Forging a new model for cancer treatment

Republished from Abdul Latif Jameel Health Insights here.

A Q&A with Professor R Charles Coombes, newly appointed special scientific advisor to Abdul Latif Jameel Health

The latest special scientific advisor to join the Advisory Board of Abdul Latif Jameel Health is Professor Charles Coombes, a renowned world-leading authority on cancer, with a particular focus on breast cancer.  We spoke to Professor Coombes about his research, his new role at Abdul Latif Jameel Health, and his vision for the future of global healthcare.

As part of its mission to accelerate access to modern quality healthcare around the world, Abdul Latif Jameel Health is continually looking to build partnerships with the leading innovators, organizations, and researchers in the global healthcare industry.

Professor R Charles Coombes is Professor of Medical Oncology, Imperial College London, and Honorary Consultant Medical Oncologist at Imperial College Healthcare Trust.  

He is also Chairman of the International Collaborative Cancer Group – a multinational trial center (based at Imperial College London) focusing on phase II and III studies in breast cancer, among other senior roles in oncology.

A keen advocate of a cross-disciplinary approach to cancer research, Professor Coombes helped to establish the Convergence Science Centre at Imperial College in 2020. 

He also runs a translational laboratory which focuses on detection of micro-metastatic disease and application to the treatment of breast cancer. 

Could you provide a brief overview of your current work?

CC: One of the most important initiatives I’m involved with at the moment is the Convergence Science Centre, which is a strategic partnership between Imperial College London and The Institute of Cancer Research, London, that was initiated around seven years ago. 

The aim of the program is to bring together the science expertise of Imperial College across a whole range of disciplines to help people with cancer. 

The most common sciences used in cancer detection and treatment are molecular and cell biology and drug discovery, but it’s now widely recognized that this isn’t enough.  

To truly make headway with this complex disease, you need to leverage the latest expertise from other scientific fields, too, such as bioengineering, mathematics, physics, population sciences, computing sciences, and so forth, which have traditionally been neglected in cancer research.

This work was built on the fact that I’ve spent half of my career at The Institute of Cancer Research and The Royal Marsden Hospital in London, and half my career at Imperial College.  It seemed logical  that if we could bring together these two great institutions, both of which, combined, probably rank among the top in the UK – if not the world – in terms of cancer expertise, it could help us solve this problem.

Could you explain how the Convergence Science Centre works?

CC: It’s a sad fact that although cancer affects nearly half of us, in the West at least, it’s not easy to predict which person is going to develop what cancer.  And if cancer does develop, it’s not easy to predict how the cancer is going to evolve in the human body.  This uncertainty means we can’t harness new molecular treatments and diagnostic technology in the best way.  We now have blood tests and sputum tests that can detect cancer at an extremely early stage, and blood tests that can tell you how the cancer is evolving in the patient.  But until we have ways of enriching these technologies, we cannot refine them to be available to everyone in the world.  

The Convergence Science Centre helps to bring multiple scientific disciplines together to try and bridge some of these gaps in crucial areas, such as the extremely complex mathematics around genetics and DNA.

What are the benefits of this approach?

CC: Cancer treatment in the West is based on a set of rather toxic treatments such as radiotherapy  and cytotoxic chemotherapy, and so forth.  These are ill-defined and non-targeted technologies that as well as combating cancer, are also damaging to normal cells.  For the ‘global south’, the aim is to sidestep these, potentially rather harmful, treatments and go straight to the latest modern diagnostic and therapeutic approaches.  For example, artificial intelligence can define which patients need to be screened, and the type of cancer and the evolution of the cancer can all be diagnosed by  blood tests.  You don’t need complex radiotherapy systems and large healthcare infrastructures.  What we will need in the future are usable diagnostic technologies and targeted treatments that will enable us to avoid the sorts of damaging treatments that people have had to undergo to have their cancer treated over the last 50 years. 

The combination of easy diagnostics and then targeted treatment following surgery is the answer to improving the survival rate of cancer in the global south.

When did you first become aware of Abdul Latif Jameel Health?

CC: It is a name I’ve known for a while – an organization that I knew was interested in improving access to quality healthcare in emerging markets in the Middle East, Africa and Asia, which is an issue I care deeply about.  I regularly attend conferences and I’m invited to give lectures in locations across the world, particularly the MENA region, and Abdul Latif Jameel is a name that often comes up.  So, when the opportunity arose to get involved more directly, I was keen to learn more. 

In your role as a special scientific advisor, what do you hope to bring to the organization?

CC: I’m a cancer clinician and cancer scientist.  There is a big gap between what people discover in laboratories and how it’s brought into clinical use and then applied to patients.  This gap is often ignored, because scientists are always moving on to the next thing, the next stage in their research, to constantly refine and improve what they’ve done. 

It needs somebody like me at Imperial College to take what they’ve developed and say “I know you’re still working on this, but what you’ve got so far looks pretty good.  There’s nothing like it out there, so let’s see if we can use it to help people.”  It’s what I’ve been doing all my career.  I’ve been involved in developing new drugs for cancer, new diagnostic tests, mainly for breast cancer, for 40 years, and that’s what I’m aiming to continue doing through my role at Abdul Latif Jameel Health.

