Interview with Prof Gary Middleton, the new lead of the Birmingham ECMC
I trained at the Marsden under many great people, but it was David Cunningham in particular who was pivotal in my embedding clinical research as part of my standard of care. and the idea that every patient deserves a trial and that every therapy advance comes from such clinical trials.
I came to Birmingham to be co-located with a clinical trial unit, which is crucial as a clinical trialist, and to develop my translational work. It’s been an amazing few years - I have been so well supported, and I feel honoured to be starting as the Lead for the Birmingham ECMC as I feel we are on the threshold of something really important in the experimental cancer medicine space here.
The breath-taking breadth of available agents, particularly in the immunotherapy arena, is both a huge opportunity and a huge challenge. The pace of change has been spectacular and the promise appears huge, but combing these agents to effect qualitative changes in outcomes and understanding the therapy niches and appropriate biomarkers for specific combinations is empirically impossible. There is a great risk of squandering time and resource and adding little of benefit to those we care for.
The development of robust pre-clinical platforms, aided by AI and machine learning, in order to determine which combinations to prioritise and where, is utterly essential. The key work of the next 3-5 years will be to translate the huge leaps in our understanding of the molecules and cell types that are antagonistic or agonistic into an effective anti-cancer immune response.
The opportunity to drive the development of novel therapeutics and the translational programmes that allow us to understand how best to use them is what excites me.
We have a large resident population, superb clinical genetics, fabulous basic science and committed clinicians, which together is what will see us move from 50% survival rates today to 75% and beyond. This may sound like hyperbole, but the progress in immunotherapy since 2012 couldn’t have been remotely envisaged back then.
The truthful answer has to be that I haven’t a clue! It is such an exciting time for our patients and those that try to care for them. The pace of scientific discovery, of technical innovation and of its clinical application, the harnessing of big data and our manipulation of that, makes accurate prediction impossible, and for that we should be thankful. This is the first time I have ever felt this way and the feeling is inspiring.
Immunotherapy is of great benefit to some patients, but many patients fail to derive any benefit at all. The most important thing for me is understanding why. How can we create a suitable microenvironment within these patients’ cancers that will allow these agents to work effectively?
I want to be in the lab for the moment someone says “I’ve got it! This is the problem and I know how to solve it, how to make these patients immune systems work and actively fight their cancer.”
But most of all, I want to be there to see the on-treatment scan of our first patient treated as a result of this scientific advance, showing the disease melting away and them feeling better and living well, because in the end that really is the point of all of our work.