Dr Naureen Starling is Training Lead at the NIHR Biomedical Research Centre at The Royal Marsden and the Institute of Cancer Research (BRC), Deputy Theme Lead for the Gastrointestinal Cancers theme and Associate Director of Clinical Research. As a Consultant Medical Oncologist based in The Royal Marsden’s Gastrointestinal (GI) Unit, Dr Starling specialises in the treatment of patients with oesophageal, gastric, pancreatic, neuroendocrine and colorectal cancers. These cancer types are also the focus of Dr Starling’s research, with her work concentrating on earlier-phase clinical trials, novel therapeutics and the delivery of individualised medicine to patients with GI cancers. Collaboration opportunities from the BRC has helped facilitate some of Dr Starling’s work. Image Pictured: Dr Naureen Starling What do your roles at the BRC involve? I am currently the Training Lead at the BRC where I lead on capacity building within the institution. I work with others to identify people we need to invest in, grow and train in order to meet the cancer research workforce needs of the future. The aim is to get people interested in research because that’s how cancer care gets better – through posing research questions, answering them and creating better patient outcomes. Within the BRC I’m also the Deputy Lead for the Gastrointestinal Cancers theme. This is where my own research comes into play, both in terms of circulating tumour DNA in GI cancers, particularly colorectal cancer and novel therapeutics, and exploiting drugs that target DNA damage response. I run my own academic studies and I’m also the principal investigator on many contracted research studies where I work with industry on what we see as the important drugs to assessing cancer. Additionally, my role as Associate Director of Clinical Research involves providing clinical input into the clinical research operations and strategy of the institution. What impact has the BRC had on GI and wider cancer research? The BRC is hugely facilitatory - it’s the bridge between the lab and the clinic and changing patient care in a short time span. One example of this is our use of liquid biopsies (blood tests) which, in the time that I have been working with the BRC, has accelerated immensely. Facilities like the Centre for Molecular Pathology allow this acceleration and collaboration with different research themes within the BRC, enables us to learn from each other. The ability to take theoretical developments and into clinic is evidenced in our TRACC study protocol. I’m working with Professor David Cunningham as Chief Investigator for the study, which also had input from BRC patient representatives during the design stage. It’s a team effort to drive the study which aims to investigate whether a liquid biopsy can identify which bowel cancer patients will benefit from chemotherapy following surgery. We are also now looking at liquid biopsies to support faster diagnosis of difficult to diagnose cancers such as pancreatic and bile duct cancers. I am chief investigator for the PREVAIL pilot study of this innovative approach. I’m also working with Dr Marco Gerlinger on the iSCORE trial to see whether immunotherapy drugs could be used to reverse resistance in a group of patients who have become resistant to Cetuximab, one of the few targets drugs we can use to treat bowel cancer. This is particularly interesting as bowel cancer does not usually respond very well to immunotherapy. The BRC provided the route for Dr Gerlinger’s observation in the laboratory to be taken into the clinic and as a result we’ve been able to recruit nine participants. We’ve already seen some early signs of promising activity and the BRC has been critical in moving the research along quickly. What might the future hold for GI cancers? There is still huge unmet need in GI cancers, particularly in the advanced setting and particularly in upper GI cancers where we don’t see the survival rates we see in other cancers. I think there is a lot of potential in terms of precision medicine and genotyping, not just for advanced disease but for those with residual disease after surgery. We need to harness science, technology, data and all the massive developments we’re seeing across those areas to focus and converge those developments on these cancers of unmet need.