Gerry Thomas

1
Overview of Cancer BioBank Networks

• Gerry Thomas
• Prof of Molecular Pathology, ICL, and Director of
  Scientific Services, WCB

2
Philosophy behind Cancer Banks

• Development of new therapies for cancer treatment
  will only happen if we have the material to
  understand the disease
• Need to solve issues of consent, and to make sure
  patients are confident enough to provide consent

working together ultimately speeds up
improvements in cancer treatment
3
Who needs to be in the loop?
Many stakeholders with different viewpoints -
funders, hospital administrators, patients,
various medical specialities, IT, plus scientific
users who have little or no clinical experience
Essential Good communication, negotiation and
problem solving skills
Desirable GSOH and clairvoyancy!
4
Embed tissue banking in routine patient care!

• ALL patients
• Pre-operative consent
• Post-operative consent
• Frozen tissue or fixed
• AMBITIOUS !

5
Virtual vs Centralised

• Continued support from local community important
• Centralisation causes resentment
• Flexibility is essential not all hospitals run
  the same way
• Centralised database with local remote access
  essential to success of virtual bank

6
Governance e.g. WCB and the UK

• Governance structures vary across the world
• In the UK the Wales Cancer Bank is
• Licensed by the Human Tissue Authority
• Has approval from the Wales Multi-centre Research
  Ethics Committee
• Has approval from relevant hospital research and
  development departments
• Sponsored by Cardiff University under the UK
  Research Governance framework

7
Why network Banks?

• Harmonisation of consent
• Agreed SOPs for collection, documentation,
  annotation and quality assurance
• Unified access policy
• Ability to source large numbers of common cancers
  and divide into subtypes (e.g. G3 Breast Ca in
  gt70)
• Ability to source adequate numbers of rare cancers

• All above increases quality and usefulness of
  sample, and increases confidence of donors and
  scientific users

8
Consent What should the patients be told?

• Patient information sheets explain that the
  patient is giving consent for generic research
  into cancer
• Research can be carried out by academics or
  industry
• Patients are unlikely to benefit themselves from
  research carried out on their tissues

9
Consent What are the patients told?

• Can withdraw their consent at any time but
  withdrawing a long time after consent may mean
  that some of their material has already been used
• Patients donate they receive no financial
  benefit
• Projects using material from the Bank will be
  scientifically reviewed by an external panel

10
Reasons for refusal - WCB

• Less than 1 of patients refuse to consent.
  No single reason only one refused because they
  didnt agree with generic consent

Other reasons

• I dont want to be bothered by another nurse

• The arm of the chair is sticky

• I have cancer and I dont want to help anyone

• I dont want my wife cloned!

11
Why do scientists want tissue banks?

• Issues of consent taken care of
• High quality material provided quality both in
  respect of sample integrity and annotation
• Different types of biospecimen available from the
  same patient DNA from blood and tissue, RNA
  from tumour and normal tissue
• Easier than setting up your own!

12
Quality matters
Todays science is expensive
13
Quality matters
14
The Importance of SOPs

• SOPs enable us to collect data on how a specimen
  is obtained and manipulated.

• If SOPs are too rigid or impractical, human
  nature means that either specimens will not get
  collected or people will not tell the truth.

• SOPs should be developed with team involved in
  collection of material to ensure they are
  practical.

15
SOPs rule!

• Material must be collected, documented and stored
  according to SOPs
• Adherence to SOPs must be regularly checked
• If you cant control quality at input level, must
  control quality at output

16
Human Tissue vs Experimental model

• Obtaining biosamples from humans very different
  from research on cell lines or animals

• Patient care must come first sometimes this
  means biological integrity of the sample may be
  altered

• Little high quality scientific research done on
  effect of time delays in processing specimens,
  handling of specimens we simply dont know our
  safe limits

17
How you collect your sample matters.
Villanueva et al., 2005 J Proteome Res 4
1060-1072
18
Is it what I think it is? Pathology QA

• A representative section of each block of tissue
  (frozen or FFPE) should be examined prior to
  release of material to ensure that
• the material is from the tissue we think it is,
• to assess the relative amounts of epithelial and
  stromal material present

19
Molecular Biology QA is my sample good enough?
20
My sample is what I think it is now what do I
do?

• Police use multiple lines of evidence to solve a
  crime researchers use multiple technologies to
  understand cancer.

• Where possible, individual samples should be
  split into different elements to provide for a
  systems biology approach to research.

• Science constantly changes tissue bank
  practices must reflect this and adapt
  appropriately.

21
Access to Samples

• Formal application, MADE EASY FOR RESEARCHERS
• What samples can be used for depends on consent
  given if this is generic (broad) then only
  Ethical issue is how good the project is that it
  is being used for
• Scientific review is therefore obligatory
• Access should be as wide as possible
• Where possible, research results should be
  collated to minimise duplication of results and
  permit comparisons of data derived from different
  samples from the same patient

22
Final Thoughts

• Tissue banks in point of care hospitals are
  essential for applied cancer research - we want
  to treat cancer in humans not in cell lines or
  animals
• High quality material leads to better medicine
• Pathology Departments should take the lead
  personalised medicine will not happen without
  Pathology buy-in

23
More info? NB plenty more out there.

• General info and links
• Marble Arch Group (www.marblearchgroup.org)
• Confederation of Cancer Biobanks
  (www.ncri.org.uk/ccb)
• SOPs for tissue collection and documentation
  etc
• Wales Cancer Bank (www.walescancerbank.com)
• Austrailian Biospecimen Network (www.abrn.net)
• Consent forms and Patient information sheets
• Wales Cancer Bank (www.walescancerbank.com)

24
Acknowledgements