From The Bench To Bedside

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— British Columbia's unique approach to cancer research and care results in positive patient outcomes and a thriving biotech industry.

Increasingly, British Columbia is being recognized around the world as a leading centre for both cancer research and care. And it's the unique integration of these two elements that is driving BC's successful outcomes in both areas. The efforts are being led by the BC Cancer Agency, which is already recognized as an international leader.

Unlike most other jurisdictions, with individual tertiary care centers, British Columbia, via the BC Cancer Agency, manages all cancer patients from first diagnosis to final patient outcome on a province-wide basis, with over 19,000 new patients cared for through the system each year. The resulting access to a single demographically complex population of uncompromised patients, offers BC's world-class clinicians a unique and unprecedented setting in which to evaluate new patient management protocols.

And then, by utilizing disciplines such as genomics, proteomics, immunology, biochemistry, imaging and surgery, the province's globally-renowned researchers are gaining a better understanding of different cancers down to the molecular level. Combine this approach with the equally international caliber research being carried out at institutions such as the University of British Columbia, Simon Fraser University and the University of Victoria and the province's ability to successfully generate intellectual property and commercial development from this research, and it quickly becomes apparent how British Columbia has achieved its leadership position.

"It's really a situation that is ideal for conducting oncology research," comments Karimah Es Sabar, executive director of provincial industry association BC Biotech. "What we have here is very special, and we're starting to reap the rewards of this important work, by not only seeing patient outcomes improve, but by seeing significant commercial potential. Several promising oncology companies are here in British Columbia and we fully expect them to be developing the next successful therapeutics and diagnostic tools - and in doing so, also generate economic value for British Columbians that can be re-invested into the healthcare system."

Such an investment was recently made when cancer research in British Columbia gained a new home and central focal point in 2005 with the opening of the new $88 million BC Cancer Research Centre. Led by Dr. Victor Ling, vice president of research, the Centre now houses over 650 researchers working on cancers that affect approximately 18 different body sites, with a major focus on prostate, lung and breast cancers and lymphoma. In total, British Columbia boasts approximately 220 senior investigators and 2,000 support staff working in cancer research, with just over half working at the BC Cancer Agency's 10 research departments that cover advanced therapeutics, genomics, cancer control, endocrinology, genetics, imaging, biophysics and molecular oncology.

The organization provides an exclusive population-based cancer care program for all the people of BC, including prevention, screening and early detection, diagnosis and treatment services, rehabilitation support and community programs, research and education. As part of its provincially legislated remit, it also maintains an unsurpassed collection of population-based data, evidence-based therapeutic protocols and extensive sample collections. The Agency provides clinical and diagnostic facilities at four regional centres and offers screening and chemotherapy services at 20 additional community cancer centres. It has also established networks of oncology professionals within the province to collaborate on patient care and treatment, including the Communities Oncology Network, Pediatric Oncology Network, Family Practice Oncology Network, Rehabilitation Network and the Surgical Oncology Network.

Because of its population-based cancer care system, BC has an exceptional state-of-the-art collection of tissues, blood, DNA, other molecular data and protected clinical information from cancer patient donors. These unique biological materials and data are available to researchers and companies to support translational cancer research in BC, Canada and worldwide. Tissues are available from four different sources, three managed by major research groups within the BCCA and Prostate Centre and the fourth, the BCCA Tumour Tissue Repository, which is a core component of the Canadian National Tumour Bank Network.
The Centre is also home to the Michael Smith Genome Sciences Centre. Named for British Columbia's Nobel Laureate in Chemistry, the GSC first gained international acclaim by being the first to sequence the SARS virus. But the greater mission of the centre is to deploy resources and technology of a high-throughput genome mapping and DNA sequencing lab to decrypt the genetic code, specifically to advance cancer research, diagnosis and treatment.

Combining the experience of world-renowned scientists, the GSC plays a major role in the fields of genomics and bioinformatics as well as various genome projects around the world. The priority of the centre is to find innovative means to automate the sequencing and fingerprinting process, develop cost-effective measures that will make such research financially viable and utilize state-of-the-art computing facilities to collect, mine, analyze and disperse data collected at this and other genome facilities.

It is of course the people which make this and British Columbia's other institutions so successful. Those people include six Canada Research Chairs (Drs. Sam Aparicio, Neil Branda, Chris Overall, John Schrader, Clayton Smith and Septimiu Sulcudean), and two winners of Canada's Top 40 Under 40 (Drs. Marco Marra and Stephen Jones). Another of the BCCA's researchers, Dr. David Huntsman, spearheaded an international research team that discovered a new gene connected to breast and ovarian cancers (EMSY).

The work of this world-renowned group along with that of BC's additional researchers, is supported by research funding of over $203 million for 1,014 projects and awards over the last five years. Over the past five years, Canadian Federal and Provincial governments have supported BC cancer research with over $115M, including $20.5M for four multi-million dollar programs awarded by Genome BC/Canada, while private-sector companies have supplied at least $18.5M, generally in the form of contract clinical research. In addition, a significant amount of US government funding has been secured through the National Institutes of Health (NIH).

