Private Care AUTUMN/WINTER 2019
LEADING LIGHT How Dr Samra Turajlic spearheads our work in skin and kidney cancers Royal visit puts mental health on the agenda
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AUTUMN/WINTER 2019
RADIOTHERAPY AT THE ROYAL MARSDEN
THE FACTS
75,000
treatments are delivered by The Royal Marsden’s Radiotherapy department every year
WELCOME As the Managing Director of Private Care at The Royal Marsden, I’m pleased to introduce the latest issue of Private Care magaz ine. W e were delighted to welcome our President, HRH The Duke of Cambridge, back to the hospital this summer to speak with staff and patients about the psychological impact of cancer treatment and the support that The Royal Marsden offers. Read more about his visit on page 6 . W e also find out why international cancer conferences are so important, enabling our experts to network, share research and ensure we’re at the forefront of the world’s best treatment and care. F inally, we speak to Dr Samra Turajlic, one of our consultants in melanoma and kidney cancer, about the research she is leading in immunotherapy and how this is changing the face of cancer treatment. I hope you enjoy this issue. Shams Maladwala Managing Director of Private Care
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linear accelerators are operated across the Radiotherapy department
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The PACE trial is looking into reducing the number of treatments for prostate cancer from 39 to five
5,000
Royal Marsden patients are treated with radiotherapy every year
40%
of all cancer patients are cured by radiotherapy
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cancer centres – including The Royal Marsden and the ICR – are in a global consortium developing the MR Linac technology ON THE COVER Dr Samra Turajlic, Consultant Medical Oncologist in the Skin and Urology units
FIND OUT MORE
For referrals and enquiries, call 020 7811 8111 or email privatepatients@rmh.nhs.uk
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U P DAT E
EXCEPTIONAL STANDARDS An artist’s impression of our Cavendish Square facility
A WORLD-CLASS CANCER CENTRE THE INTERIOR FIT-OUT has started at The Royal Marsden Private Care’s new diagnostic and treatment facility for private outpatients in Cavendish Square in central London.
Due to open in autumn 2020, the centre will have consulting rooms, chemotherapy chairs, a minor procedure suite and imaging facilities, significantly improving how private patients
access, experience and use our services. Patients can expect to have an appointment booked following their initial enquiry, and will be able to directly access diagnostic services without prior referral. We will also provide next-day appointments and sameday scans and results. The new location, between Oxford Street and Harley Street, will allow us to offer world-class standards of cancer care in the heart of London’s most respected healthcare district. Shams Maladwala, Managing Director of The Royal Marsden Private Care, said: “This is an exciting new development for Private Care, where patient demand has increased considerably over the past five years. “As a specialist cancer centre, Cavendish Square will have the clinical expertise, facilities and technology to provide a leading service. Our multidisciplinary teams will be on hand to offer personalised care.”
TALKING POINTS “We work in a high-pressure environment and need to look after our own mental wellbeing” Page 6
“ASCO is the largest cancer conference in the world, with more than 3,000 scientific abstracts presented every year”
“Upper GI cancers have some of the poorest survival rates of all solid cancers, so these are a prime focus of research”
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“Potent drugs have boosted the survival of our patients with metastatic kidney cancer” Page 14
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IN BRIEF Professor appointments
Two Royal Marsden consultants have been awarded the title of Professor by The Institute of Cancer Research, London. Sanjay Popat, Consultant Medical Oncologist in the Lung Unit, is a specialist thoracic oncologist, while Chris Parker, Consultant Clinical Oncologist in the Urology Unit, is a specialist in the management of prostate cancer.
ACCESS FOR ALL Dr Christina Messiou aims to increase the use of wholebody MRI
Patients in control
Coordinate My Care (CMC), the digital system that enables care plans to be shared between healthcare professionals across L ondon, now allows patients to create their own care plan online. The new service, myCMC, gives patients who are chronically ill or nearing death more control over what happens in an emergency, such as whether they want to be resuscitated or if they wish to die at home, and allows details to be shared between care providers.
Maggie’s centre opens
The new Maggie’s centre at The Royal Marsden has opened its doors to patients, marking another step forward in the redevelopment of our Sutton hospital. Maggie’s provides free support and information to people living with cancer in warm and welcoming centres run by expert staff across the UK, as well as online.
