Reinvigorating commercial clinical trials in the UK will help us beat blood cancer

In October 2022, the Association of the British Pharmaceutical Industry (ABPI), reported a 44% decline in the number of commercial clinical trials – trials funded by pharmaceutical or biotechnology companies – initiated in the UK between 2017 and 2021. Following this concerning fall, in February 2023, the Government announced an independent review into the UK commercial clinical trials landscape to be led by Lord James O’Shaughnessy[1]. Blood Cancer UK and many other stakeholders including industry, medical research charities, academia and the NHS provided input to this review.

At the end of May, Lord O’Shaughnessy published his independent report, including 27 recommendations to address the challenges the UK faces in this area. These challenges concern slow, bureaucratic trial approval processes; transparency and data; accountability; research as a systemic priority in the NHS; incentives for clinicians to take part in research; conversations between clinicians and patients about research; use of the NHS’ data assets and primary care’s currently negligible role in clinical trial activity.

At Blood Cancer UK, we know that clinical trials to improve treatments and outcomes for people with blood cancer are crucial. For many people with blood cancer, clinical trials are the only and best treatment option and over 40% of the treatments on the Cancer Drugs Fund are for blood cancer. Because research saves lives, in 2020 we set up our Clinical Trials Support Service to provide information, advocate for and offer impartial advice to people with blood cancer and their loved ones about trials they are enrolled in or that might be available to them. This service is part of our work to break down the barriers to accessing clinical trials and has already helped over 100 people with blood cancer with trial searches.

Recently, Dr Emma Searle, a Consultant Haematologist and Honorary Senior Lecturer at The Christie, shared her frustration with slow, bureaucratic clinical trial approval processes in the UK. Dr Searle’s devastating example was used by Lord O’Shaughnessy to demonstrate the human cost of the UK’s underperformance in clinical trials. Please be aware that Dr Searle's tweet contains a hard-hitting and upsetting example. If you're affected by this, our Support Line is here for you. You can call us on 0808 2080 888 or get support by email.

We therefore welcome Lord O’Shaughnessy’s recommendations that aim to increase opportunities for British patients to have early access to innovative treatments by doubling the number of people taking part in commercial clinical trials in the next two years and for that number to double again by 2027. Lord O’Shaughnessy’s recommendations include the creation of a clinical trial directory for patients, clinicians, researchers and sponsors; establishing a Clinical Trials Career Path in the NHS Workforce Plan and a target to approve new trials within 60 days.

The review also recommends that all patients receiving genomic sequencing of any kind in the UK should be offered a chance to give consent for their data to be made available for approved research. Since all children with cancer, and adults with certain types of leukaemia are already offered genomic sequencing at diagnosis, if adopted, this recommendation could quickly draw many people with blood cancer into research.

Another recommendation is the creation of Clinical Trial Acceleration Networks (CTANs). The aim of these networks is to enable government and the NHS to develop processes for every step of a trial in specific areas. Following the review, the Government has already committed £20 million over two years to establish two to three CTANs and indicated that a CTAN for cancer is likely to be one of the first. This funding commitment comes through the Chancellor’s Life Sciences Package.

Lord O’Shaughnessy writes that ‘If the UK is truly going to be a science superpower, we have to use every asset at our disposal. There is no reason why this cannot happen: we have the workforce, the scale, the data, the science base, the research charities and many other strengths, but arguably none is more significant than the NHS.’ He goes on to call for public commitment from leaders across the UK to confirm our ambition for the NHS to become the world’s leading platform for health and life sciences research.

It has been concerning to see the number of commercial clinical trials in the UK fall over recent years and so Blood Cancer UK welcomes Lord O’Shaughnessy’s recommendations that aim to double the number of people taking part in these trials in the next two years.

We urge the Government to adopt and implement all 27 recommendations, to reduce the burden preventing new trials from starting, incentivise clinicians to get involved in trails and to give people with blood cancer earlier access to innovative treatments.

We are pleased that the Life Sciences Package announcement saw Professor Peter Johnson named as Chair of the UK’s Cancer Mission. The Cancer Mission is one of a series of healthcare missions, designed to drive innovation to transform the healthcare landscape and save lives. Professor Johnson, an oncologist and lymphoma (a type of blood cancer) specialist based at the University of Southampton, is currently leading a Blood Cancer UK funded project on precision medicine in aggressive lymphoma and was involved in a key clinical trial, REMoDL-B, which led to a new way of classifying lymphomas.

We would like to congratulate our colleague Professor Peter Johnson on being named as Chair of the UK’s Cancer Mission and we look forward to working with him and other collaborators on the Mission as it develops.

The Government has welcomed Lord O’Shaughnessy’s 27 recommendations and has so far pledged to deliver five commitments. We are pleased to see £121 million promised for these five commitments on speeding up and improving trial approvals and contracting; streamlining processes for approaching patients about research, enhancing data on trials activity and setting up CTANs. A full implementation update on the current commitments and the foundational recommendations accepted by the Government will be published in the autumn, alongside a more comprehensive response to the review.

In this comprehensive response, we hope to see the Government offer commitment to and funding for Lord O’Shaughnessy’s remaining recommendations, such as introducing incentives to hospital departments and clinicians, including those in primary care, to engage with research and a campaign in partnership with medical and research charities to promote research to the public. Recommendations in these areas are particularly important for encouraging the initiation of trials in underserved areas, engaging marginalised communities in medical research and developing the clinical research workforce of the future.

By taking these recommendations seriously and prioritising research in its upcoming NHS Workforce Plan and Major Conditions Strategy, the Government has an opportunity to reinvigorate the UK’s commercial clinical trials landscape, which will only offer more opportunities for research to save lives and beat blood cancer.

If we want to beat blood cancer in a generation, then we need clinical trials to bring new, innovative and effective treatments to people with blood cancer as soon as possible. In our input to Lord O’Shaughnessy’s review, we stressed that trials funded by the pharmaceutical industry are more likely to focus on novel agents that show potential for improved treatments, more lives saved and fewer side effects and that declining access to these treatments directly impacts health outcomes for many people with blood cancer, who otherwise have limited options in routine care.

Our policy team will be holding government to account on its commitments and asking it to adopt all 27 recommendations, ahead of the full response it has promised to publish in autumn.

Meanwhile, we continue to fund research projects that transform our understanding of blood cancer and lay the groundwork for new commercial clinical trials and new treatments. Earlier this year, we announced that we were funding 16 new research projects spanning all types of blood cancer, worth over £4 million.

If you need personalised support to understand what clinical trials might be available to you or someone you care for, speak to our expert Clinical Trials Support Service – learn more here. If you would like to feed your own experiences of accessing clinical trials, or supporting your patients to do so, into our policy work, you can contact us on [email protected]. You can also ask your MP, MS, MSP or MLA to write to the Health Secretary/Health Minister in support of the O’Shaughnessy recommendations and to ask the Government what plans are in place to deliver on their commitments.

[1] Lord James O’Shaughnessy is a Senior Partner at consultancy firm Newmarket Strategy, a Board Member of Health Data Research UK (HDR UK) and a former Health Minister. He served as Parliamentary Under-Secretary of State for Health from December 2016 to December 2018.