St. Luke’s Lecture 2011

25/01/2011 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2

Professor Francis J Giles, MB, MD, FRCPI, FRCPath.  Director, HRB Clinical Research Facility, National University of Ireland Galway, Professor of Cancer Therapeutics, National University of Ireland Galway & Trinity College Dublin

Optimising Ireland’s contribution to curing cancer

Summary of lecture

If his portrait of the future of Ireland’s optimal contribution to a global effort to eradicate cancer as a public health issue, Professor Giles defined three characteristics that must define our research output. The research must be impeccably conducted and reported, novel, and and offer welcome to opportunities for international collaboration.  An important metric are how successful our combined national effort is in terms of bringing new anti-cancer approaches to regulatory and reimbursement approval. A second is that, by the competitive execution of that process across its entire spectrum, our provision of a nurturing research environment for the Irish preclinical,  translational, and and physician scientists currently making enormous contributions to bioscientific research outside this country.

He stated that at a time when a welcome increase in prosperity in the most populated areas of the world is being reflected by increasingly rapid enrolment of patients in large numbers on late phase studies, Ireland clearly needs to increase its focus on the earlier parts of drug and device development. This early part of the anticancer research process is intellectually extremely challenging, involves every branch of science, offers career opportunities in a diverse area of very high calibre professions, and encourages retention and expansion of Ireland’s existing foreigner and device manufacturing capabilities, and in total offers the nation’s best prospects for retaining a pivotal role in international bio scientific research.

Professor Giles pointed to recent creation by the United States of a National Centre for Advancing Translational Sciences (NCATS). This new centre within the National Institutes of Health will focus on the early part of anti-cancer and medical research up to and including the conduct of early phase clinical studies. The US is also seeking to rapidly reduce what has clearly become the destructive bureaucracy associated with research conduct, regulatory assessments, and the assessment of the value of new anti-cancer approaches. In this latter regard, Professor Giles highlighted the deterioration in the availability of key anti-cancer medications in England and the relationship between this deterioration in care and national reimbursement decisions. He emphasised that it was particularly important that Ireland, at a critical stage in its economic development, imported the best and avoided the worst of other nations’ policy decisions in this regard.

He used the example of Chronic Myeloid Leukaemia (CML) where an increasing emphasis on the accurate targeting of a key driver of the cancer has resulted in incremental significant improvements in survival of patients. He then illustrated how the experience in CML has educated ongoing endeavours across the entire spectrum of anti-cancer research, and indeed has positively impacted research endeavours across the entire spectrum of health care. He advocated a immediate future of Irish anticancer research which would have a very heavy emphasis on the early phases of anti-cancer agent development and the conduct of later stage studies with a particular emphasis on the compounds or approaches that have emerged from research conducted in Ireland. The later stage (Phase III), larger patient number studies will always be necessary, he said, but we need to emphasise the need for those conducted in Ireland to be wherever possible involved in assessing approaches generated locally. As an overall strategy, he outlined a process whereby Irish anticancer research could be optimised by the creation of an Irish equivalent of an NCI- designated Clinical Cancer Centre which would then evolve into the European equivalent of a US NCI-designated Comprehensive Cancer Centre. The template for this process has been well-established and there are numerous Irish researchers who have helped to implement this process in other places, he emphasised. And numerous more to whom we need to offer an optimal research environment and welcome them home, he concluded.

This being the thirty-fifth St. Luke’s Lecture since its beginnings in 1975.