MYELOMA BOOST A TEAM AT The Royal Marsden is working to increase the use of whole-body MRI in the diagnosis and treatment of patients with myeloma. The National Institute for Health and Care Excellence recommends whole-body MRI as first-line imaging for all patients with myeloma in the UK. Compared with X-ray and CT scans, which spot myeloma only after it has caused irreversible bone damage, whole-body MRI can detect the disease at an earlier stage. But until recently, there were no guidelines on how it should be performed
and reported, and not enough radiologists trained in the technique. Now, thanks to a team of radiologists, physicists and haematologists at The Royal Marsden working in collaboration with international colleagues, there is a consensus on how the technique should be performed and reported. The MY-RADS (Myeloma Response Assessment and Diagnosis System) guidelines, published in the US imaging journal Radiology, are expected to help standardise the use of whole-body MRI and make it easier to adopt the technique.
Dr Christina Messiou, Consultant Radiologist at The Royal Marsden, led the MY-RADS project. She said: “We know the difference this technique can make to early diagnosis and the prevention of irreversible damage, and are committed to breaking down the barriers to equitable access.”
“Whole-body MRI can make the difference in early diagnosis”
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U P DAT E
‘Liquid biopsy’ speeds up breast cancer detection A PERSONALISED BLOOD test for women with early breast cancer could detect the return of the disease nearly 11 months earlier than hospital scans, a new study at five UK hospitals has found. The ‘liquid biopsy’ test, developed at The Royal Marsden and The Institute of Cancer Research, London (ICR), was found to work in all types of breast cancer, and could detect the early signs of the spread of the disease around the body (outside
of the brain). Further research is now needed to understand how the test could be used in the clinic to help guide treatment and improve patient outcomes. The study was published in JAMA Oncology and was largely funded by Breast Cancer Now, with additional support from Le Cure for The Royal Marsden Cancer Charity and the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the ICR.
SIMPLE TEST ‘Liquid biopsies’ could benefit breast cancer patients
ESMO appointments Two of The Royal Marsden’s consultant medical oncologists have been elected to prestigious positions at the European Society of Medical Oncology (ESMO).
Dr Susana Banerjee has been elected to serve as ESMO Director of Membership for 2020-21. It is the first time a Royal Marsden consultant has been nominated to join the
ESMO leadership. Meanwhile, Dr Ian Chau has been elected to serve as President of ESMO Asia for the 2020 conference. He is also the Scientific Co-Chair for the 2019 event.
THE SHARING OF INTELLIGENCE Experts from The Royal Marsden presented on a wide range of research topics at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago. ASCO is the world’s largest cancer conference, attracting around 40,000 attendees with more than 3,000 new studies being presented. One Royal Marsden-led study presented at this year’s conference suggested that female patients with cancer of the oesophagus and stomach are more likely to survive longer than male patients, but are also more likely to experience worse gastrointestinal side effects from treatment. Researchers said the findings would help to tailor the management of patients and will lead to further studies to understand why the differences exist. The Sarcoma Unit played a major role in the international STRASS trial, the results of which were also presented at the conference. The trial investigated whether the addition of radiotherapy prior to surgery would have any benefits over surgery alone, and was described by the authors as an excellent example of international collaboration.
FIND OUT MORE
Read about the importance of ASCO and other cancer conferences around the world on page 10
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HELP AT HAND
Our President came to the Chelsea hospital to meet staff and patients and discuss mental health, the psychological impact of cancer treatment and the support offered by The Royal Marsden
HRH THE DUKE of Cambridge visited The Royal Marsden this summer to speak to patients and staff about the impact of cancer treatment on mental health and psychological wellbeing. The Trust offers a programme of psychological and emotional support, which is fully funded
by The Royal Marsden Cancer Charity. The Duke spoke to Julie Gallagher, who received psychological support from The Royal Marsden team following her second diagnosis of throat cancer in 2018. “I really struggled mentally and emotionally when I
GOOD TO TALK The Duke chats with inpatient Rebecca Readshaw
relapsed,” she says. “The team were so supportive and really helped me get to a place where I can learn to live with what has happened, and see a future for myself and my family.” He also met Huw Jones and his wife Kate, who both received counselling from the
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R OYA L V I S I T
Kensington Palace
“It was a privilege to share with The Duke our approach to supporting psychological and mental wellbeing”
Family Support Services team after Huw was diagnosed with a rare cancer of the appendix, which has a high rate of recurrence. Huw says: “We had five sessions of the couples counselling, which gave us a safe space to talk about our feelings together and the
uncertainty about the future. The sessions were invaluable; I can’t thank the counsellor and the team enough.” The Royal Marsden also provides counselling for staff. Working in a cancer hospital can bring with it some harrowing and emotional experiences, and the Trust
STAFF SUPPORT The Duke meets The Royal Marsden’s Cally Palmer (top) and front-line staff (above left and right)
ensures that support, guidance and counselling are in place for anyone who needs it. Matron Aly Foyle was diagnosed with stress, depression and compassion fatigue in December 2017. She spoke to The Duke about the support she received from The Royal Marsden while >
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“We need to look after our own mental wellbeing so we can take care of patients as well as possible”
she was on sick leave, and following her return to work. “It was a very upsetting and difficult time, but with the support of my family, GP and The Royal Marsden team, I not only got through it, I came back stronger than ever,” she says. “I use any opportunity I have to talk
about it – if I can help one person, it makes my experience more worthwhile.” Zoë Bullock, Senior Staff Nurse in the Critical Care Unit, has also worked with the staff support service following challenging cases on the unit. “The Trust holds debrief sessions for the team when
THE ROYAL TOUCH The Duke with patient Vivian Marchant (top), Pauline Gore (above left) and patient Julie Gallagher (above right)
a patient we have looked after for a while passes away and when we have challenging situations,” she says. “We work in a highpressure environment and need to look after our own mental wellbeing so we can continue looking after patients as well as possible.”
