the field, when they could focus on diseases where the opportunities are clearer cut.

More than just money

These two factors, challenging biology and relatively low levels of research into them, pose organisations like Cancer Research UK a ‘Catch 22’ problem.

To make sure we get the best value from our supporters’ donations, we only fund the best science – great ideas with the potential to make a big difference to people affected by cancer.

The way we fund research works by researchers applying to us to support their ideas to tackle cancer. So even if we were to say, “Right, we’ll spend £100m on lung cancer tomorrow”, a lack of high-quality research ideas from scientists to fund means there’s a risk this money would go to waste.

So how do we change this situation, and find new ways to treat patients who desperately need new options?

Time for change

We urgently need to speed up progress, but simply setting aside more money won’t achieve this ambition alone. So we’ve been working hard to find ways to remove these barriers and support the growth of the research community – especially more junior researchers to swell the ranks of future experts – so that there’s more high-quality research to fund.

And just two years after we set out to make a difference we can reflect on some significant steps forward.

To strengthen the lung cancer research community, we opened the Lung Cancer Centre of Excellence – joining up experts based in Manchester and UCL. The Centre helps create an environment in which they can share ideas, results and forge new relationships. And in December 2015 they hosted their first lung cancer conference, bringing together around 220 leading researchers from around the world.

Likewise, there is a renewed focus on other hard-to-treat cancers too. Thanks to our commitment to fund more research in these areas, world leaders like Professor Andrew Biankin (pancreatic cancer) and Professor Richard Gilbertson (children’s brain tumours) have moved to the UK. Conferences and workshops have taken place to both share ideas and network, and to brainstorm with world leaders about how best to tackle the challenges ahead.

And as we help revitalise the research community, we’re increasingly able to fund more large studies across these forms of cancer.

One of the most ambitious is our National Lung Matrix trial – a large precision medicine trial that’s testing new treatments in patients based on genetic changes driving each individual person’s lung cancer. And TRACERx, which opened in 2013, is our largest ever single investment in the disease, a study to track how lung cancers changes at the genetic level over time – crucial to help scientists figure out drug resistance.

In pancreatic cancer, we joined forces in 2015 with Stand Up to Cancer and The Lustgarten foundation to fund an £8 million international Pancreatic Cancer Dream Team of experts from the UK and US.

In brain tumour research, one of our recently announced Centres’ Network Accelerator Awards was given to Edinburgh to focus on gliomas – the most common type of brain tumour. They will be creating a large collection of lab-grown brain tumour cells taken from patients during surgery to tackle the problem of the lack of samples to study and boost research into the molecular and genetic causes of the disease.

And in oesophageal cancer we’ve boosted funding of the International Cancer Genome Consortium (ICGC) project to uncover the genetic faults driving the disease. Understanding the genetic mistakes could uncover different types of oesophageal cancer and shine a light on potential new ways to treat it. We’re also supporting the next stage of testing Cytosponge – a test to spot people with a condition that puts them at higher risk of oesophageal cancer – rolling it out in selected GPs surgeries across the UK.

The bottom line

So by creating a stronger, more cohesive research community, we’ve been able to boost the amount of money we spend on the four cancer types, in a way that’s likely to lead to tangible improvements for patients in the future.

In fact, when you put it all together, in the last two years alone the amount we spend on lung and pancreatic cancer research has more than doubled. And we’re continuing to work with brain tumour and oesophageal cancer experts to ensure we similarly boost the research in these types of cancer too.

But of course, there’s a long way to go. While we’re making big strides towards speeding up progress against hard-to-treat cancers, we won’t take our foot off the accelerator until this translates into a better outlook for patients. We need to keep them at the top of the priority list until more people survive these cancers.