Press Pack Interview with Associate Professor Richard Mair for Episode 2

You’ve spent your career tackling one of the deadliest forms of cancer, glioblastoma. What makes this particular disease so aggressive and hard to treat?

Glioblastoma is a type of cancer that spreads widely through the brain. Even though the tumour may have clear boundaries on a scan, we know that cancer cells escape from the main tumour into the surrounding brain and can travel long distances over time, sometimes even reaching the other side of the brain. Because a glioblastoma is in the brain, any treatment, whether it’s surgery or radiotherapy, must be precise. The example I often give is that, with several cancers, you can remove a margin of healthy tissue on either side of the tumour to maximise the chances of removing all the cancer. In the brain, that simply isn’t possible as the huge complexity and importance of brain function make this unfeasible. Glioblastoma also sits behind the blood-brain barrier, a wall of cells that protects the brain from infection but also makes it very difficult for drugs to gain access. As relatively few people are affected by this type of cancer, which is of course a good thing, it is often seen as commercially unattractive for pharmaceutical investment. Patients are often fragile and unwell, which further complicates treatment and research. For all these reasons, glioblastoma remains a very challenging cancer to treat.

What first drew you to brain surgery?

I was fascinated by the challenge of understanding and working on arguably the most complex structure in the universe. The high-stakes nature of the surgery took some getting used to, but every operation carries a profound sense of meaning and purpose. As someone who wanted to do a job that was both unique and deeply meaningful, brain surgery really ticked all the boxes. I’m always thrilled and relieved that I chose this path as I find every day an exciting new challenge, be it operatively or scientifically.

For decades, the standard of care for brain cancer hasn’t changed: surgery, radiotherapy, and chemotherapy. What made you decide it was time to rewrite that story?

The fact that something hasn’t changed for so long often makes change essential! I find it stimulating to explore why a problem has been considered insoluble. I enjoy using technology and creativity to reframe old challenges in new ways. We now have technological and conceptual opportunities that didn’t exist previously and all of this increases our chances of successfully tackling this challenge and making a genuine difference for patients. I want to transform outcomes for patients, and that is incredibly motivating.

Your frustration with the lack of progress inspired you to pioneer a revolutionary clinical trial using personalised treatment. How does this trial work, and why is it such a breakthrough?

Together with an amazing oncologist, Professor Juanita Lopez at The Royal Marsden Hospital, we are trying to move brain cancer trials into a more technological (and molecularly) focussed era. By combining her expertise in clinical trials with my data-driven and logistical approach we have delivered a new type of brain cancer clinical trial that matches patients with treatments based on the specific features of their tumours. What makes this trial different is that we are constantly learning and adapting how we deliver medicines. Right now, we currently look at specific faulty genes to decide if a treatment might be successful. But there is so much more data that is now available to us that enables us to ramp this up a notch. The human genome contains tens of thousands of genes that we can now analyse within days of the patients surgery – and potentially even before they have had an operation. There is also a wealth of additional information such as imaging, whole body metabolism and how the immune system is responding to the cancer. Our goal is to use all of this information to fine-tune which drugs, combinations of drugs or new approaches, such as cancer vaccines or immunotherapies are most likely to work for each patient, individually. This adaptive, data-led model for a clinical trial represents a major shift in how we treat and even think about treating brain cancer, making it much more precise and personalised.

Previously, analysing a tumour’s genetic mutations and matching them to a drug could take months, time your patients simply didn’t have. How did you and your team manage to cut that process down to just weeks?

It came down to team work, logistics, and hard work. We refused to accept the received wisdom or the sense of nihilism that sometimes pervades this field. We continually questioned everything, innovated wherever we could, and streamlined each step. Ultimately, teamwork was key. It is the reason we have achieved what we have, and it is what will drive us forward.

Your trial allows new drugs to be added as science advances, an evolving model rather than a fixed one. How could that change the future of clinical research?

We have several new drugs in setup to add to the platform which is really exciting. However, beyond adding new drugs, this trial also seeks to better understand and characterise a patient’s tumour, individually. By doing so, we can ensure every patient receives treatment tailored precisely to them. We now know that the processes driving tumours can vary a lot, not just between different people, but even within a single patient. This variation can affect how well a treatment works. That’s why we’ve shifted the way we test treatments. In the past, drugs were only tested in the lab to see if they worked before reaching people, but now we’ve moved testing into the patient setting, too. This gives each person the best possible chance of receiving the most effective drugs for them. This trial design combines advanced data science with the latest pharmaceutical and immunological therapies, making it truly innovative.

