APPENDIX 47
Letter to the Committee Specialist from
Dr Camilo Colaco, Managing Director, ImmunoBiology Limited
I am writing with regard to my recent conversation
with Guy Rickett to make some observations that may be pertinent
to the deliberations of the Committee. I should say at the outset
that I have no axe to grind as I do not work in cancer research
(though I did work at ICRF in 1983-4) and I am presently running
a biotechnology start-up working on infectious disease vaccines
which has no vested commercial interest in any cancer therapy.
I am a molecular cell biologist who has worked on the fringes
of immunology for many years and do know something about immunobiology
which is central to a number of cancer immunotherapy approaches
and thus have some knowledge in this area. I should say, however,
I do have a chip on my shoulder regarding cancer treatment from
a patients perspective as having been through the cancer experience
with a number of family and friends I would like to see the best
efforts in cancer therapy benefiting the patient as soon as possible.
The point of reference that I am using is that
though the primary aim of the exercise is to optimise the translation
of cancer research into clinical therapy, the ultimate goal of
the cancer research must be effective patient therapy and the
fresh look at cancer research should thus not be limited to basic
molecular research but include applied research that is primarily
concerned with therapy rather than basic science. This is particularly
relevant with regard to the questions of overall resource and
the organisation and co-ordination of research efforts; while
the funding of basic research is the primary focus of the major
charities such as the ICRF and drug therapy research has the option
of industrial sponsorship, cell-based therapies and in particular
patient specific immunotherapies are impossible to progress without
central funding from the NHS or the DOH. Thus if a public/private/industrial
collaboration is to be effective in achieving the ultimate goal
of successful cancer treatments, division of sponsor funding to
ensure adequate funding of all promising approaches should be
considered.
I should say that, in my opinion, the questions
regarding the centralisation, or not, of the effective co-ordination
of cancer research will not address the crucial requirement to
ensure that the goal of effective cancer therapy rather than vested-interest
drives the UK cancer research effort. One means of addressing
this issue may be to find ways of introducing more cancer patient/general
public involvement in at least the NHS and DOH input.
Finally, I would like to illustrate the above
points by briefly considering the situation of the approach of
patient-specific cancer immunotherapy which is currently being
trialled with significant success in Germany, Switzerland and
the US (see eg, Nature Medicine, March 2000, vol 6, p. 332) but
not in the UK despite our obvious strengths in the basic science
of immunology that underlies these approaches. While a drug trial
could attract industrial sponsorship (the company could produce
and sell the drug as in the case of Tamoxifen or Taxol), such
a cell-based applied project (as opposed to a basic science project
such as mutational analysis or even gene therapy) may get limited
funding from the CRC (only if run by a CRC principal investigator)
or the MRC (small clinical budget) but can only really be funded
from public funds such as from the DOH or NHS. This funding has
to be obtained against the backdrop of the unpopularity of immunotherapy
resulting from the failures of "magic bullet" monoclonal
antibody therapy (despite our scientific blindness to the fact
that cytotoxic T-cells and not antibodies are the most effective
anti-tumour response!) even for a fundamentally different approach
to immunotherapy such as dendritic-cell based therapy (eg see
Molecular Medicine Today, Jan 1999, p14). More importantly, clinical
application of such patient-specific therapy will require the
provision of some hospital infrastructure and facilities such
as GMP cell-handling centres (as required for bone marrow transplant
centres which use similar technology) and, given the promise of
this approach in the trials to-date, this need to be addressed
by government based bodies in the UK.
I would like to end with a few comments on specific
points on the TOR, ref. No. 6 and I would be glad to discuss any
of the above points further with members of the Committee:
— the adequacy or otherwise of the
overall resource in cancer research in the UK, including the roles
and policies of the MRC and cancer charities in cancer research
and clinical trials: adequate funding for basic science (eg ICRF
internationally leading molecular biology research, CRC funding
for cancer genetics) but poor funding for applied research;
— the effectiveness of the organisation
and co-ordination of UK cancer research efforts between the main
funders, institutions and regulators for the best cancer treatment
outcomes: MRC CCT good step in this direction particularly with
involvement of charities; could have more public involvement;
— barriers to taking forward basic
research into the clinic within and between institutions: dependent
on personnel and particularly heads of institutions;
— the number and distribution of centres
of cancer research excellence adequate; would more widespread
geographical distribution make a difference as dependent on personnel?;
— whether there is a need for a UK
National Cancer Institute: again would more central geographical
location make a difference as dependent on personnel? Could be
an argument for better/closer collaborations but travel/e.mail
make point mute?;
— the conditions required in the UK
to ensure industrial investment in development and clinical trials
of anti-cancer drugs: could benefit from tax incentives following
along lines of recent changes. Would not benefit approaches for
patient-specific therapy as not a commercially viable proposition;
— the suitability of the UK and European
regulatory regimes, and ethical approval process for anti-cancer
agents: suitable for drug trials but not cell-based therapies;
— the cost barriers to industry, universities
and research institutes of trials of new drugs and treatments:
industrial sponsorship for drug trials especially if tax benefits,
cell-based or patient-specific trials will need central public
funds;
— the suitability of NHS oncology centres
for the prosecution of clinical trials: don't know, large teaching
hospitals certainly have capability;
— the value and status of research
amongst NHS clinical oncologists: need to make vocation/patient
treatment more attractive goal than career advancement; and
— the application of NHS R&D funds
to clinical oncology research: central public funds needed for
present gap in funding sources for cell-based or patient-specific
therapies; need to consider provision and funding of infrastructure
requirements for providing therapies if present promise delivers.
16 April 2000
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