Professor William Gallagher:

I want to explain the process. Cancer trials are a patient-focused component but it is key also that we again resource sufficiently the discovery element, an example being the use of RNA vaccines in the treatment of Covid. That company was actually focused on using the technology for cancer vaccines. What is odd about it is that it has really accelerated because of the utility in the context of the treatment of Covid but a really big interest has now gone back towards trying to look at the efficacy of these types of approaches in treating cancer. However, the foundation is discovery. We have to have something to bring forward into the clinic. It is critical that we have that continuum within cancer research across the island - the ability to find new things, take those from the laboratory bench and bring them towards the clinic. That process is called translational research, where we try to translate our discoveries.

We have some very good examples of programmes. When we are talking about AICRI, it is a virtual project, not a bricks and mortar project; it is about people coming together in a team-based approach. We have good examples of that happening already and showing efficacy. For example, I had the pleasure for six years of leading a programme called BREAST-PREDICT, which was funded wholly by the Irish Cancer Society to the tune of €7.5 million over the six years. This programme had a big impact in terms of new discoveries in the breast cancer space. It funded a team of just over 30 people between Cork, Dublin and Galway, and also had connections in Northern Ireland and with Cancer Trials Ireland. I will give a couple of examples of specific outcomes. Professor Bryan Hennessy, who is based in the Royal College of Surgeons in Ireland and in Beaumont Hospital, had a specific interest in trying to understand why certain breast cancer patients may have an initial response to treatment but then develop a resistance over time. He had uncovered a new idea about how that occurred and then had to come up with a new drug combination strategy from the laboratory bench, and he was able to transition this in Ireland in a first-of-its-kind study worldwide. That is an example of true translational research or foundational research, where we come up with discoveries and bring them forward into the clinic. Having that continuum is critical.

There is another concrete example which leads into the economic question. There is a well-known assay or test in early-stage breast cancer which is called Oncotype DX. With early-stage breast cancer, while it is great that mammographic screening is catching the breast cancer much earlier, the challenge then is that we potentially might over-treat patients with chemotherapy and it is a clinical dilemma with which patients and clinicians are faced. If we have information to predict whether the disease is going to progress, we can have a decision as to whether to get chemotherapy. The Oncotype DX test was approved for public patients in Ireland in 2011 and this was the first country in Europe where patients within the public healthcare system got access to that technology. Why was that the case? It was because Irish clinicians were really at the forefront of bringing forward that technology and validating it.

The world's biggest clinical trial was called the TAILORx trial. The hospitals within the Irish context that participated in the trial, out of 900 hospitals worldwide, were some of the world's biggest accrual centres. For example, St. Vincent's University Hospital was second out of 900 across the world. Even though we are a small country between the two jurisdictions, we punch above our weight.

What is critical is not just advances in terms of clinical decisions but it is has been demonstrated that it actually saves money. For example, because we are sparing patients from chemotherapy and the debilitating effects of chemotherapy when they may not stand to benefit, that actually saves the Exchequer money. The first cost-effectiveness analysis studies were performed on patients within the Irish system. Professor Lawler might want to tackle the economics question.