Professor Rebecca Fitzgerald’s hopes for cancer research

On World Cancer Day, Professor Rebecca Fitzgerald, Founder & Director of Cambridge’s Early Cancer Institute, offers her hopes for cancer research this year. 

Cancer scientists are privileged to do experiments on living cells derived from patients to study cause and effect. We can also study the effectiveness of new diagnostic tests or treatments in clinical trials.

An unanswered question is why some people are more susceptible to specific cancer types than others and to what extent we can halt or reverse the process. For some cancers there is a strong hereditary component linked to a single gene and this makes a good starting point to tackle this question.

In 2024 we started an experiment to grow mini-organs in a dish from patients with a hereditary form of stomach cancer. We are altering the DNA sequence of one gene at a time, thanks to a gene-editing method called CRISPR, to understand what kills the cells with cancerous potential while leaving the healthy cells intact.

I hope that in 2025 we will learn what the key vulnerabilities are which we could target for a treatment. The idea would be to follow-up our leads with a clinical trial and this approach could be extended to other cancer susceptibility syndromes.

Clinical trials for new drugs typically involve small studies to test safety and efficacy followed by larger studies that randomise hundreds of patients to drug or placebo. For new screening or prevention trials thousands of patients are randomised to show a benefit.

In COVID-19 we became familiar with these sorts of studies, but whereas showing a benefit takes months for infectious diseases it takes years for cancer trials because cancer evolves over years before it kills the host.

In 2025 we aim to complete recruitment of a third of patients to a very large trial of 120,000 individuals to see whether our screening test can reduce the morbidity (treatment side-effects from late-stage cancer) and mortality from oesophagus cancer.

The test comprises a sponge-on-a-string cell collection device coupled with very sensitive laboratory tests to detect the pre-cancer state Barrett’s oesophagus. Of interest Norman Barrett from whom this condition is named was an undergraduate at Trinity College in the 1920s.

Taking a leaf from the COVID-19 trials we are contacting individuals to take part in a Heartburn Health Check via a text message from “NHSResearch” so that we can reach a wide range of eligible participants from across the UK. The simple test will be delivered in mobile units to make it as accessible as possible. https://www.earlycancer.cam.ac.uk/our-research/our-clinical-studies/best-4-trial

I await the time when screening will become the most common route for cancer diagnosis in future. Coupled with new vaccine technologies we might be able to pre-empt the gruelling chemotherapy and surgery combinations of recent decades.