Professor Rebecca Fitzgerald’s ‘Innovation Alliance’ to tackle cancer

The new Head of Oncology at Cambridge is a Sherlock Holmes fan who bandaged the babysitter as a youngster and has a radical new vision for tackling humanity’s greatest murder mystery: cancer.

Professor Rebecca Fitzgerald is the first woman to head oncology, the first med-tech entrepreneur in the job, has raised £35 million for cancer research and is renowned in her field for the ‘pill on a string’ that has transformed diagnostics for esophageal cancer.

The founder of the Early Cancer Institute in Cambridge said she grew up wanting ‘to make things better’ and once qualified, relished her work with patients.

As a junior doctor she was more focused on patients than clinical research but during a job interview a senior figure made her realise that ‘I should think beyond my clinical duties to future horizons in medicine that could be transformative.’

Two decades on and that is exactly what Professor Fitzgerald is doing. As Head of Oncology in Cambridge’s prestigious School of Clinical Medicine, she will play a pivotal role in the collaborative endeavour at the heart of the Cambridge Biomedical Campus, where ground was broken recently for the Cambridge Cancer Research Hospital.

The Cambridge Cancer Research Hospital is a brand-new concept where clinicians, academic scientists, patients and industry work side by side in clinical settings to discover innovative solutions to find cancer earlier and treat it better, or even prevent it.

Currently, the outlook for many of the 1000 people diagnosed every day in the UK with cancer is poor. ‘We often detect cancer too late, and our treatments are too imprecise and not tailored to an individual patient’s needs,’ says Professor Fitzgerald. ‘As a result, one in two patients die of their disease. Furthermore, the treatments can be horrible.’

Professor Fitzgerald saw the depressing consequences of late diagnosis early in her career. She specialised in gastroenterology, more by accident than design, because she enjoyed ‘the detective work’ it often required.

Meeting patients with advanced esophageal cancer for whom there were no treatment options in the 1990s laid the foundations for her quest for a new diagnostic test.

Esophageal cancer is one of the hardest to treat, with under 20% of those diagnosed in the UK living for five years. Esophageal and gastric cancers represent a substantial proportion of cancer diagnoses worldwide.

But the University of Cambridge strapline ‘we’re changing the story of cancer’ is apt when it comes to Professor Fitzgerald’s career.

While working in a London hospital she secured a research grant and was chatting with a senior colleague about the challenges of relying on endoscopies to research Barrett’s Esophagus – the condition that can lead to esophageal cancer. “You need a bottle brush for the esophagus,” he joked.

That throwaway line came back to Professor Fitzgerald when she returned to Cambridge to set up her own lab. Most patients she saw with Barrett’s Esophagus were not forewarned of their condition and endoscopies were not very effective diagnostic tools.

She asked the engineers at the old Laboratory of Molecular Biology if they could make a tiny bottle brush, and this was followed by an easier-to-swallow sponge in a capsule attached to a thread. This idea had been trialed in Asia in the 1950s but dropped because the design was extremely uncomfortable for patients and the post-test analysis proved inaccurate.

Today the science and accuracy of such cell test results is far advanced. The ‘pill on a string’– known as the EndoSign® – has proved its efficacy in four large clinical trials and is being distributed across the NHS through Cyted Health, the spinout company Professor Fitzgerald co-founded with her former PhD student Dr Marcel Gehrung and long-time collaborator NHS consultant Professor Maria O’Donovan.

The EndoSign® can be administered by a nurse in just seven minutes and is less invasive for the patient than an endoscopy – for which there are often long waiting lists in the UK.

From pioneering this device, Professor Fitzgerald drove Cambridge’s commitment to the early detection of cancer – previously considered ‘too difficult and long-term’ by funders and policy makers.

Traditionally medical researchers focus on cancer patients to try to understand the causes of cancer or to identify new treatments. Today they are also looking at healthy people to understand why some cells do not become cancerous.

Building on the ‘Cambridge legacies’ – the discovery of the structure of DNA and new fast sequencing methods – the next step is to identify the ‘tipping points between normal ageing, early cancer and late-stage cancer’, says Professor Fitzgerald.

Cambridge is uniquely placed to accelerate this process she says, ‘with its ecosystem of scientists, technologists and clinicians fuelling new breakthroughs in cancer detection and treatment, especially when given early opportunities to talk with industry.’

Professor Fitzgerald’s first-hand experience collaborating with entrepreneurs, AI experts and engineers to set up Cyted Health was transformative. ‘It gave me ideas for different ways to tackle a problem and a deep respect for entrepreneurs and business leaders.’

The advent of AI to analyse masses of patient data and link it to research data, such as the profiles of tumours, is a game changer.

The analysis of patient databases at scale has been critical for breakthrough discoveries in early cancer,’ says Professor Fitzgerald. ‘Using this knowledge, we can start to identify patients at risk even before symptoms occur.’

The nexus of expertise has burgeoned at the Cambridge Biomedical Campus where research organizations sit beside NHS hospitals, AstraZeneca and a host of entities involved in the prevention, diagnosis, treatment and care of patients with cancer.

There is more space for startups and established companies, which play an essential role in Professor Fitzgerald’s ‘Innovation Alliance’ vision.

While companies are starting to shift from stand-alone developments in science parks towards working more closely with academic centres in major cities, in this Innovation Alliance we will bring the partners together into one physical space to cement relationships and work towards common goals.

With companies primed to act when intellectual property from scientists is available, ‘patients will benefit from more rapid access to new technologies and medicines to find cancer early and treat it better, providing economic benefits for the NHS,’ says Professor Fitzgerald.

The seven-storey Cambridge Cancer Research Hospital, which is currently under construction, will include a Teenage & Adult Ward, and a pre-cancer clinic in a bid to prevent the disease. Professor Fitzgerald’s aim is for patients and the public to be actively involved, for example, in helping develop research studies, joining clinical trials (rather than ad hoc participation) and participating in health education programmes.

The Cambridge Biomedical Campus sees more than a million NHS patients a year and has 22,000 employees. As Head of Oncology at the heart of the Cambridge quest to change the story of cancer, Professor Fitzgerald is still driven by her childhood determination to ‘make things better.’