The Alliance collaborators
The unification of the pancreatic cancer research community is at the heart of what makes the Pancreatic Cancer UK Early Diagnosis Research Alliance so exciting. It is made up of not one single institute, but delivered collaboratively across the UK by a network of experts.
- University College London, with
- Barts Cancer Institute
- Imperial College London
- The Institue of Cancer Research
- University of Liverpool
- University of Oxford
- University of Strathclyde
Principal investigator: Professor Steve Pereira
Duration: three years
Priority area 1: Equipping GPs to make accurate decisions
Lead investigator: Professor Julia Hippisley-Cox, Professor of Clinical Epidemiology & GP at the University of Oxford
Cancer Decision Support Tools (CDSTs) exist to help doctors make cancer diagnoses. However, these tools need to be improved specifically for pancreatic cancer to help GPs make a more accurate diagnosis or a referral when the first symptoms appear.
QCancer, a Decision Support Tool developed to help GPs consider a diagnosis of cancer, is already in use. The tool has been implemented on GP practice computer systems across the UK. Underpinning QCancer is QResearch, a large validated research database which makes use of approximately 30 million patients registered with approximately 1,500 GP practices in the UK, including longitudinal data from over 20 years. It includes detailed information on patient demographics (year of birth, sex, ethnicity, deprivation), medication, clinical diagnoses, referrals, clinical values, and investigations.
Analysis of this enormous dataset provides an opportunity to refine the QCancer tool specifically for pancreatic cancer, and make it more powerful at calculating the risks to patients of having the disease. This simple strategy has been identified by the team with a particular focus on calculating the risk of PNETs, something which has never been done before.
Professor Hippisley-Cox has been instrumental in developing the near-universal QCancer tool and is therefore expertly placed to make QCancer more sensitive at predicting pancreatic cancer.
Priority area 2: Enhancing biomarker tests
Lead investigators: Professor Justin Hsuan, Professor of Molecular Cell Biology and Dr John Timms, Reader in Cancer Proteomics, both at University College London
Biomarker identification is often highlighted as a key method of potentially diagnosing cancers earlier. Further developing our knowledge of the earliest and most significant biomarkers of pancreatic cancer is crucial and the team will develop new biomarker algorithms to accurately predict pancreatic cancer sooner. The aim of this project component is to combine a variety of biomarkers and develop corresponding algorithms that can:
- detect Stage 1 and 2 pancreatic cancers
- detect PNETs
- identify high-risk pancreatic lesions.
Crucially, the team will aim to develop predictive algorithms which will do this more than one year earlier than they do currently.
There will be a joint focus on pancreatic cancer and PNETs, the latter for which currently there are very few predictive biomarker tools. That is why it is hugely important that Professor Justin Hsuan, a world-leading expert in neuroendocrine tumours at UCL, will be help lead this element of the project. Joining him will be Dr John Timms, who leads one of the UK’s most established teams at UCL in using intricate datasets and mathematical models to improve the sensitivity and validity of biomarker panel tests.
They will also explore collaborations with teams around the world developing similar tests for cancers. Links have already been made with institutions such as Lund University in Sweden, and John Hopkins University in the US which developed the highly impactful CancerSEEK test. These collaborations could be hugely important to bringing the technology and data to a UK healthcare setting much sooner.
Priority area 3: Providing evidence for implementation
Lead Investigators: Dr Melody Ni, Research Fellow in Decision Analysis at Imperial College London and Dr Robert van der Meer, Reader in Management Science, University of Strathclyde, Glasgow
The Alliance has helped to forge a brand new collaboration between pancreatic cancer academics and some of the UK’s leading health economists. The team will undertake a rigorous analysis which seeks to understand the practical barriers to, but also identify opportunities for, the implementation of new diagnostic tools being developed. As part of a stakeholder analysis, patients will also be consulted and invited to share their experiences of pancreatic cancer diagnosis.
This team, led by exceptional thinkers in health economics and implementation science, will work in synchronisation with the clinical research teams, adding an extra layer of evidential validation as the project looks to increase the proportion of cases that are potentially curable at diagnosis.
Priority area: Plotting a new diagnostic pathway using the findings of the Early Diagnosis Award
Lead Investigators: Professor Steve Pereira, Professor of Hepatology and Gastroenterology at University College London and Dr Chiara Braconi, Senior Researcher at the Institute of Cancer Research
Professor Pereira and Dr Braconi will:
- Set up a brand new biobank, taking samples from patients with vague symptoms at a variety of sites across the UK
- Use these samples to validate the tools and tests in priority areas 1 and 2
- Use knowledge gained from all elements of the project to understand how the new tools can actually be implemented into the real-world NHS setting, as a pathway which improves diagnosis.
The decision to collect samples from patients with vague symptoms, but also an unconfirmed diagnosis is very important, as these will help the team generate robust data and know for sure if the tests work for patients – in effect a ‘real-time’ clinical trial of the biomarker tests and diagnostic tools. This study will also make links and potentially offer a diagnostic pathway for members of the public who are participating in the EUROPAC study, which is working to identify ‘high-risk’ patients based on their family history.
This will be the first time that such a comprehensive rapid diagnostic pathway is designed in conjunction with an overhaul of conventional GP tools and the refinement of biomarker tests. Whilst this is an ambitious element of the project, feedback from international experts agreed that this needed to be undertaken and evaluated now, and by this team, if we are to change how we diagnose pancreatic cancer in the future.
Monitoring progress with international, independent expertise
To ensure the Alliance will deliver on its aims, the project will have both internal and external monitoring and management built in as part of its governance design.
Professional project management of the network of researchers and programme objectives will be led by a designated team of specialists at the Surgical Intervention and Trials Unit (SITU), which is part of the world-class Division of Surgical Interventional Science at University College London in Bloomsbury. SITU has a long history of managing large cancer detection research trials, with a very successful record in delivering high-impact trials in bladder and prostate cancer, strengthening the integrity of the Early Diagnosis Award project.
Ms Chris Brew-Graves, SITU’s Director of Operations, will lead a team providing:
- Project management
- Operations support
- Database services
- Trial and WP4 sample collection coordination
The Alliance will also benefit from external oversight, from an independent panel of international experts who will act as a project steering committee. They will meet regularly to keep the project on track, act as independent liaison to ensure methodological robustness, and maintain the research integrity of the project. The committee will be Chaired by Professor Steve Smith who also chairs Pancreatic Cancer UK’s international Scientific Advisory Board. This puts him in the prime position to oversee the steering of the project, along with providing advice and guidance to the group. Professor Smith will work with the team to appoint members with expertise in:
- Biomarker development
- Clinical experience of pancreatic cancer from the perspective of oncology or gastroenterology
- Health economics and biostatistics
- Lived experience of pancreatic cancer
This will include one person with lived experience of pancreatic cancer from Pancreatic Cancer UK’s Research Involvement Network.