Smart People:
Stephen Nabarro

Stephen Nabarro, head of clinical operations and data management at Cancer Research UK Centre for Drug Development, talks to PharmaTimes about his role in cancer research

What is your background and current role?
I have always been passionate about improving treatments for cancer patients. This started with my PhD at Great Ormond Street Hospital (University College London) where I worked in the lab developing novel cellular vaccines for two different paediatric cancers. This was years before the huge explosion in immuno-oncology, so it’s incredible to think about the subsequent progress in this field. A good example of the progress made is that, at the start of this year, the first ever child was given chimeric antigen receptor (CAR-T cells) as a treatment on the NHS (it happened to be at Great Ormond Street Hospital) to treat acute lymphoblastic leukaemia. After completing a post doctoral fellowship at the Medical Research Council Laboratory of Molecular Biology, I joined Cancer Research UK in the Centre for Drug Development as in my mind the most exciting oncology experiments are when you administer a novel treatment to patients for the first ever time! I’ve been at Cancer Research UK for twelve years now and still find working on first in human trials hugely rewarding in my role as head of Clinical Operations and Data Management.

What does your day-to-day work involve?
We currently have a portfolio of 22 novel anticancer agents, of which half are in the clinic actively recruiting patients, so my role is to support the study teams working on these trials. Early phase oncology clinical trials are incredibly complex and it is an absolute team effort both within Cancer Research UK as the sponsor, but also with external stakeholders including the investigators and their teams at the participating hospitals, plus our pharma/biotech partners that provide us with access to their drug. Building and maintaining strong working relationships with all these stakeholders is a time-consuming but very rewarding part of my role. Establishing and maintaining these complex networks is something we pride ourselves on in the Centre for Drug Development.

What are the key recent advances in your field?
The approval of checkpoint inhibitor antibodies (such as anti PD-1 nivolumab and pembrolizumab in 2014) has transformed cancer treatment and been the major talking point at ASCO over the last few years. It’s interesting how we now see increasing numbers of novel agents that are designed to be used in combination with checkpoint inhibitors, eg to overcome resistance to these inhibitors. I have mentioned CAR-T cells already in this interview and for good reason. Biotherapeutics have taken a huge leap forward in recent years and there is huge excitement in our field because of their curative potential. However, this excitement is curbed by the huge cost of the intricate manufacturing process for an autologous vaccine (and the fact that it is only available at a handful of leading research hospitals in the world). One possible route to make this type of cellular vaccine affordable and available at all hospitals is generating ‘off-the-shelf’ vaccines made from allogeneic cells. We are playing our part in this effort by sponsoring a first in class trial in collaboration with Asterias using an allogeneic dendritic cell vaccine in non-small cell lung cancer, which is a cancer of unmet need.

What do you see as your biggest professional achievement in this role?
When I joined Cancer Research UK I felt I wanted to stay as close to the science as possible, but over the years I have developed an even greater passion, which is the people side of the role. I find it hugely rewarding supporting talented sandwich students who then come back to us when they graduate and flourish at Cancer Research UK and go on to successful careers within the pharmaceutical industry.

What drives your passion for your area of work?
We are in a privileged position because our sole driver is maximising patient benefit, which I find incredibly motivating. As an academic sponsor, we don’t have the same commercial/financial requirements of drug development divisions within pharmaceutical companies. Our charity is seen as a trustworthy leader in our field, and as such we have the opportunity for a lot of direct involvement with patients and carers. I find working directly with patients (which this year has ranged from designing a more patient-friendly informed consent document through to filming a podcast) hugely inspiring.

If you could highlight a single thing that would make the biggest difference to cancer related R&D, what would it be?
In the UK, genetic profiling of all cancer patients at the time of diagnosis, to enable the best use of the new wave of targeted treatments, is within touching distance but is stubbornly challenging to make routine practice in the NHS. This vision for precision medicine has the potential to dramatically improve survival rates.

What is your greatest frustration with your profession?
As an industry we are relatively resistant to change and slow at grasping the opportunities from the technology revolution we now live in. In my home life I have not read a 20-page document cover to cover in years, eg I have never read my full mortgage statement or holiday insurance cover, the summary table is sufficient. Yet we still expect patients to read and fully digest 20-page informed consent documents at such a difficult time in their lives, even when we know poorly informed patients are more likely to drop out of a clinical trial early. I’m pleased to see that electronic informed consent documents are becoming more widely adopted by sponsors, as are apps for patients so they can easily contact their nurse and doctor and put them in more control of their treatment.

In the 12 years you’ve worked for Cancer Research UK, what have been the most exciting developments?
During my time at Cancer Research UK I am fortunate enough to have worked on Phase I trials for two novel agents that have now become very successful marketed drugs. In fact, the first trial I ever worked on when I joined Cancer Research UK as a Clinical Research Associate was abiraterone. This is now marketed as Zytiga and there are 200,000 men worldwide per year with castration-resistant prostate cancer that are eligible to be treated with this drug. What excites me is thinking which of our current portfolio of novel agents in our hands in the Centre for Drug Development might go on to have a similar patient impact.

What are your passions outside of work?
I am sports mad! I have become a keen runner over recent years, which stemmed from our team at work deciding we wanted to do some joint fundraising by running the Cancer Research UK Winter Run. We set up a work run club to spur us on with training and three years later the Winter Run has become an annual highlight in our work calendar. The most rewarding thing I do at weekends is coach my daughter’s under eights cricket team. 

‘Genetic profiling of all cancer patients at the time of diagnosis, to enable the best use of the new wave of targeted treatments, is within touching distance but is stubbornly challenging to make routine practice in the NHS’