Cancer: what are the barriers to research?

cancer research

Everyone imagines a world without cancer, but getting there is difficult. With World Cancer Day coming up on February 4, we took the opportunity to ask some life science company CEOs, CMOs, and chief scientific officers the same question about cancer research. 

We asked CellCentric CEO, Will West; iOnctura CEO, Catherine Pickering; ISA Pharmaceuticals chief scientific officer, Kees Melief; Leucid chief scientific officer, John Maher; Precirix consulting CMO, Jennifer Wheler; and Versameb CEO, Klaas Zuideveld, for their input.

We’ve split the responses over three separate articles, and in this one, we wanted to find out what the barriers and challenges are currently to cancer research.

Jennifer Wheler, consulting CMO, Precirix

There are many challenges to cancer research including:  funding gaps in both private and public sectors (notably in the early ‘valley of death’ – from preclinical to clinical evaluation); the pressures of both academic research and research in industry that can dampen creativity and lead to prioritization of results over willingness to take risks and to explore areas that may end up being highest yield (high risk, high reward; innovation that can result from non-pressured, joyful focus for interest’s sake vs outcomes); the challenge of establishing a viable research career in all populations of scientists, but notably in minorities including women.  

While the challenges are many, this is a ”golden” time for cancer research with accelerated discovery and progress as it has never been seen before in history.

Will West, CEO, CellCentric

The regulatory hurdles are becoming ever higher, and not necessarily helpfully for patients.  If it costs too much, or takes too long to get an initial approval, some effective products might not stay the course. 

Catherine Pickering, CEO, iOnctura

Clinical trials remain costly and can be incredibly long which is a barrier for many companies, particularly smaller ones.  However, new initiatives are starting to help companies overcome these barriers and get their drugs to the patients that need them faster.  Consortia of organizations can work together in fluid adaptive clinical trial designs to test multiple drugs in one setting, increasing the power of the study and decreasing the numbers of patients and time needed to test the drugs.

One great example is the PanCan network who are testing multiple research avenues in their Precision Promise Clinical Trial.  The requirement for a randomized control arm can also be a barrier for recruitment as patients will often want to be on the active arm, rather than a placebo or standard-of-care. 

However, Synthetic Control Arms are starting to emerge as regulatory body-endorsed approaches to control arms which are being used to get drugs to the market quicker, particularly in rare diseases.

Klaas Zuideveld, CEO, Versameb

Collaboration, whether between pharma and biotech or with academics and shared incentives are the key to success in research. Policy changes and reduction in financing could jeopardize these.

Therefore, I think we must be careful not to let for example drug price controls such as the ones outlined in the recent US Inflation Reduction Act disincentivize innovative biotechs working with large pharma.

Kees Melief, CSO, ISA Pharmaceuticals

The barriers and challenges to cancer research are: 1) Financial (lack of reimbursement of expensive personalized therapies by insurance companies and health organizations). 2. Big Pharma hesitation (personalized treatment requires a different philosophy than the blockbuster drug desire of big pharma). 3) Regulatory (failure of regulatory authorities to develop efficient rules for personalized treatment).

John Maher, CSO, Leucid

My experience has mainly been with academic and clinical research to which I will confine my comments.

The first obvious challenge is the limited funding available to support cancer research and this is very dependent on geographical location. Having participated in and chaired a number of grant awarding committees, I am struck by the number of fundamentally decent submissions here in the U.K. that ultimately fail to make the cut and are not awarded. Funding is distributed in a markedly skewed manner across research labs with many perceived top research groups doing very well while young/emerging researchers can struggle to make the breakthrough. Salaries for scientific faculty members are also often poorly competitive while demands increase year on year, prompting an increase in discontent and frustration especially among mid-career scientists.

Perception of the value of scientific research is heavily influenced by the names and impact factors of scientific journals within which the work is published. Respectively, these features are driven by eminence (rather than evidence) and average citation number – instead of the intrinsic quality or impactful-ness of the work.

The quality of mentorship available for young researchers is also highly variable and this can have a detrimental effect on both staff development, retention and career progression. By its very nature, science is competitive as novelty of findings are at a premium, but this can discourage the early sharing of data between groups. As a result, efforts may be reduplicated, slowing the ultimate advancement of the field. Universities are often cash-strapped and this may mean that there is a lack of investment into critical infrastructure or core facilities.

Similarly, new discoveries generated by researchers can be wasted by universities which do not have the budget or vision to protect emerging intellectual property. This becomes very important when one is working to develop new diagnostics or treatments since the lack of patent protection of the product means that it is virtually impossible to commercialize, irrespective of its intrinsic value or therapeutic potential.

A further potential barrier to research is the challenge of building necessary collaborations. In some cases, it may be difficult to secure buy-in from potential collaborators who could help to advance the research more rapidly, for example by providing a particular experimental approach or area of expertise.

Finally, disease models are often poorly representative of the corresponding tumor types, hampering our understanding of underlying pathology or selection of the best new therapeutic interventions. In attempting to navigate some of these issues, high quality mentorship remains a serious requirement for any committed junior scientist.

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Clinical cancer research also faces significant barriers. Cancer physicians are extremely busy and often do not attribute sufficient priority to clinical trial activity for their patients. Moreover, structural and clinical barriers commonly hinder the participation of otherwise willing patients in clinical studies. Accordingly, fewer than 5% of cancer patients participate in clinical trials, leading to significant delays in recruitment and drug development.

Regulatory barriers may also hinder progress, especially where regulatory agencies are short staffed, which is a recognized issue in some territories currently. Variability in regulatory processes between different territories is also commonplace and highlights a need for better streamlining and standardization of procedures globally. In making these points, it should also be acknowledged that clinical trials are extremely expensive and newer in silico approaches are likely to prove pivotal in improving drug candidate selection.

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