APPENDIX 29
Letter to the Committee Specialist from
Professor C R W Edwards, Principal, Imperial College School of
Medicine
You have already received a submission indicating
the benefits to cancer research accruing from the juxtapositioning
of our ICRF and CRC funded research. On reading through the paper
I was struck by the fact that little attempt had been made to
put this into a context that was easy for a reader who was not
aware of the recent changes in London medicine. I therefore asked
Professor Coombes to produce a revised version and enclose this.
I hope that this will be of value to your very important deliberations.
CANCER RESEARCH
AT IMPERIAL
COLLEGE SCHOOL
OF MEDICINE,
LONDON
Background
With the creation of the Imperial College School
of Medicine (ICSM) in 1997, we recognised that an important advantage
of developing a Medical School within a College specialising in
physical and chemical sciences would be that we could harness
these basic science groups to enhance cancer research within the
new Medical School. With this in mind we created the Department
of Cancer Medicine which is one of four departments within the
Division of Medicine. The Division of Medicine is in itself one
of nine Divisions within the Medical School. The Department of
Cancer Medicine has approximately 120 staff and is divided into
three sections one of which is Cancer Research Campaign funded,
the other Imperial Cancer Research funded and the third receives
joint funding from the Cancer Research Campaign and the Medical
Research Council. Shortly after the creation of the new Department
plans were put in place to unite all three sections of the Department
in a single building on the Hammersmith Hospital site. The reason
for this was that the new Cancer Centre which is a clinical facility
had been built on the Hammersmith Hospital site and in addition
the Hammersmith Hospital site has the largest scientific and clinical
science infrastructure of any campus in the United Kingdom with
more than 2,000 scientific and clinical staff engaged in research.
This move created a coherent department within a single building.
Shortly after the move efforts have been made
to try to co-ordinate cancer research within Imperial College
and the Imperial College School of Medicine. In order to do this
a Cognate Group entitled Cancer Studies has been established which
attempts to bring together individuals doing cancer research whether
or not they are within the Department of Cancer Medicine. This,
for example, includes scientists in Chemistry and Physics, basic
scientists in Biomedical fields such as those working in Biochemistry
on the South Kensington site of ICSM, and also surgeons and radiologists
who may be within the Divisions of Surgery and Investigative Sciences
respectively.
This new Cognate Group has now been established
and has monthly meetings. There are more than 600 individuals
within the Cognate Group, making it one of the largest cancer
research groups in the United Kingdom.
The Current Cancer Research Facilities
1. The integration of MRC/CRC/ICRF funded
research on the site in the principal ICSM Clinical Research Base
at Hammersmith Hospital.
Each Unit comprises approximately 45 research
personnel and they share specialist equipment and common core
facilities, as well as co-ordinating research strategy and clinical
trial protocols through a Departmental Research Committee of all
principal investigators. The presence of the MRC Clinical Sciences
Centre including the MRC/CRC PET Oncology Unit on the same campus
further enhances the opportunities for multidisciplinary research.
The ICRF-and CRC-funded investigators in ICSTM
are capitalising on the complementary strengths of the two organisations,
and the situations represents in microcosm how wider co-ordination
of the charities' portfolios might work to best effect.
Both groups have basic research aimed at target
identification in the areas of receptor biology, signal transduction
and gene transcription, and translational programmes to bring
these to the clinic through small molecule agents and gene therapy.
Advantage is being taken of the well developed machinery of the
CRC Phase I Committee and New Agents Committee to achieve this.
The increasingly important field of molecular pathology, for tumour/patient
profiling for selection and validation of new therapies, is well
represented and will interface with the ICSTM initiatives in genetics,
genomics and proteomics.
2. The identification of R&D funded
research and attempted integration of this research in London
by means of a "Pan Thames" Committee which has representation
from all major cancer centres in London.
The cancer services of the NHS Trusts in the
West London Network are organised on the basis of tumour site
specialisation and benefit from being academically led. The Hammersmith
Hospitals Trust is investing in a new Clinical Investigation and
Research Centre with excellent facilities for study of experimental
therapeutics in both inpatients and day patients.
3. The creation of a Cancer Studies Cognate
group within ICSM. This "Virtual Centre" has 110 team
leaders and 700 members, ranging from basic scientists to cancer
clinicians, and is the focus for co-ordinated cancer research
within the ICMS.
The National Cancer Institute
With regard to the creation of a National Cancer
Institute, the organisations within London University constitute
by far the larger conglomerate of cancer research and treatment
in the UK. This may provide the opportunity to create such an
Institute, by joining The Institute of Cancer Research with cancer
research at ICSM.
There is no overall co-ordination of cancer
research in the UK, with the exception of the UKCCCR which deals
with a fraction of the multi-centre clinical trials currently
ongoing. Such co-ordination would be desirable, particularly in
the area of translational cancer research.
The necessary bureaucracy involved in the animal
testing, and subsequent trials in patients is increasing, as is
the study of human cancer tissues. All these cumbersome regulatory
steps are a disincentive to clinicians to evaluate new agents
in the clinic.
This, together with the difficulty in identifying
specifically the sources of R&D funding in hospital Trusts
to support clinical trial activity, accounts for why more patients
in the UK are not entering clinical trials. Other major issues
revolve around the paucity of cancer specialists in the UK. Some
solutions to these problems have been sought by ICSM and the Hammersmith
Hospital Trust.
15 March 2000
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