Before the COVID-19 pandemic, my lab studied how cancers evolve to develop treatment resistance and metastases, both of which are leading causes of cancer-related deaths. Our expertise is rooted in cancer genetics and genomics, and we conduct large-scale translational studies in patients with cancer.

Credit: Royal Marsden NHS Trust

COVID-19 hit patients with cancer hard through disruption of hospital services, halting of clinical trials, and a requirement for many of these patients to self-shield. Possibly worst of all, our lack of knowledge of how cancer and cancer therapies may interact with COVID-19 led to many patients interrupting cancer therapies, despite the lack of an evidence base. This compelled us to rapidly set up a prospective clinical study to evaluate adaptive immunity to SARS-CoV-2 infection and, subsequently, vaccination, in patients with cancer. We recruited ~1,000 patients and evaluated close to 20,000 samples in just over 18 months, during which time we gained a rapid education in infection and immunity from virologists who study RNA viruses, and immunologists who study B cells and T cells. Patients with cancer often have defects in adaptive immunity, from either disease or treatment, which also provided an opportunity for understanding immune responses to SARS-CoV-2 in the general population.

Our research showed that the immune response to the virus or the vaccine in patients with solid cancer was largely preserved and was not affected by immunotherapy or targeted therapies, whereas immune responses were blunted in patients with blood cancer, especially for emergent variants of concern. This contributed to the prioritization of patients with blood cancer for additional vaccine doses, which boosted the proportion of protected patients.

As well as our research discoveries, we learned other valuable lessons during the pandemic. We talked to colleagues pursuing similar studies across the world, from Australia to California, with new research questions emerging from these conversations. We interacted with patient advocates, cancer charities, policymakers and health economists. We learned that anything is possible when there is urgency and when we can cut through bureaucracy. As researchers, we feel more knowledgeable, more connected and more innovative.

We have now decided to end our COVID-19 research program, with the final follow up sample collected in April 2022. Our research protocol has been suspended but is ready to be reactivated if necessary.

This will allow us to pivot back to cancer research with renewed determination. Cancer is a global health issue that will continue to dominate healthcare needs across the world: one in two people will develop some form of cancer in their lifetime; rates of some cancers have doubled in the past few decades; and cancer accounted for nearly 10 million deaths in 2020 — almost one sixth of all deaths worldwide — with most deaths in low- and middle-income countries.

If cancer is treated as a health emergency, like COVID-19, translation and drug development can be accelerated. The time from drafting our COVID-19 study protocol to recruiting the first patient was 6 weeks, in contrast to the many months or even years needed for cancer research. This was achieved by faster ethics reviews and implementation of remote patient consenting and data collection. During the pandemic, in the UK alone over half a million people took part in research into COVID-19. Patients with cancer are highly motivated to take part in research that will benefit others, but the opportunities to do so are often limited by geography, local resources and time, which can be exacerbated by social deprivation.

Cancer is in some ways a greater challenge than COVID-19, as it is not one disease but at least 200 diseases. With no ‘one-size-fits-all’ cancer therapy, there are almost 300 drugs licensed, each associated with variable and unpredictable efficacy and toxicity. Each instance of cancer will have unique characteristics in that person, and outcomes for the same cancer subtype diagnosed at the same stage can be starkly different between two people. The therapeutic landscape of cancer has changed profoundly over the past decade, but many patients are still not well served by the new therapies, while for others, resistance emerges because of the inherent adaptability of cancer.

We are pivoting back to cancer research to play our part in another health emergency. A multi-disciplinary effort from the diverse cancer research community will be needed to develop new therapies, repurpose existing drugs, understand side effects and survivorship, and ensure that new drugs are available in all healthcare settings, irrespective of resources. Translational cancer research should be a core part of cancer care delivery everywhere, ensuring that valuable learning takes place with every patient, in every country.

While we are picking up our research where we left off, we are applying what we have learned, scientifically and practically. We are more mindful of public interest in research and the need to leverage this interest for the benefit of cancer discoveries. For other researchers who pivoted to COVID-19 from other disease areas, I hope they can revive their original research with the type of support and urgency we experienced working on COVID-19.