Perspectives on oncology personalised healthcare: Malcolm Ranson (transcript)
In the build-up to pharmaphorum’s first round table video debate, due to be published at the end of September on oncology personalised healthcare, Paul Tunnah speaks with the first participant, expert researcher Professor Malcolm Ranson, to hear how it is already impacting on cancer treatment for patients.
This media accompanies the round table video debate ‘Oncology shaping the future of personalised healthcare‘, sponsored by AstraZeneca.
Ahead of the round table video debate ‘Oncology shaping the future of personalised medicine’, pharmaphorum will be releasing individual video interviews with the four expert participants. Below is the transcript from the video discussion between Paul Tunnah and Professor Malcolm Ranson, an expert cancer researcher and clinician, where he shares his views on how personalised healthcare is changing the way physicians view and treat cancer, plus the impact it is having on their patients.
(interview conducted July 2013)
PT: What does personalised healthcare mean to you?
MR: What we’ve really seen is personalised medicine / personalised healthcare as being something much more precise, it’s much more predictable. It’s often safer and can be delivered sometimes as a single agent. The expectation can be that personalised medicines can have high efficacy, but also reduce toxicity. So it really is, from both a physician and patient perspective, quite transformative.
“We have to think about tumours in a rather different way than we perhaps did in the past…”
PT: Does personalised healthcare mean we need to reclassify cancer?
MR: We’ve always accepted, I think, both diagnostically and implicitly therapeutically that cancer is very heterogeneous. So for instance PI3 kinase mutations may occur across multiple malignancies, and that may play into the therapeutics that we want to use. We are now understanding that that is not only between patients, but actually also sometimes within the same patients. And that transition of molecular change actually changes with a patient over time. So all of those features mean that we have to think about tumours in a rather different way than we perhaps did in the past when we were doing things much more empirically.
PT: How does personalised healthcare impact on specialisation?
MR: We have anatomical tumour specialists – breast cancer, lung cancer, colon cancer, etc. In the early phase part of development, then the expertise perhaps needs to be constructed somewhat differently. So we might perhaps recognise that someone is an expert in cell-cycle control or programmed cell death or angiogenesis. So I think that the way that oncologists view themselves inevitably will shift, but it differs between whether they’re in late-phase development and treatment and phase three; or whether they’re in experimental medicine, where science is still trying to be applied in a clinical setting.
PT: How well do current diagnostic processes support personalised healthcare?
MR: Typically at the moment, we will look at a very limited range of diagnostics and biomarkers at original diagnoses. But we need to look much wider than that in the future, and as I’ve mentioned before we need to look across the piece at different time points in the patient’s illness. And what that means is we need to be able to assess the biomarker; assess the molecular profile more easily. Perhaps sometimes we may not be able to biopsy the tumour, so we may need to look at blood, circulating free DNA, circulating tumour cells, other media into which we can gain molecular information.
PT: What is the main healthcare benefit of personalised healthcare for patients?
MR: Well it’s certainly about efficacy in the sense that in the situation where personalised medicine is successful, then rapid, sustained, durable responses can be achieved. Often in those circumstances, one can deliver treatment as a single agent and that means less toxicity and better quality of life. Treatment with the right personalised medicine in the right patient at the right time can really transform their lives.
“I’m very optimistic about the future of personalised healthcare…”
PT: What is holding personalised healthcare back?
MR: At the moment we’ve still got huge scientific gaps in our knowledge and to some extent we need to try and fill those gaps in as quickly as we can. We need to build the piece, in terms of that collaboration across all the organisations that are charged with delivering personalised healthcare in the future; and that’s pharma, academia, universities, healthcare providers like hospitals, biomarker development companies, bioinformaticians and geneticists. We need all of those partners to come together to address the needs and the shortfall that we have. Those partnership arrangements can be very synergistic, and they are beginning to gather momentum as we move forward. I’m very optimistic about the future of personalised healthcare and I think that patients will stand to benefit enormously in the future from it.
PT: How do we ensure all cancer patients benefit from personalised healthcare?
MR: There is the worry that we might leave behind tumour sub-classes or sub groups of patients in whom research is less successful or is more challenging. And we therefore need partnerships between industry, non-governmental agencies and universities to try and bridge those gaps. We don’t want to leave behind difficult-to-treat tumours like pancreatic cancer or lung cancer in developing personalised medicine, simply because they are less commercially viable for pharmaceutical companies. And that comes back to the issue of really making sure that there’s a partnership, and that the players are delivering it in the future.
About the interviewee:
Malcolm Ranson is Professor of Medical Oncology and Pharmacology at the University of Manchester and has been an Honorary Consultant at the Christie Hospital since 1995. He leads a team of clinical researchers at the Christie Hospital conducting Phase I clinical trials focused on apoptosis, cell signalling and biomarker development. His clinical work is closely aligned with the translational biomarker work of Professor Caroline Dive and the Clinical and Experimental Pharmacology group based in the Paterson Institute. He instigated and led development of the Early Phase Trials Unit at the Christie Hospital in Manchester which opened in 2003 and was its Clinical Director for 10 years. The Oak Road Treatment Centre is one of the largest early phase clinical research units in Europe and draws upon a large patient population and is part of the Manchester Cancer Research Centre. Malcolm is the joint centre lead for the Manchester Experimental Cancer Medicine Centre, funded by Cancer Research UK and the Department of Health to support and develop translational cancer research locally and nationally.
For more information about his work please visit the following pages:
Professor Malcolm Ranson at the University of Manchester
The Christie Foundation Trust Clinical Trials Unit
How is personalised healthcare changing cancer treatment?