Cancer Research UK and other funders play a huge role in supporting pioneering science like yours. How vital is that backing, and what difference does it make to the speed and scale of progress?

Cancer Research UK has been absolutely vital to our progress. By designating brain cancer as a “cancer of unmet need,” they inspired a new generation of cancer biologists and clinical trialists to focus on this area. Our partnerships with Cancer Research UK, other charities, and government-funded bodies such as the Medical Research Council and the National Institute for Health and Care Research (NIHR) have enabled a truly collaborative approach, linking everything from early discovery and molecule development to clinical delivery and trial integration across the UK and beyond. Their support has been instrumental in allowing us to deliver what we do.

You’ve spoken about wanting to “transform this idea of cancer as a death sentence.” What would that transformation look like in practical terms?

There are several exciting possibilities, from early detection and faster treatments to shifting cancer into a manageable, long-term condition. Much like high blood pressure, we could monitor and adjust treatment regularly based on how the treatment is benefiting the individual at that moment in time. The ability to monitor and treat people dynamically, rather than giving a couple of treatments and hoping for the best would be a paradigm shift for brain cancer care. What excites me most is the potential of harnessing the immune system more effectively. It already plays a key role in finding and attacking cancer cells, but if we can empower it to do even more, that could be a game-changing approach across many cancer types but especially brain cancer where current immune-based treatments have been disappointing.

When you’re telling patients there’s nothing more that can be done, how does that experience drive your determination to find new answers?

It underpins everything I do and how I live my life. Often, people with cancer are shocked by their diagnosis, having had no major health issues before. It is incredibly hard, but I try to face that difficulty with compassion and a determination to make things better. Patients sometimes say I have a “terrible job,” and perhaps in some ways they are right, but it is also a privilege. It reminds me constantly how precious our health is and how important it is to keep pushing for progress.

Your work is both deeply scientific and deeply human. How do you balance the emotional weight of treating patients with the analytical demands of cutting-edge research?

I realised early on that doing diverse, emotionally demanding tasks allows me to focus on what might go right rather than what is going wrong. I try to find insight and positivity in every scenario.

There is always hope, and every apparent dead end can lead to a new path. Breaking complex challenges down into their component parts and analysing them rationally gives me perspective and the motivation to keep going.

You’ve spoken about wanting to build “a village” of scientists and collaborators to cure brain cancer. How important is teamwork and shared purpose in a field like this?

It is fundamental. When Professor Lopez and I first started working together, we had both experienced situations where previous collaborations had failed. That is partly why our partnership works so well, because we share trust, energy, and a sense of purpose. I try to instil enthusiasm and tenacity in my team, offering encouragement and recognition for their work. It motivates people, attracts talent, and strengthens our collective drive toward our shared goal of curing brain cancer.

What have you learned from patients like Amanda, who we see in the documentary, one of the first to join the trial? How do their experiences feed back into the science?

I learn a huge amount from my patients, every week in fact. Their bravery and hope continually inspires me. I am always struck by their generosity, as so many are willing to take part in research even if it may not benefit them directly. People often say, “If it helps others, I’m happy to do it.” That selflessness, that desire to help others, is deeply ingrained in our nature and our society, and it is something that continues to move and motivate me.

You’ve said your ultimate aim is to cure brain cancer, but that you’re “optimistic, not stupid.” What keeps you hopeful when the challenge is so great?

I see it as a complex puzzle — if it were easy, we would have solved it by now. The fact that we haven’t doesn’t mean it’s impossible. When we revisit past failures in science and medicine with fresh eyes and modern tools, we often uncover why something did not work, rather than simply assuming it could not work. It is like a forensic scientist re-examining a cold case; there is usually a clue we missed the first time. Finding those clues and using new technology to follow them is incredibly exciting and keeps me hopeful.

What do you hope viewers will take away from seeing this journey, both the science and the humanity, unfold in the Channel 4 series?

I hope they see that every patient is an individual, yet many share a similar journey with each person benefiting from the care, compassion, and respect that modern healthcare can provide. I want viewers to understand that we now have the capability and the belief to change the destination of that journey but that we need their support to continue to do what we do and to make further progress.

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