A Q&A with Prof. Andy Pettitt, Liverpool Cancer Research Institute and LHP Cancer Programme Director, Professor of Experimental Medicine at the University of Liverpool and Consultant Haemato-oncologist at The Clatterbridge Cancer Centre NHS Foundation Trust. 

Q: September is a significant month for haemato-oncologists around the country. Why is September 2020 even more significant for haemato-oncology here in Liverpool?

September is Blood Cancer Awareness Month and 2020 has been a significant year for patients with blood cancer in our region. Here in Liverpool, the configuration of clinical services and biomedical research have undergone a transformational change which should ultimately lead to measurable improvements in health outcomes for patients both locally and nationally.

Q: How common is blood cancer nationally and in our region in particular?

Blood cancer is the fifth most commonly diagnosed malignancy in the UK. Every 20 minutes, someone finds out they have blood cancer. According to the National Institute for Healthcare Research (NIHR), the North West Coast Clinical Research Network (CRN) has one of the highest rates of blood cancer in England. In Liverpool, blood cancer is almost as common as prostate cancer and is responsible for more cancer-related deaths than all other types of cancer apart from lung and colorectal.

Q3: What are the specialist needs of blood cancer patients and how is the service configured to provide for such patients in Liverpool? 

Blood cancer patients have varied and complex need as the term “blood cancer” covers more than 100 different sub-types including myeloma and many different types of leukaemia and lymphoma. Many people with blood cancer need stem cell (or bone marrow) transplants to eradicate their disease. Until now, patients with blood cancer in Liverpool have received their inpatient care from senior doctors and nurses from The Clatterbridge Cancer Centre but on wards in the Royal Liverpool University Hospital where they have benefited from access to a range of specialist support services.

On 15th September, two new wards opened in the new Clatterbridge Cancer Centre – Liverpool specifically for patients with blood cancer. These state-of-the-art facilities are the culmination of five years of work to bring blood cancer care together with other cancers. They include a stem-cell transplant unit, isolation rooms, and a special air filtration system to reduce the risk of infection in people with a weakened immune system. 

The opening of the new wards now means our patients will continue being cared for by the same Clatterbridge team but in a brand-new facility alongside other specialist oncology services. The Clatterbridge Cancer Centre – Liverpool is right next door to the Royal and this means that our patients still benefit from the excellent support that we’ve been so lucky to have all these years from our colleagues in other specialties. In other words, our patients now have the best of both worlds.

Another crucial service for patients with blood cancer is regional Haematological Oncology Diagnostic Service (HODS) which is hosted by Liverpool Clinical Laboratories in the Liverpool University Hospitals NHS Foundation Trust. HODS were introduced as a standard of care within the NHS to reduce diagnostic error and improve clinical outcomes by combining different strands of diagnostic information into a single, definitive report. Under the leadership of Dr Geetha Menon, the Liverpool HODS has evolved into a fully integrated service – one of only a few in the UK. Quality of reporting and turnaround times are excellent, and activity has increased year on year with more than 14,000 tests performed in 2019. The HODS provides a comprehensive range of tests (including genomic) and is a partner in the North West Genomic Laboratory Hub. Having such an excellent diagnostic service in Liverpool means that our patients are diagnosed rapidly and accurately so they can start the appropriate treatment at the earliest opportunity. It is a real jewel in the crown for Liverpool with vast, but hitherto untapped, research potential.

Q: The Clatterbridge Cancer Centre – Liverpool is also right next door to the University of Liverpool, what does this mean for the opportunity for research in blood cancer?

Research in haemato-oncology (blood cancer) is long-established here in Liverpool, and I have been very privileged over the years to work with colleagues to contribute to advances in the field. I am passionate about research and the value it brings for patient care. I strongly believe that we should strive to embed research in the clinical service to ensure that as many patients as possible have the opportunity of taking part in research and have their treatment as part of a clinical trial. With the opening of Clatterbridge Cancer Centre – Liverpool right next to the University of Liverpool, the restructuring of the Faculty of Health and Life Sciences and the establishment of a fully integrated HODS, we now have a fantastic opportunity to take our research to the next level and this, in turn, will bring even more benefit for our patients.

Q: What are some flagship projects and research initiatives that you and colleagues here in Liverpool have been recently involved with?

Over the last 2 decades, the regional haemato-oncology unit has built up a comprehensive and continually replenishing portfolio of commercial and non-commercial trials across all disease areas and has been among the top UK recruiters for a number of such studies. Trial recruitment is supported by a dedicated clinical research team that is funded partly by the NIHR via the North West Coast Clinical Research Network (NWC CRN) and partly by commercial trial income. All consultants are local Principle Investigators for NIHR portfolio studies. Some consultants are also involved in trial development through membership of National Cancer Research Institute (NCRI) Research Groups (RGs) and/or Subgroups, while some, including myself and Professor Nagesh Kalakonda, are also Chief Investigators for national/international studies focusing on treatment stratification and optimising risk/benefit in vulnerable patient groups. 

