Beating cancer: ambition and action

10. Research

Our Ambitions

To embed research in the ethos of our healthcare services.

To give individuals access to, and opportunity to participate in, clinical trials appropriate to their circumstances.

To support a clear programme of research targeted at improving outcomes and/or experiences of cancer.

Research is essential to enable developments to improve cancer prevention, diagnosis and treatment.

Through its own response mode grant schemes, and co-funding arrangements with the National Institute of Health Research, cancer research charities, and Research Councils, the Scottish Government Chief Scientist Office (CSO) provides funding opportunities for the academic community in Scotland for research into the prevention, diagnosis and treatment of cancer.

Through investments in the NHS Research Scotland infrastructure CSO supports clinical research networks, data safe havens and accredited tissue biorepositories to facilitate recruitment to cancer studies and the use of tissue and health data in cancer research. In addition, recent large-scale strategic investments in genomics and precision medicine (see below) provide new opportunities for cutting-edge research to understand better the genetic and molecular profile of cancers and the support the development of new more effective diagnostic approaches and treatment strategies targeted to individuals.

We know that a research-active health service delivers better outcomes and we are working to embed research in the ethos of our healthcare system. Individuals benefit through access to novel therapies and the ongoing implementation of evidence-based best practice. In the longer term, research provides understanding of the causes of cancer, leading to benefits at the population health level.

Recent advances in the understanding of cancer biology have allowed many cancers to be stratified into sub-types based on their genetic profile, meaning that individuals are beginning to be offered more personalised treatments tailored to their particular tumour type. The availability of well-characterised individual cohorts, tissue or specimens, and/or data is essential to support the transition to more personalised medicine and to support a wide range of research.

The creation of a network of NHS Research Scotland (NRS) biorepositories^[88] for the supply of tissue to meet non-commercial and industry research needs has been supported by CSO infrastructure investment to Scottish Health Boards in Grampian, Greater Glasgow and Clyde, Lothian, and Tayside. These operate as separate biorepositories managing their local archival and project stored tissue but working as a network sharing good practice and in the provisioning of samples from across Scotland.

Through CSO infrastructure investments safe havens have now been established in the four nodes of NHS Research Scotland to facilitate health research across Scotland using routinely collected health and other relevant data. Together, these safe havens are forming a federated network working to agreed principles and standards to collaborate on research studies and to share best practice. Other cancer specific research projects funded by CSO currently underway include:

• £250,000 for a project comparing Laparoscopic and Robot-Assisted Radical Prostatectomy performed by experience and volume-matched surgeons in Edinburgh and London across a number of parameters, including individual-reported outcomes.
• £169,504 over 3 years to investigate JAK2 targets in haematological malignancy.
• £153,774 over 3 years to develop a measurement-guided medicine intervention to optimise cancer pain control.

Partnerships with third sector colleagues is vital to supporting research and there are a number of jointly funded initiatives under way, for example:

• Along with Cancer Research UK Experimental Cancer Medicine Centres in Glasgow and Edinburgh/Dundee. These form part of a UK-wide network of 18 centres established to drive the discovery, development and testing of new cancer treatments, including for breast cancer. The Scottish Government provides annual funding of £350,000 to support this initiative.
• £450,000 to support Scottish-led breast cancer research in partnership with Breast Cancer Now.
• In pancreatic cancer CSO is co-funding of £150,000 for Pancreatic Cancer UK's Research Innovation Fund. With additional funding from Pancreatic Cancer Scotland there is currently approximately £400,000 available for pancreatic cancer research in Scotland.

Precision Medicine and Genomics

Precision medicine is a field which has the potential to transform health care in the years ahead. It is expected to bring benefits for individuals and for the health service alike by reducing the risk of wasteful and ineffective prescriptions, providing better and more effective personalised treatment to individuals, tailored to their genetic make-up and the particular characteristics of their disease.

In February 2016 the First Minister committed £4 million to support research into precision medicine to help build the infrastructure needed to support development and commercialisation.

By knowing the whole genome sequence, it may be possible to offer a diagnosis where there hasn't been one before, understand better the cause of disease and work out how best it might be managed.

On 1 March 2016, the establishment of the Scottish Genomes Partnership was announced. This will see further investment of £4 million from the Scottish Government and £2 million from the Medical Research Council. This Partnership, which is a collaboration of Scottish Universities and the NHSScotland genetics services, working with Genomics England on the diagnosis of rare diseases using whole genome sequencing to support the use of whole genome sequencing in programmes of research on a number of rare genetic diseases including some cancer types.

This builds on £15 million investment in whole genome sequencing technology by the Universities of Edinburgh and Glasgow.

Clinical Trials

The recruitment of people into clinical trials is essential if the potential benefits of new therapeutics are to be realised. Through the CSO we provide funding to support the Scottish Cancer Research Network (SCRN) whose remit is to increase, support and sustain clinical trial activity in cancer.

Over the period 2012-15, the network supported the recruitment of, on average, more than 7,600 Scottish people into cancer clinical trials. The important role of the network was recognised by the appointment in 2014 of an NRS Cancer Research Champion. This CSO-funded post provides leadership and support for the future development of the SCRN's role in promoting and delivering cancer clinical trials in Scotland.

A distinct feature of the Scottish research landscape is the close working between the NHS Research Scotland Ethics Service and the Health Board R&D offices, which has removed some of the artificial barriers between these two functions and streamlined the process of obtaining the necessary approvals for study commencement. As part of our Delivering Innovation through Research - Scottish Government Health and Social Care Research Strategy^[89] the CSO is working to ensure that Scotland continues to lead the agenda on streamlining the research approvals process and reducing bureaucracy, recognising that there is scope for further improvement.

New EU Clinical Trials Regulation, likely to come into force over the next few years, will streamline the authorisation process and harmonise requirements for clinical trials in Europe. One of its key features means that applicants will only have to submit a single application for a clinical trial, regardless of the number of participating member states, and, in Scotland, this will mean that a single decision on a clinical trial will replace the current separate approvals given by the Medicines and Healthcare products Regulatory Agency and the Research Ethics Committee.

Through the new Regulation there will be clear opportunities for Scotland to capitalise on this new efficient approach and the CSO will ensure Scotland's readiness when the new Regulation is implemented.

Actions - Research

• We will build on our research expertise and investments in precision medicine by funding two research exemplars in ovarian and pancreatic cancer, progressing genetic understanding of these diseases and supporting the adoption of genome-based treatment in to the NHS.
• We will work with the UK regulatory authority to introduce greater flexibility in the clinical trial activities that can be undertaken away from the core site, allowing cancer people with cancer across Scotland greater access to studies being led from the central belt.
• We will continue to invest in cancer research infrastructure, and will work with Cancer Research UK to support the continuation of the Experimental Cancer Medicine Centres for a further 5 years.