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R OYA L V I S I T
As part of the visit, The Duke met Pauline Gore, widow of Professor Martin Gore, who was an oncologist at The Royal Marsden for 40 years before he died suddenly in January. Alongside Pauline, The Duke spoke with close colleagues of Professor Gore about the impact of his loss
on staff and patients. He also met inpatients in Ellis Ward, chatting about their treatment and ongoing care at The Royal Marsden. Cally Palmer, Chief Executive of The Royal Marsden, says: “It was a privilege to welcome The Duke back to The Royal Marsden, and in particular to
A WARM WELCOME The Duke says hello to staff, patients and their families and friends
share with him our approach to supporting staff and patients’ psychological and mental wellbeing, as it is a topic so close to his heart. “He was also touched by some of the stories about Professor Gore, who was often a key figure in The Duke’s earlier visits.”
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Chicago American Society of Clinical Oncology (ASCO) Meeting
San Francisco
Orlando American Society of Haematology (ASH) Annual Meeting and Exposition
American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium
San Antonio San Antonio Breast Cancer Symposium
MEETING OF MINDS
Atlanta American Association for Cancer Research (AACR) Annual Meeting
Global conferences provide an essential platform for The Royal Marsden’s clinicians to share their research and collaborate with colleagues from around the world ATTENDING MAJOR ONCOLOGY conferences is an important part of cancer researchers’ work, providing a valuable opportunity to hear about the latest advances and to collaborate with worldleading researchers to improve treatment and care for patients. The American Society of Clinical Oncology (ASCO) Annual Meeting is the largest cancer conference in the world, with more than 3,000 scientific abstracts presented every year. Dr Avani Athauda, Clinical Research Fellow, presented the latest findings on oesophageal and stomach cancers at this
year’s conference (see more on page 5), where she also received the ASCO Conquer Cancer Foundation’s Merit Award. She says: “Scientific research and clinical trials are rapidly evolving in oncology. Attending conferences is paramount to keep on top of new advances. “International conferences are also an opportunity to network with other researchers from around the world. New ideas and collaborations may develop and shape future projects to benefit patients.” Mr Marios Tasoulis, Locum Consultant Oncoplastic Breast
Surgeon, highlighted that conferences offer opportunities for oncology professionals across a variety of roles. Writing in the ASCO Daily News, a publication shared with all 40,000 attendees and members, Mr Tasoulis said: “Surgical oncologists must remain abreast of the galloping scientific developments, and maintain the knowledge to inform patients about all the options. Linking surgical oncology trials with research is significant. “The melting pot of cancer experts helps promote the exchange of scientific
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CONFERENCES
Glasgow
Glasgow
Paris
National Cancer Research Institute (NCRI) Cancer Conference
Association of Breast Surgery Conference
European Association of Dermato-Oncology (EADO) Congress
Geneva International Society of Geriatric Oncology (SIOG) Annual Conference
Barcelona European Society of Medical Oncology (ESMO) Congress
Singapore European Society for Medical Oncology (ESMO) Asia Congress
Athens Barcelona International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer
knowledge and ideas to further advances. I have found the discussions to be a truly rewarding experience that has led to the development of exciting new projects.” Closer to home, members of The Royal Marsden’s Breast Unit attended this year’s Association of Breast Surgery (ABS) Conference in Glasgow. They presented the latest news in breast cancer surgery, including Magseed, a small magnetic marker placed into patients to help guide surgeons during procedures; the use of 3D images to better prepare patients for surgery; and
European Society of Gynaecological Oncology Congress
improving the quality of data on implant-based breast reconstructions. Miss Nicky Roche, Consultant Breast Surgeon and ABS Conference Secretary, says: “This is one of the largest breast surgery conferences in Europe, and a great opportunity to share research with colleagues from around the world.” Reflecting the truly multidisciplinary approach at the heart of The Royal Marsden, several specialists may work on studies for presentation at conferences. Andreia Fernandes, Clinical Nurse
Specialist Team Leader in the Gynaecology Unit, has led on a study with gynaecological surgeon Mr Desmond Barton to better understand what life is like for women after pelvic exenteration – the removal of all organs from the pelvic areas. She is looking to present the ‘promising’ results at the European Society of Gynaecological Oncology Congress in early November. Andreia says: “It’s important that oncology professionals across The Royal Marsden are engaged with the research community, both nationally and internationally.”