One example of such a study is the CR-UK funded PETReA trial which is investigating risk-adapted treatment in follicular lymphoma. This phase III study is recruiting from multiple sites in the UK and Australia and was one of only six ongoing trials selected for oral presentation at the 2019 scientific meeting of the International Conference in Malignant Lymphoma. The trial includes two sub-studies, one in collaboration with the UK PET Core Lab at St Thomas’ Hospital in London to investigate new approaches to imaging in follicular lymphoma, and the other in collaboration with colleagues in Psychology to understand the factors that influence patient decisions about whether to take part in research. The trial also includes a sample collection that will support laboratory research in collaboration with the Barts Cancer Institute in London.  

This is one of several national sample collections co-ordinated by the Liverpool haemato-oncology group. The collection and storage of high-quality, clinically annotated tumour samples (biobanking) is of fundamental importance to translational science, and the Liverpool haemato-oncology group is widely regarded as a national leader in biobanking in CLL and lymphoma with continuous funding from Blood Cancer UK since 2006. In fact, the UK CLL Biobank was recently highlighted as an example of best practice by the National Cancer Research Institute (NCRI).

In addition to clinical trials and biobanking, the haemato-oncology research group includes a large and vibrant community of laboratory-based postgraduate research students and post-doctoral scientists, all of whom are working on inter-related related projects and provide support for one another. Research is focussed on understanding, predicting and overcoming drug resistance and intolerance and makes extensive use of our local biobank, as well as the national biobanks that we host. Through a network of local, national and international collaborations involving researchers in many different disciplines, the group has established several powerful new techniques that can be applied to many different types of cancer, e.g. SWATH-MS, kinome profiling, mass cytometry and single-cell RNA sequencing. In collaboration with local colleagues specialising in data science, we are also exploring new ways of making sense of the vast amount of information that these techniques generate.

As a group, we have received numerous awards/endorsements from Cancer Research UK and Blood Cancer UK, while at a regional level, we are grateful to The Clatterbridge Cancer Charity, North West Cancer Research, and the BlooM Appeal who have supported many different research projects and initiatives over the years. The group also works closely with multiple industry partners who have provided not only research funding but also free drug to the value of many £ millions for clinical and laboratory studies of novel and emerging therapies.

Q: How do patients get involved in blood cancer research here in Liverpool?

Local patients with blood cancer and their carers have come together as a vibrant and purposeful community – the Liverpool Haematology Support Group. The group meets every month and is administered by Leukaemia Care. The patient group has close links with the local BlooM Appeal charity and is signposted by other charities including Lymphoma Action, Myeloma UK, MDS UK and Macmillan Cancer Support. The patient support group has a particularly strong association with the Chronic Lymphocytic Leukaemia (CLL) Support Association (CLLSA) which has held biennial meetings in Liverpool over the last eight years. Together, these connections and activities have provided an ideal framework through which we have been able to keep our patients informed about the latest developments in different types of blood cancer and offer them the opportunity to get involved in research.

In addition to taking part in research, patients can contribute to research through membership of oversight committees where they can contribute to study development and implementation, for example by helping with the drafting of important study documents such as the patient information sheet and research ethics application, and several of our patients have taken on these roles. Moving forward we want to further develop our patient and public involvement in research and would very much welcome expressions of interest.

Q: When we are back in a year’s time to discuss Blood Cancer Awareness Month what would be the greatest that you will want to remark upon about blood cancer and cancer research in Liverpool?

Now that the haemato-oncology service previously based in the Royal has been transferred into the new Clatterbridge Cancer Centre – Liverpool, the next task will be to create a single, integrated haemato-oncology service. Expanding the service via a hub-and-spoke model will allow more patients to benefit from specialist care and access to clinical trials, while at the same time allowing treatments to be given closer to home where this is appropriate. It will also open up new research opportunities which will ultimately benefit patients. I would hope that significant progress is made towards this objective by next year.

I would also like to see an expansion of the academic haemato-oncology group to offset recent and forthcoming retirements. This could be coupled with the development of research capability in cellular therapy to complement the recent investment in immuno-oncology. 

I am very keen to see progress towards harnessing the research potential of the Liverpool HODS. An important first step will be to set up the pathways and consent processes required for the collection and storage of diagnostic material surplus to requirements. There is also great potential to apply new technology platforms to the diagnostic process in collaboration with researchers in the University as well as industry partners.

Finally, I would like to see significant progress in harnessing Liverpool’s considerable expertise in data science to address important clinical questions via national datasets, as well as annotating stored clinical samples with clinical and biological data and facilitating data sharing and analysis as part of our biobank.