Peter Johnson, CBE, MD, FRCP, FMedSci, professor of medical oncology at the University of Southampton and National Clinical Director for Cancer at NHS England, delivered the keynote address at SOHO UK, which centered on how the UK is strengthening its national infrastructure to expand access to cancer trials and accelerate research. In this interview, he highlights initiatives such as the Cancer Vaccine Launchpad and national prescreening networks designed to link smaller hospitals with major trial centres and speed patient recruitment into clinical trials.
What changes are happening across the UK to speed up clinical trial activation and expand prescreening so more patients, including those treated outside major centres, can access cancer trials?
The UK has enormous potential to run cancer trials all the way through from first-in-human up to large-scale, practice-changing trials and has a long history of doing exactly that. But many of the things that have made it more difficult, particularly for commercial partners, have been around process and activation. Since the pandemic, we have seen prolongations in setup times, slow delivery, and less well-networked systems than we would want.
What we have started to put in place, which is beginning to bear fruit, are systems for accelerating setup, building capacity at trial sites, and upskilling the cancer workforce for trial delivery. At the same time, we have set up a system of prescreening for much wider referral networks, ensuring that patients diagnosed and treated in non-research-intensive hospitals can nonetheless be considered for participation in trials through a two-stage process. They’re prescreened, and the relevant molecular diagnostics are carried out on tumour material or blood to allow them to be referred into trial sites where they might be suitable. It comes down to two things: the acceleration of experimental medicine hubs and the broadening of our reach to cast a much wider recruitment net through prescreening.
What is an example of how the NHS is using its national infrastructure to both widen trial access and speed up data collection for complex studies?
One example is a network called the Cancer Vaccine Launchpad, which we set up specifically to address the question of screening people for participation in personalised cancer vaccines using the tumour mutanome to construct mRNA vaccines, which is being exploited by BioNTech, Moderna, and partners. When we thought about how we wanted to do that, we recognised that we would need to streamline the process for going from tumour biopsy to nucleic acid extraction to sequence analysis to vaccine production to deliver that in a timely way.
We also recognised that for many common cancers, we would need to start that process in smaller hospitals, where the diagnosis was determining people’s eligibility for trials. We started this with a trial in colorectal cancer, where, if you looked at the proportion of the UK population that might be proximate to those trial centres having operations for bowel cancer, about 17% of patients were having a bowel cancer operation. By building the Cancer Vaccine Launchpad network for inward referral, we broadened that to 60% of the population. This huge expansion of potential eligibility allowed us to get more representative samples and to finish the trial a year ahead of schedule. It was an international trial, and once we opened this referral network, the UK was recruiting faster than the rest of the world put together. There’s a worked example of broadening prescreening and trafficking into clinical trials for people trying to do complex experimental cancer medicine.
In five years, how do you expect national prescreening and routine NHS data systems to change how quickly patients in the UK can access clinical trials and how studies are delivered?
In five years, we hope to have a national system for prescreening to determine eligibility for experimental cancer medicine, allowing the UK to give patients access to trials faster than anywhere else in the world. We will also have a national data system, which will allow us to derive the readouts, certainly for large-scale studies on the basis of routinely available data.
For trainees and early-career clinicians, what practical steps would you recommend if they want to get involved in clinical research early and understand how trial systems work?
Make sure you get involved early in your career in the conduct of clinical research so you understand the processes and regulatory requirements, which can seem a bit dry from a distance. If you engage with it early and understand how the systems work, you can start to work out solutions to the problems you encounter along the way.
How can the UK deliver trials faster and make them available to more patients?
This is an evolving landscape, but the UK is positioned to deliver trials more rapidly for patients. It’s possible to democratise and spread the availability of trials across the whole population. By being smart about how we devise our systems and how we link smaller and larger centres and networks of expertise, we can make trials widely available. This will have the benefit of offering participation to more people, gathering evidence more rapidly, and, as a very important spinoff for the UK, readying the system for therapeutic and diagnostic innovation. Often, routine service developments can be piggybacked off what we did in research studies.
Prof. Peter Johnson has worked for the NHS Trust since August 1998. He has been the chief investigator in multiple trials in lymphoma and immunotherapy, the National Clinical Director for Cancer at NHSE England, and was the chief clinician at Cancer Research UK from 2008 to 2017. In 2016, Prof. Johnson was appointed CBE for services to cancer research , and in 2017, he was made a fellow of the Association of Cancer Physicians.