Abdul Latif Jameel Health has a particular focus on improving access to healthcare in the global south.  Is this important to you?

CC: Yes, absolutely.  It’s an issue I’m passionate about.  For example, I’ve lectured in Nigeria where there was a single cancer center with functioning equipment for the entire country of 160 million people.  I’ve been to many countries in the region where there is huge poverty, inequality, and a lack of diagnostic capability. 

As well as financial hurdles to overcome, there are often cultural ones, too, in terms of educating people about cancer and helping them to understand that it’s not something to be ashamed of or embarrassed about. 

What do you see as the biggest challenges for cancer research and treatment?

CC: I think education is the most important thing.  You could invest any amount of money, but without education it is only going to have a limited impact.  The first thing to do is to educate people about illnesses and what can be done about them.  The next priority is screening people at risk and introducing some sort of clear pathway for them to get help easily.  To a certain degree, a lot of this could be done remotely using modern technology.  The idea of people having to travel hundreds of miles and wait for hours in a hospital in the hope of seeing a doctor doesn’t work in the modern world. 

One thing the COVID-19 pandemic taught us is that communication across the world is much easier than we thought.  We should be using this to our advantage to make healthcare much more accessible in those markets that most need it.

How could technologies like artificial intelligence and big data help to improve this picture?

CC: These kinds of technologies are hugely important to the fight against cancer, and increasingly so. Artificial intelligence (AI) is sometimes spoken of as if it’s some sort of separate discipline, but it’s not.  It’s already integrated within the work that  I and many cancer researchers do. 

Half the scientists we employ now are specialists in AI.  Not just talented mathematicians, but people who also understand genetics, biology, cancer, who can bridge these divides and bring that knowledge together.  This is modern cancer research, and this is what the Convergence Science Centre aims to do. 

A single cell is probably more complex than all the computers currently available throughout the world.  Within a tiny teaspoon of blood from a cancer patient, there are more than a million fragments of DNA and RNA, all of which give information about the type of cancer they’ve got and how to treat that cancer.  But decoding that information and making it sense of it all is impossible without AI.  Working out which sub-populations have a greater propensity to develop cancer and therefore more likely to benefit from screening is another critical area where AI is essential.   And then of course, there are the families with a history of cancer where AI is vital for helping us to understand the genetics of cancer predisposition.

Another area where AI is essential is in terms of chemistry and target identification.  When, for example, a blood test shows there is cancer present and that it is growing and dividing by a certain type of factor, to build a drug to inhibit that you need to know the structure of the protein that the drug is supposed to bind to, to inhibit the cancer proliferation in that particular patient.  It’s extraordinarily complex and relies on AI at virtually every stage in the journey to discover a new drug. 

How has the pandemic changed the narrative around global healthcare?

CC: I think it has changed it in two main ways.  First, it has shown people that science can have a global impact.  There’s been a certain amount of cynicism about modern science among commentators before the pandemic, around climate change for example.  The pandemic has shown the massively positive impact that science can have and how it can improve health outcomes for people across the globe.

The second big change is that the pandemic has highlighted the inequality of healthcare between different regions of the world.  The proportion of people in the global south who have been vaccinated is still incredibly low, for example.

Within the field of cancer specifically, there is growing understanding that, in the same way that viruses evolve and change their genetics to overcome treatments, cancer does too.   People have become used to the idea of sequencing viruses and the same thing is true in cancer.  You need to monitor the cancer in the patient to predict what treatments you’re going to give the patient.  That’s very similar to the development of vaccines for mutated viruses. 

How do you hope Abdul Latif Jameel Health can help to improve this picture and address some of these challenges?

CC: I believe Abdul Latif Jameel Health has a fairly unique role in that it is interested in early diagnosis, and it seeks to bring the latest healthcare advances to underserved markets in the global south.  The Butterfly iQ+ handheld ultrasound device, for example, is an example of a technology that could make a huge difference in many markets though earlier diagnosis.   

Abdul Latif Jameel’s strong legacy in the region, its knowledge, understanding and existing partnerships, can also be a great advantage in getting these technologies out into the market and overcoming some of the barriers – often cultural and practical issues as much as financial ones. 

Looking ahead, how optimistic are you for the future of cancer research and cancer treatment?

CC: I’m biased, because in my area of breast cancer I’ve seen the cure rate improving quite dramatically throughout my career, so in that sense I’m very optimistic.  Of course, there are still big discrepancies in breast cancer rates across the globe, but overall, I’m hopeful that in 10 years we will have significantly improved the cure rate.

Other cancers, like lung cancer, pancreatic cancer, brain cancer, stomach cancer for example, are very difficult to treat, partly because they are diagnosed too late.  This is where some of these technologies around testing, screening and early diagnosis are vital.  These could change the face of cancer treatment, particularly in the global south, if we can apply them effectively. 

So, I’m optimistic, but it needs to be done on almost an ‘industrial’ scale rather than the piecemeal methods that have been used up to now.