ESMO Translational Research Award winner, Dr Samra Turajilic, gives insight on what it was like to work on cancer research at the start of the COVID-19 pandemic and the impetus behind the CAPTURE study. Image Dr Samra Turajilic, Consultant Medical Oncologist at The Royal Marsden Dr Samra Turajilic, Consultant Medical Oncologist at The Royal Marsden, has been awarded the 2022 European Society for Medical Oncology (ESMO) Translational Research Award for her outstanding work in the field. This includes her studies on cancer evolution (particularly for renal cell cancer, which is a type of kidney cancer) with the ADAPTeR clinical trial, as well as vital research into how COVID-19 impacts cancer patients through the CAPTURE study, which was funded by a generous grant from The Royal Marsden Cancer Charity and partly-funded by the BRC. Here, Dr Turajilic reflects on how and why CAPTURE was set up, and what its findings meant for cancer patients. Reacting to COVID-19's impact on cancer patients The start of the COVID-19 pandemic saw our lab briefly decamp home. In the first couple of weeks of that confused and chaotic time, we rapidly realised our lack of knowledge regarding the interaction between cancer, cancer therapies, infection, and immunity. The absence of evidence had profound consequences for cancer patients. What was more critical: to avoid COVID-19, or continue cancer therapy? There were broader measures impacting patients, too, including the pausing of recruitment to clinical trials, a reduction in routine cancer screening and the guidance to self-shield. The self-shielding list was so broad that almost all our patients were on it, deepening their isolation from the world, sometimes in the final months of their life. Making life-changing decisions in the dark was deeply uncomfortable. The Royal Marsden’s renal and skin research team worked tirelessly to develop a protocol and get it ethically approved. We realised we could not limit our study to the patients with melanoma and kidney cancer on our unit, and that we needed to include patients with all types of cancer in order to help inform clinicians across the hospital and further afield. We also had to develop procedures for patients being treated with a broad range of interventions, from surgery and radiotherapy to chemotherapy and targeted therapies. It was the most collaborative project my team had ever carried out in the hospital. We got to know many teams and colleagues we never would have met otherwise. Overcoming obstacles to develop the CAPTURE study In parallel, we began to discuss the immunological assays needed to evaluate how our patients and staff responded to COVID-19. This led to the development of the CAPTURE study, which was made possible thanks to funding from The Royal Marsden Cancer Charity’s emergency appeal, to better understand the effects of COVID-19 in patients with cancer and in healthcare workers. As part of this, we wanted to know about T-cell as well as B-cell responses, which meant we needed to collect and process blood tests on the same day, with the lab and hospital separated by six miles during strictest restrictions. In the early days, only four scientists in the lab worked to set up the sample reception, processing, tracking and downstream work. We needed a rapid education in infection and immunity, and we were glad to find ourselves surrounded by RNA virus experts, B-cell immunologists, and T-cell immunity and HIV experts at the Francis Crick Institute, where I am a Group Leader. We could also see the broader cross-learning value of investigating these questions in cancer patients who had aspects of their humoral and adaptive immunity compromised by disease or treatment. During this time, we also met and interacted with many patient advocacy groups, cancer charities, policymakers, and health economists. Crucial findings on cancer and COVID-19 from the CAPTURE study As the pandemic evolved and there was talk of vaccines, we knew that we would need focus on our work within CAPTURE on understanding how they would work in our patients and how the vaccine types, scheduling and dosing would impact the level of protection. The vaccination programme was being rolled out both at the hospital and in the community, and we started by placing volunteers in crucial positions around the hospital to recruit patients to the trial. This was doubly challenging as we could never disturb the main objective on the ground: taking care of the patients. In the end, almost 1,000 patients with cancer were recruited into CAPTURE. We collected, tracked, and analysed around 20,000 samples and more than 200 data points were entered for each patient. We learned that the immune response to COVID-19 disease or vaccine in patients with solid cancer was preserved, like that in the general population. Critically, we saw that life-saving immunotherapies did not impact our patients’ ability to mount an immune response. In patients with blood cancer, the story was different, and there was a clear reduction in how well their immune system responded. However, we could see that additional vaccine doses were consistently boosting the proportion of patients who would be protected and were delighted when this patient group were prioritised for additional boosters at the times of high-community transmission. This article was adapted from an article on The Royal Marsden's website.