One important focus of the research is biomarkers. Between 2001/2 and 2005/6 British Columbia received over $9M in funding for the study of potential biomarkers of breast, lung, prostate, oral, ovarian and skin cancers, the majority being for basic research. Cancer stem cell research has also received over $9M in funding over the past five years and is an area in which British Columbia researchers such as Drs. Connie and Allen Eaves have achieved global prominence.
But cutting-edge research and world-leading patient care are not the only successful outcomes of these organizations -- an impressive pool of technologies and spin-off companies has also emerged. Over the past five years, BC cancer researchers have been granted numerous patents, which continue to fuel the development of the local biotech industry while also providing opportunities to potential development partners. These inventions have formed the basis of 17 BC companies, with technologies licensed by each of the three main universities and the BCCA.

In addition to these companies that are founded on technology from BC's universities and the BCCA, the province is home to at least another eight companies focused on oncology. These 25 companies, along with the approximately 75 additional biotech companies in BC, make up what is now the seventh largest biotech cluster in North America and range in size from two to 360 employees. The oncology companies have products spanning the development and commercialization spectrum with seven already having marketed or approved products. Approximately half are developing anti-cancer therapeutics and another one quarter involved with drug delivery technologies, with others developing diagnostic tools and devices.

One such company, OncoGenex Technologies, is founded on technology out of the lab of Dr. Martin Gleave at the Prostate Center at Vancouver General Hospital, also part of the Vancouver Coastal Health Research Institute. Like BCCA, this centre effectively combines basic research, translational and clinical expertise and is where Dr. Gleave developed the technology for OncoGenex. Known for his incredible ability to multi-task, Dr. Gleave routinely performs surgery as a practicing uro-oncologist in the morning followed by continuing to lead his research at the Prostate Centre while also managing his role as co-founder and chief scientific officer at OncoGenex -- all in the same day. This work resulted in him being named the recipient of the 2006 BC Biotechnology Award for Innovation and Achievement, among many other accolades. And the ongoing collaboration between the Prostate Centre and OncoGenex has brought the company to the point of having three products in clinical trials (OGX-011, OGX-427 and OGX-225 designed to selectively inhibit the production of proteins that are associated with treatment resistance and that are over-produced in response to a variety of cancer treatments), and to having an impending IPO on both the TSX and NASDAQ stock exchanges. By following this collaborative route which is encouraged in British Columbia, the company has achieved significant milestones in a very cost-effective manner.

OncoGenex CEO Scott Cormack comments, "To date, we've only spent about US$8 million. If you take the nearest comparable that exists in the industry, it would probably be about 10 times that to be where we are right now." OncoGenex is a tremendous example of British Columbia translational approach to research, rapidly moving innovations to the patients. Cormack adds that "In order for a business to be successful, they need key elements - people, money, markets and technology, and BC has all of that."

The excellence of British Columbia's researchers, accompanying infrastructure and corporate innovations has also attracted numerous international partners. In fact, at least 89 companies have signed 197 contracts or agreements with the BC cancer researchers over the past five years, including 12 of the world's top 15 pharmaceutical companies. In 2005/6 alone, the researchers obtained over $6M from 51 companies which took advantage of British Columbia's extensive support facilities for cancer research including microarray, sequencing, mapping, bioinformatics and GMP capabilities.

With its unique province-wide patient management system, BC is also a hot bed for clinical trials. Unlike most other jurisdictions, which move patients from primary and secondary to tertiary care facilities as their disease progresses, BC's cancer patients are managed by the same tumour specific team from first therapy to final outcome. A complete record of a patient's management (e.g., therapy, outcomes, etc.) is housed within a centralized registry managed by the BCCA. Biological samples from each patient are stored in the province's biorepositories. Tumour teams are responsible for therapeutic protocols and policy decisions, rapidly translating experimental medicines and novel processes into routine care if the outcomes data support this.

Both the BCCA and Prostate Centre have clinical research teams involved in Phase I, II and III national and international studies, and both have a translational approach to research, rapidly moving innovations to the patient and monitoring their impact on population health outcomes. The BCCA is also currently expanding its Phase I/II clinical trials capacity by constructing a dedicated stand-alone Phase I/II clinical research unit that is expected to be operational this year.

So it's an incredibly exciting time for cancer research in British Columbia, as the province truly represents the best of the field -- from the world-class studies being conducted, to its optimal platform for research, to the exceptional level of care and the commercial potential that companies are quickly moving towards. Karimah Es Sabar sums it up by saying, "What we have here in British Columbia is our very own scientific paradise and we look forward to having the opportunity to share it with the world."

RESOURCES:

BC Cancer Research Centre: www.bccrc.ca

BC Biotech: www.bcbiotech.ca

University of British Columbia UILO: www.uilo.ubc.ca

Michael Smith Genome Sciences Centre: www.bcgsc.ca

The Prostate Centre at Vancouver General Hospital: www.prostatecentre.com