Soft-spoken and articulate, it is easy to picture Marco Marra hidden in a laboratory, isolating DNA and sifting through reams of reports. But the genome scientist – and one of Canada’s leading experts in molecular oncology - is the ultimate team player and cheerleader, boosting the efforts of colleagues both near and afar.
As Marra is quick to admit, chasing cancer is not a solitary pursuit. It’s a relay, between biologists and bioinformaticians, academics and clinicians - and, most importantly, those who are actually being treated.
"We can't do any of this without the patients who participate in the research," Marra said. "Although the things we discover are interesting in an academic sense, unless they can be tested in patients, we really haven't learned much about the impact on cancer."
Marra, director of Canada’s Michael Smith Genome Sciences Centre at BC Cancer (GSC) in Vancouver, also knows there’s only so much he can do from his isolated outpost on the west coast of Canada, which is why he relishes any role he can play in the international cancer community, and ICGC ARGO in particular.
“There’s great value in the concept of community on an international scale. We’re engaging in a huge experiment, a giant learning opportunity. Having access to great thinkers, data and shared experiences promotes discovery and brings additional benefits to the patient populations that we serve,” Marra said.
One of the most cited scientists in his field, Marra has more than 400 scientific publications under his belt, and is about to be inducted into the Canadian Medical Hall of Fame. He caught the world’s attention in 2010, when he and his colleagues at the GSC and BC Cancer presented the first case of whole genome sequencing being used to inform cancer treatment.
That project was parlayed into a pilot study for how whole genome sequencing could be expanded to other cancer patients, and it has continued to grow in scale. It is now an integrated program incorporating both research and clinical practices across the BC Cancer network, a model for those wishing to set up similar initiatives around the world.
Although genomics is now an integral part of both cancer research and treatment in Canada—thanks in large part to Marra, who co-founded BC Cancer’s Personalized OncoGenomics (POG) program—this wasn’t always the case. When Marra first returned to Canada from the Washington University School of Medicine 20 years ago, some of his colleagues told him “that DNA stuff has nothing to do with cancer.”
He’s successfully manoeuvred that roadblock, but there are others in his path. One of the most cumbersome is drug availability. In many cases, genome analysis points to a therapy that’s not indicated for the patient’s type of cancer, leading doctors to ask, “What is the meaning of having whole genome analysis if it points to a drug that you can’t get?”
Rising to the Challenge
Rather than cowering when confronted by such a challenge, Marra encourages his colleagues to rise to meet it -- by collecting incontrovertible evidence that patients should have access to drugs based on genomic properties, and that withholding such access is unethical. If the current system of approvals is not aligned to what is needed, then scientists may need to fight, jurisdiction by jurisdiction, to change it.
“There’s no reason why we ought not to, and every reason why we ought to,” he said. “We are not going to be transformational without a bit of pain.”
Marra is encouraged by recent rulings by regulatory authorities, like the U.S. FDA’s approval of pembrolizumab for the treatment of adult and pediatric patients with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) solid tumors -- the first approval of a cancer drug based on mutation rather than site.
“It’s a very important sign of what can be achieved,” he said. “We need to shun fatalism. If you don’t engage and drive a research program that supports changes, then you can’t win.”
Marra and his colleagues contributed their science to the ICGC, and the GSC has now aligned itself with ARGO. Marra said the organizations share an important strategic objective: taking the knowledge gained during the 25K Project and the Pan Cancer Analysis of Whole Genomes project, and turning it into direct impacts on human health. This comes in the form of translational medicine, advocacy, outreach and communication.
“We’re all having our challenges, but by banding together and sharing our experiences, we can go further, faster,” Marra said.