trying out drug combinations, identifying new targets and developing new drugs against those targets.” Professor Medema is well aware that the continued


success of the NKI’s programmes depends largely on two things – the scientists working in the institute’s labs and the money needed to fund the whole operation. While he is sure he has the very best people in place right now, he is less sure about the funding. “One of the most important things for us at NKI is to great scientists


have understanding, working here, scientists


dedicated to truly understanding cancer and, with that


translating it into clinical


application,” he says. “The scientific rigor and quality of our work is key to our success and our standing in the cancer research community worldwide.” Medema also believes that being a relatively small


institute plays a big part in its success and attracting the best scientists. The institute is also connected to a cancer hospital and so each group of people know each other, which helps make


that sense, I am very positive translation


between fundamental research and clinical testing relatively quick. “In this


about the


opportunities we have in translating science,” he says. “We have definitely entered an era where we can start to match the knowledge we have gained in the lab to new drugs. “But the problem is more complicated as there seems to be a tendency for politicians,


funders and the


private sector to want us to shift entirely towards translation – and this is a serious risk. I think a healthy cancer research institute needs to have a healthy ratio of


fundamental, translational and


clinical research. “Of course, you can debate exactly what that ratio


should be, but our success and the future developments we make are all going to stem from our fundamental research, so this has to be resourced properly.” Medema uses the example of the NKI’s results with


deep sequencing and the technologies these have produced to illustrate this point about the need for continued fundamental research and striking the right balance in terms of applying the knowledge of cancer it creates. “Once we


have exploited the power of deep


sequencing we are going to need to understand the next level,” he explains. “When we sequence a tumour, it doesn’t mean we know the mutations that are present in each individual cell in that tumour, since we know there is a variety of cells in the tumour and they will all determine the drug response. This is another level of complexity and I think we desperately need to cultivate the mindset, not only in the institute but also outside the institute, that in order to solve the problem of cancer we need to apply what we already know but at the same time we need to continue investigating the fundamental nature of the disease. “It’s very tempting to say ‘we know that, we can do


this, so let’s do it, let’s apply it all’. That approach will lead to some successes, but lots of it won’t. So we


28 “My vision for the institute is that we need a good


mix of science,” he explains. “We need the type of science that leads to relatively quick translation, and this we are doing now – turning our knowledge of mutations into tangible physical


therapies and


transferring our knowledge in immunology into tangible new immune therapies, for example. We must continue to do this. “But at the same time,” he warns, “we need to have


sufficient power as an institute to do the fundamental science that is going to progress technology, progress our knowledge. “I am optimistic about the future for cancer research


and I am optimistic about all the ingredients we have in place at NKI to make real progress. That is not to say we don’t face great challenges, we do, but if we maintain that healthy ratio of fundamental research and translational research, then we will continue to deliver a greater understanding of the disease and in turn deliver new technologies and drugs to treat it.”


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“We have definitely entered an era


where we can start to match the


knowledge we have gained in the lab to new drugs”


should just be aware that if we move too much away from fundamental science, then in five years’ time we will not have anything to apply because we will have no new knowledge to build on. “So the challenge for the entire scientific community


is to explain the importance of fundamental research, because for the public it may seem more logical for us to put all of our efforts into the translation of the knowledge we have at present and do new trials instead of doing research with no known outcome, no definite end result.” Despite


these concerns about cancer research,


Professor Medema is certainly clear about how NKI should continue to work. He is optimistic that the institute will continue to extend scientific knowledge of cancer, put that knowledge to rigorous clinical testing and develop new drugs and treatments for the disease.


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