Let’s Make a Real Difference in Cancer

Pharma companies should consider increasing collaboration with non-profits; it’s all about delivering the best outcomes for patients. We interview Lars Erwig about his passion for helping cancer patients.

What first inspired your interest in drug development?
 

It all started with my mother being diagnosed with cancer, undergoing several years of treatment and ultimately dying of cancer when I was 11 years old. It led me to pursue a career as a medical doctor with the ambition to develop new medicines. I studied medicine in my hometown of Hanover in Germany and began my research career with a fellowship in the US, studying oxygen transport, while I was a medical student.

After completing medical school and my first doctoral degree, I started my medical training in general medicine and nephrology. My research focused on the innate immune system and the role of macrophages in inflammation. My clinical focus was on multisystem immune diseases such as lupus and vasculitides.

And what led you to the role at Cancer Research UK’s Centre for Drug Development?
 

I started to conduct clinical trials in addition to my basic science laboratory work – and I was increasingly exposed to the pharmaceutical industry. After contributing as a consultant to the development of a novel treatment for lupus, I gave up my academic career and joined GSK. Next, I became the CMO of a joint venture between GSK and Google, developing implantable devices to treat autoimmune diseases. For the last four years, I worked for Johnson & Johnson, trying to find new promising therapies in academia and biotech, with the aim to accelerate pharmaceutical development.

I joined Cancer Research UK as director of our Centre for Drug Development in February 2024. I want to use my experiences in academia and industry to develop more effective, tailored therapies that are better tolerated by patients. I want to help turn the great ideas from Cancer Research UK and our partners into clinical programs that are executed to the highest standard and make sure that they are partnered appropriately to set them on a path to benefit patients expeditiously. I also hope that we can turn our attention to some of the rarer, harder to treat types of cancer.

What are the big trends affecting drug development and clinical trials right now?
 

Over the past few years, the larger pharmaceutical companies have shifted their focus to later-stage clinical development. There are good reasons for this; these companies have the capital required to conduct highly expensive phase III trials, the experience needed to navigate the complex regulatory landscape to get new treatments approved, and the necessary infrastructure to manufacture those treatments at scale. These are resources that are vital for getting new treatments to market – which academia and smaller biotech companies simply do not have.

To preserve their resources for later-stage development and commercialization, however, pharmaceutical companies are doing fewer and fewer early-phase trials. That means that the industry – and patients – increasingly rely on academia and biotechs to do the innovative, early-stage development work for new treatments.

People assume there is a lot of activity when it comes to drug development for cancer, but are there cancer indications that are getting left behind?

There is still a significant unmet need for rare indications, including cancers that affect children and young people. Rare indications are considered those diagnosed in fewer than 6 in 100,000 people a year, but together they account for almost a quarter of all cancer diagnoses. That’s more than any single cancer type, but there are far fewer treatments available.

The reasons for this are clear – rare cancers receive less research funding, they are harder to diagnose, and there are fewer patients to participate in clinical trials. There is a lot more that we need to do to improve outcomes for people with rare cancers.

Patient recruitment is known to be a big challenge in running trials – and has been for years. What changes could make a difference?

There should be more international collaboration between research institutes and non-profit organizations to widen the potential patient population and ease the challenge of patient recruitment. This would be particularly beneficial for trials of rare cancer treatments, where the patient populations are much smaller.

Through Cancer Research Horizons – the innovation arm of Cancer Research UK – the Centre for Drug Development is already in clinical development collaborations with industry partners all over the world, but up until now we have exclusively used UK sites and UK patients. A major barrier to expanding trials to another country is the added complexity that different regulations bring. Collaborating with an organization in that country helps to overcome that barrier, broadening the pool of potential patients and easing recruitment pressures.

How much of the clinical trial burden in rare indications falls to non-profit? Is there a lack of interest from pharma companies?
 

There is a much lower financial incentive to develop treatments for rare indications; the challenge of recruiting from smaller patient populations pushes up the development costs, and the limited market size makes it even harder to recoup that cost. Orphan drug designation and other regulatory measures encourage more investment in rare diseases, but there is still a gap in available treatments. Non-profit organizations are crucial to filling that gap. If we do not fund these trials, no one else will.

How are non-profits partnering with one another to ease the pressure?
 

Cancer Research UK is one of the only cancer charities in the world that has established an in-house drug development facility capable of executing early-stage clinical trials with standards fit for regulatory approval downstream. It is essential that high-quality research funded by non-profits can be translated into benefit for patients. We need to expand the capabilities of the Centre for Drug Development to make sure that, through collaboration with other non-profit funders, patients across Europe can access our most transformational trials.

We initiated partnerships with KWF Dutch Cancer Society in November 2023 and the Norwegian Cancer Society in March 2024. These are two leading cancer research charities that share Cancer Research UK’s patient-first vision of developing treatments. The partnerships allow us to pool patients, resources and expertise, taking the most promising breakthroughs in our respective research networks through to the clinic where together we’ll have access to more trial sites and patients.

The groundwork for these partnerships began long before I joined the Centre for Drug Development, but I can already see the power of this collaboration model and am committed to expanding our partnerships further. European countries are much slower to deliver clinical trials than the US, which benefits from centralised administration across a large, diverse patient population. Without this federal framework, it is important for us to forge our own collaborations across Europe, especially since Brexit cost the UK its access to the EU’s clinical trial database and made it less attractive for researchers and clinicians to work here.

What other success stories can you tell us about?
 

The first trial under the partnership with KWF focuses on improving radioligand therapy outcomes for children with neuroblastoma, a rare cancer that accounts for around 6 percent of total childhood cancer diagnoses. This is a follow-on trial to a previous Cancer Research UK-sponsored study (NCT02043899) that, despite promising results, couldn’t progress because of a loss in manufacturing capabilities within the UK.

With the wealth of nuclear medicine expertise in the Netherlands and extra funding from KWF to support a clinical trial, we can continue working towards this unmet need. The trial will be led by University College London in the UK and the Princess Máxima Center in the Netherlands. It would not have been possible without our partnership with KWF. 

What call to action would you make of the pharma industry?
 

Promising compounds in pharma companies are frequently discontinued for limited commercial value, particularly in rare and pediatric cancers. We may be able to take these molecules forward because we define value differently in a non-profit organization. If we can partner with big pharma to advance these compounds and de-risk them in the process, they may reach a threshold that enables regulatory approval and direct patient benefit. We are not always aware of these compounds sitting on companies’ shelves and I would urge pharma companies to reach out.

The other way pharma companies can work with non-profits is to make marketed compounds available to enable the Centre for Drug Development to test new molecules in combination with established products.

Despite all the advances made in recent years many challenges remain in treating cancer and further progress depends on close collaboration between big pharma, non-profits, academia, governments and patients. Non-profits can be an important place for innovation, and I would encourage the pharma industry to proactively seek partnership with non-profits, not just for scientific progress, but also in clinical development.