A key pillar of the George Institute’s mission is to find better treatments for the world’s biggest health problems. With cancer being the second-leading cause of death worldwide, the Institute’s researchers are now using their expertise to help improve outcomes for women with a particular type of breast cancer.

According to the National Breast Cancer Foundation, breast cancer is the most commonly diagnosed cancer in Australia, with approximately 55 new cases diagnosed each day, or over 20,000 a year.

Around 10–15 percent of these patients will have the HER2-positive type, characterised by high levels of the HER2 (human epidermal growth factor receptor 2) protein on the surface of the cancer cells.

Monoclonal antibodies targeting this receptor protein are the mainstay of HER2-positive breast cancer therapy, but in around one in ten patients they can cause damage to the heart. This can lead to patients having to interrupt or stop their cancer treatment, which impacts their chances of survival.

George Institute researchers, together with a team from The Garvan Institute of Medical research recently completed a review of studies that have tried using heart failure treatments to prevent heart damage associated with this type of cancer therapy.

The team identified five clinical trials including over 900 patients that were completed in both early and metastatic disease. They found no significant difference in the number of people who developed heart complications when they were treated with preventative heart medication, compared to those on placebo. But Dr Clare Arnott, Co-Director of the George Institute’s Better Treatments Program said that certain medications did appear to reduce the risk of cancer treatment being interrupted.

“We need more evidence to know whether we should be prescribing these medications to patients undergoing HER2 positive chemotherapy to improve their heart outcomes,” she said.

The team has now received funding to set up a pilot study to help fill the evidence gap.

“The study aims to prevent cardiotoxicity from treatment with the drug herceptin in women with breast cancer - there are currently no proven therapies to prevent the adverse effects of this drug on heart function,” said Dr Arnott.

“We hope this research will lead to more such trials, so that doctors and patients have the information they need to decide whether to add preventative heart treatment to their care.”

The theme of this year’s World Cancer Day, “Close the Care Gap”, and according to Prof Anil d’Cruz, President of the Union for International Cancer Control, Director of Oncology at Apollo Hospitals, India,

“By 2030, it is estimated that 75% of all premature deaths due to cancer will occur in low- and middle-income countries. Importantly, this care gap is not only between high- and low-resource settings. Disparities exist within most countries among different populations due to discrimination or assumptions that encompass age, cultural contexts, gender norms, sexual orientation, ethnicity, income, education levels and lifestyle issues. These factors potentially reduce a person’s chance of surviving cancer – and they can and must be addressed.”

In 2020 Imperial College London and The George Institute for Global Health embarked on a new collaboration to drive the development and evaluation of innovative and sustainable global health systems. Following a successful initial collaboration, a new five-year commitment has been agreed, that will focus on health systems, women’s health and multimorbidity.  

The collaboration will build large-scale, transformative research initiatives supporting progress towards universal health coverage and sustainable development by addressing the greatest challenges to health globally.  

Professor Jonathan Weber, Dean of Imperial’s Faculty of Medicine, said:

“I am extremely pleased to see the continuation of our collaboration with The George Institute, and am excited about its vast potential to drive improvements to health systems and the wellbeing of people around the world. 
 
“From women’s health and clinical trials, to training the next generation of students and addressing the challenges of multimorbidity, I look forward to great success together during the years ahead.” 

Professor Robyn Norton, co-founder and Principal Director of The George Institute for Global Health, said:

“We are delighted at the evolution of our collaboration. Working together, we believe there is potential for seismic change to the health and lives of individuals and communities globally. 

“We look forward in the coming months to making several professorial-level appointments in each of the three research areas of focus to strengthen our work together.” 

Innovative health systems 

The COVID-19 pandemic has illustrated the urgent need to develop evidence-based strategies that enhance the effectiveness of health systems. Around the world, enormous challenges are faced in delivering essential care, particularly for those living in disadvantaged circumstances. 

Through the collaboration, researchers with expertise across a broad range of disciplines will work with policymakers, healthcare providers and communities to develop and evaluate ways to produce sustainable improvements in health systems and services, so improving health and care for all. This will include a focus on frugal innovation and disruptive entrepreneurship that supports improvements to the health of populations in resource-poor settings. 

Professor Ian Walmsley, Imperial Provost, said:

“This new five-year partnership with The George Institute will complement Imperial’s strengths to build on our already significant profile in public and global health. 
 
“Our organisations have aligned aims and ambitions to improve health through research and innovations, and we will together see the opportunity to have significant impact in developing sustainable, innovative global health systems that populations around the world need to thrive.” 

Improving women’s health  

By working with colleagues across Imperial, the collaboration will be convening a new, transdisciplinary network to address the major health issues facing women and girls across the globe. This will target non-communicable diseases and injuries (NCDIs), and under-studied and under-resourced conditions that specifically affect women. 
 
This work will take a multi-faceted approach to improving women’s health through research, policy, and advocacy, with a particular focus on low- and middle-income countries and under-served populations in high-income countries—including those of North West London, given the equity challenges these communities face. 

By harnessing the collective strengths of researchers at Imperial and The George, in collaboration with global peers, this significant programme has the potential to produce a ‘quantum leap’ in the health of women and girls worldwide. 

Professor Deborah Ashby, Director of Imperial’s School of Public Health, said:

“Our initial partnership with The George Institute for Global Health over the past year has been incredibly successful and fruitful. 
 
“I am delighted to see this relationship extended and enhanced by drawing in expertise from across Imperial College to tackle some of the world’s most pressing health issues.” 

Understanding multimorbidity 

The global burden of multimorbidity—where individuals are affected by multiple diseases—is one of the most significant challenges to the sustainable health agenda and will be a core target of the collaboration.  

A College-wide initiative will be established, dedicated to world-class research to prevent and treat these most damaging clusters of NCDIs, and communicable diseases. 

Professor Stephen MacMahon, Principal Director of The George Institute for Global Health, said:

“In most countries, including the UK, a large proportion of the adult population suffers from more than one disease, and the greater number, the greater the risk of premature death. 

“The Covid-19 pandemic illustrates this clearly. For example, among people infected with Covid, the risk of death was around 50% higher among those with diabetes and more than 100% higher among those with diabetes and other chronic conditions such as heart disease.   

“This unique research programme is specifically designed to develop effective strategies for the simultaneous prevention and treatment of multiple diseases.”  

The George Institute at Imperial 

The George Institute is based in the Translation and Innovation Hub on the White City Campus, a region that is quickly emerging as the capital’s newest hub for life sciences research and innovation. 

The team will also work with the Imperial Clinical Trials Unit to expand the number and scope of high-quality randomised clinical trials seeking to answer urgent questions facing healthcare providers globally.  

Planetary health and the links between the environment and human health will be another priority focus. Imperial’s existing world-class research, training and innovation will be augmented with The George’s expertise in NCDIs, in working with partners in low- and middle-income countries, and its focus on developing and evaluating innovative solutions to address global challenges.  

The collaboration will also enhance Imperial’s world-leading educational offering by providing students with opportunities to work in multicultural, international teams, and across disciplinary boundaries. It will develop students with the skills in innovation required to create solutions to complex real-world problems.