A vision of the future with C-Further

Give us your take on where we are around developing and producing interventions for children’s and young people’s cancer – is it fair to say there’s a market failure here?

There is certainly a lack of commercial incentives to push the current market to pursue the development of therapeutics for children.

Now, there are some innovative approaches attempting to overcome that. There are, for example, drug development companies focused on childhood cancers but who look for opportunities that can be backed up by an adult market.

A huge issue is the cost associated not only with bringing therapies to market, but also keeping them on market. For companies which are set up to make a return on investment, then there’s a challenge between doing what everyone knows is the right thing to do – to bring drugs for childhood cancer forward – versus the requirement to make that financial return.

And so, with C-Further we need to start addressing that. We need to figure out how we can make those financial constraints lower, to allow more people to work in this space. For me, that’s what C-Further is about – thinking about different ways that we can address those challenges.

Ultimately, we want to be able to make therapeutics for these rare cancers. I just can’t imagine being in front of a parent and saying that I can’t do anything for your child because their cancer is too rare, that that isn’t a position which any of us would want to be in.

There are alternative commercial incentive mechanisms in existence that try and change this, that are there to help create an environment of lower risk – are there any that could work for the development of drugs for children and young people?

I think it’s going to need a smorgasbord of incentives. There’s not going to be one thing that makes it work.

I think the priority review voucher in the in the US has been a really useful tool because it allows a swifter route to review – a vital hurdle in the approval of any drug. Anything that can speed up the process will inevitably also make it cheaper. And certainly, there are lot of positives that drug regulators already do in an attempt to support this – reducing fees, for example, giving scientific advice and helping these things go through. But for cancer in children and young people, obviously there is still a lack of drugs coming through.

Also, we see that many therapeutics approved for children are drugs initially designed for adult indications which only deal with a very small fraction of pediatric cancers. That’s often because children and young people’s cancers aren’t a mutationally driven disease, they’re a developmentally driven disease. And so, we need drugs targeted to address that specifically – which inevitably means bespoke therapeutics.

So, to drive more drugs to the clinic, we need to address the whole pipeline, from development through to market.

So, tell us about the C-Further consortium then. What is it? And what would you love to see it achieve?

Ultimately, it’s about driving impact for patients.

If we can get one drug into children that helps them – that improves treatment or gives them fewer side-effects – that will show there is a pathway to do this, which is the ultimate aim.

We’ll also look at the drug discovery process itself to see if we can speed that up – we need to ask: ‘Can we use AI and various other approaches out there now to do that?’

But in the shorter term, we are looking to convene the community. This must happen if we are to make progress. It can’t just be CRUK and LifeArc – we just do not have the capacity to do this alone. We’ve got to bring the community with us as there is a role for everyone.

We need the researchers so we can help them take their discoveries further forward, to get the impact they want. We need the organisations that have some of the technologies needed, whether that is the models or the facilities to do the drug discovery work. We also need other people that can bring their funding and their opportunities with them.

We need to build a portfolio of potential therapeutics. If you go for one drug, the chances are you’re going to fail. And hopefully that portfolio will lower the commercial risk such that some of them can actually be produced at scale and provide some return financially. And we must do that in a way that provides something that is affordable for health providers.

All that is a tough task, but we have a real opportunity with C-Further to convene the right people and organisations to do it. I really think it can be something that everyone can be a part of. C-Further is not LifeArc’s or CRUKs… it’s everyone’s.