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ONE SIZE DOES NOT FIT ALL Our research into gastrointestinal cancers is advancing our understanding of how different patients respond to treatment The Royal Marsden’s Skin Unit has a national and international reputation for treating melanoma, the fifth most common form of cancer in the UK
THE ROYAL MARSDEN offers a comprehensive specialist service for the diagnosis, treatment and care of patients with gastrointestinal (GI) cancers. In particular, upper GI cancers have some of the poorest survival rates of all solid cancers, so these are a prime focus of our research. A key aim of GI cancer research is to improve cure rates, as well as reducing complications and avoiding
over-treatment, by making treatments more precise and tailored to the needs of individual patients. An important part of tailoring treatments is recognising that a one-sizefits-all approach may not be suitable. A recent study, which included more than 3,000 patients with upper GI cancers treated with chemotherapy, found that female patients had a better response to treatment
TAILOR-MADE TREATMENT Professor David Cunningham
than males, but were more likely to experience side effects. “This is a significant finding and furthers our understanding of two types of cancer that affect almost 16,000 people each year in the UK alone,” says Professor David Cunningham, Consultant Medical Oncologist and Head of the GI Unit at The Royal Marsden, Director of the NIHR Biomedical Research Centre (BRC) at The Royal Marsden
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GI CANCER RESEARCH
RISK ASSESSMENT Dr Anguraj Sadanandam (far left, on right of picture); Professor Andrea Sottoriva (left)
and The Institute of Cancer Research, London (ICR), and lead for the BRC’s GI Cancers research theme. “There is a growing body of evidence that suggests gender can be an important factor in cancer treatment, and that clinicians need to be aware of such differences. For example, knowing that female patients are more likely to experience side effects such as nausea and vomiting, or diarrhoea, may allow consultants to provide patients with tailored chemotherapy support in order to optimise the management of these common problems.” Understanding which patients will benefit from specific drugs and their risk of tumour progression is also vital if personalised and adaptive treatments are to be given. A recent study jointly led by Professor Andrea Sottoriva, Deputy Director of the Centre for Evolution and Cancer at the ICR, discovered that patient outcomes in colorectal cancer can be predicted by analysing tumour DNA in blood and tissue biopsy samples, in combination with mathematical modelling. “The genetic makeup of cancer is highly complex and ever-changing,” says Professor Sottoriva. “Understanding how tumours evolve in
response to treatment is key to combating drug resistance.” An exciting new test, developed by scientists at The Royal Marsden and the ICR, analyses seven key genes to identify gastro-oesophageal cancer patients who are at risk of relapse following chemotherapy and surgery. Dr Anguraj Sadanandam, Team Leader in Systems and Precision Cancer Medicine at the ICR, says: “Our test could help select patients who are at high risk of relapse after surgery, allowing new therapies to be developed with the potential to change the future standard of care for this subset. “If it works on a wider scale, this approach to treating gastro-oesophageal cancer could personalise standard clinical treatment and improve quality of life after treatment.”
“There is growing evidence that gender can be an important factor in treatment”
PROFESSOR DAVID CUNNINGHAM OBE Head of the Gastrointestinal Unit Professor Cunningham is a Consultant Medical Oncologist, Head of the Gastrointestinal Unit and the lymphoma clinical trials unit, and Director of Clinical Research at The Royal Marsden. He also holds the post of Director of the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London. He has conducted multiple early-phase and Phase III randomised trials in the fields of gastrointestinal oncology and lymphoma, and is pursuing the development of targeted agents and immunotherapy for the treatment of these diseases. Professor Cunningham was awarded an OBE in the 2019 New Year Honours for services to cancer treatment and research.
