Kampala, Cambridge, Childhood Cancer (KamCamChildCan; KC³): Improving childhood cancer outcomes

Prof Suzanne D Turner and Dr Jackson Orem

University of Cambridge and Uganda Cancer Institute

KC³ is a collaborative project between the department of pathology at the university of Cambridge and the Uganda Cancer Institute (UCI) with the aim to improve the lives of children with Burkitt lymphoma (BL). BL is a cancer of the immune system which when occurring in children in Sub-Saharan Africa (SSA) is driven by Epstein Barr Virus (EBV) infection in malaria endemic regions (endemic BL; eBL) whilst in high income countries (HIC), it can be linked with EBV infection but is not associated with malaria (sporadic BL; sBL). However, anecdotal evidence suggests that as malaria infection is being increasingly controlled, more children in SSA are presenting with disease more consistent with sBL. Regardless, there is a clear disparity in survival rates with children in HIC benefitting from improvements in therapy with overall survival rates now approaching 95%, whilst for children in LMIC, dependent on where they live, survival varies from just 10-60%. The intention of our research is to close this gap, to facilitate kinder and more effective treatments for children regardless of where they live.

In order to achieve this goal, with finding initially from the institutional grant awarded to Cambridge university from the Global Challenges Research Fund, and more recently from the Alborada Trust, we have established a BL research lab at the UCI in Kampala. These capacity building awards have allowed us to purchase equipment and conduct training activities with staff exchanges occurring between Cambridge and Kampala. We have also secured ethical approval to establish and build a biobank of childhood BL tumour tissue. This will allow us to study the unique genetics of eBL at an unprecedented level though analysing the sub-clonal heterogeneity of this malignancy. Banking of blood plasma from the same patients will also enable us to develop non-invasive tests to monitor disease progression and, in time, to facilitate early disease detection.

We have been fortunate enough to have secured further funding to continue this work from both the Little Princess Trust and the Great Ormond Street Hospital charity in the UK. In the former case, we have funding to take us to 2024 and in the latter to 2025 to achieve three main goals:

1. To improve our understanding of how eBL develops and evolves at a sub-clonal level towards the development of less toxic yet efficacious therapies specifically for this patient population (Great Ormond Street Hospital charity).
2. To develop non-invasive assays to monitor response to treatment to facilitate early adjustments to the treatment regimen thus improving therapeutic outcomes (Little Princess Trust).
3. To apply the non-invasive assays to allow the early detection of eBL by working alongside malaria clinics (Little Princess Trust).

				Our lab and bioresource at the UCI with (left to right) Sylivestor Kadhumbula (lab technician), Ezra Anecho (research facilities manager) and Dr Nixon Niyonzima (director of research)
							Interactions with government, policymakers Our visit with Dr Aceng , Hon. Minister of Health, Uganda (5th from left) with Jackson Orem and Suzanne Turner, KC3 co-leads (6th and 7th)
					The new Uganda Cancer Institute build The new building will house purpose built research labs adjacent to treatment units that will facilitate research activities