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DR SAMRA TURAJLIC Consultant Medical Oncologist DR SAMRA TURAJLIC is a Consultant Medical Oncologist in The Royal Marsden’s Skin and Urology units. She is the Chief Clinical Investigator of translational studies into melanoma and kidney cancer. Her main research goal is to improve our understanding of the biology of kidney cancer and melanoma and the reasons for the success or failure of different treatments. As a centre of excellence with an international reputation for groundbreaking research in melanoma and pioneering new treatments for the disease, we collaborate with our academic partner The Institute of Cancer
Research, London and other respected organisations. Dr Turajlic is also a Clinician Scientist at the Francis Crick Institute, a biomedical discovery centre dedicated to the understanding of disease development and translation. She divides her time between her Royal Marsden clinic and her research group at the Crick. In addition, Dr Turajlic is a member of the National Cancer Research Institute’s Bladder and Renal Cancer Clinical Studies Group, the European Society for Medical Oncology’s Faculty group for genitourinary cancers, and the scientific committees of several research organisations.
CAREER HIGHLIGHTS 1999 Graduates from University of Oxford with a BA in Physiological Sciences 1999-2002 Completes clinical training at University College London 2013 Completes PhD at University of London (ICR) in melanoma genetics and targeted therapy resistance
Q&A 2014 Awarded Cancer Research UK Clinician Scientist fellowship to study cancer evolution at the Francis Crick Institute 2015 Appointed as a Consultant in the Skin and Urology units at The Royal Marsden 2019 Appointed Group Leader at the Francis Crick Institute
Q How has the treatment of kidney cancer and melanoma changed during your career? A When I started, the only approved treatment for metastatic melanoma was chemotherapy, which was largely ineffective. The average life expectancy of patients with advanced melanoma was around six months. Thanks to remarkable advances, it’s now
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C O N S U LTA N T F O C U S
“The Royal Marsden is at the forefront of oncology research and integrates the expertise of a variety of specialists” Q What services do you provide at The Royal Marsden? A I see patients with the diagnosis of either melanoma or kidney cancer. I provide a comprehensive evaluation of their disease and recommend the best approach to treatment.
four years – and exciting new therapies on the horizon are likely to improve this further. Kidney cancer has followed a similar trajectory in that chemotherapy was not a good option. Today, we have two main classes of potent drugs – targeting molecular changes in the tumour environment or enabling the immune system to attack cancer cells – that have boosted the survival of our patients with metastatic kidney cancer.
Q What areas of research are you involved in? A All areas of melanoma and kidney cancer research. I lead a research group at the Francis Crick Institute that focuses on improving our fundamental biological understanding of these two cancers and aims to translate these findings for patient benefit. I am also involved in clinical trials of new therapies and combinations in these cancers. Our laboratory work over the past five years has uncovered the factors that account for the variable clinical behaviour of kidney cancer, and we are currently exploring how we can implement this knowledge to improve how we select patients for treatments. Q What developments are taking place in the treatment of kidney cancer and melanoma? A The greatest advances in the past five years have been in the field of immunotherapy. The new generation of drugs – so-called immune checkpoint inhibitors – are now licensed for the treatment of melanoma
and kidney cancer. They are not effective in all patients, so trials are exploring combining immunotherapy with other types of cancer treatments, as well as cellular therapies and vaccine approaches. Q What does the future look like for treating patients with these cancers? A The key will be in understanding every patient’s disease at an individual level and being able to predict its course and the likelihood of specific treatment being effective. There are also questions about the correct sequence and combination of different available therapies and their side effects. At the heart of these challenges are questions that concern cancer biology, which will only be answered through continued research that integrates basic, translational and clinical studies. Q What is special about the service offered at The Royal Marsden? A The Royal Marsden is at the forefront of oncology research internationally and integrates the expertise of a variety of specialists, all of whom bring a unique perspective to the discussion of clinical problems and are always mindful of new scientific and clinical developments.
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As Europe’s largest cancer centre, The Royal Marsden has the expertise, facilities and technology to provide the highest standards of personalised care, and we treat more private patients than any other UK centre. By choosing The Royal Marsden, you are ensuring the best possible treatment and care, at the moment a patient needs it most. Because where a patient goes first really matters.
Life demands excellence
To refer a private patient, contact our Central Referral and Information Line on +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk royalmarsden.nhs.uk/private
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