The magazine for the UK’s only Biomedical Research Centre dedicated to cancer | Spring/Summer 2018
Rise of the machines How our experts are at the vanguard of new robotic surgery techniques
More options, faster
A gut feeling
Tried and tested
Getting involved
Bringing new therapies to young patients
The link between gut bacteria and radiotherapy
Scanning the first healthy volunteer on our MR Linac
The valued role of patient representatives
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The BRC in numbers A snapshot of the work of the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London
25% of all consultant medical oncologists in the UK trained at The Royal Marsden or the ICR
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centres – including the ICR – are in the worldwide consortium that is developing the MR Linac technology
1st £15m
robotic hysterectomy in the UK was performed at The Royal Marsden
has been committed by The Royal Marsden Cancer Charity for research over the 2017-22 period
42,000 50% patients across the UK are currently taking part in up to 600 pioneering clinical trials supported by The Royal Marsden
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of all cancer patients receive radiotherapy at some point during their treatment
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DIRECTOR’S NOTES
Contents 04 Forefront The latest research news 07 Expert voice Professor Vinidh Paleri discusses robotic surgery 08 Meeting the complex needs of young patients Our researchers are leading the way in paediatric cancers 11 Q&A Professor Udai Banerji on smarter early-stage trials 12 Making their voices heard How patient representatives contribute to our research
Cover photograph: Professor Vinidh Paleri, Consultant Head and Neck Surgeon at The Royal Marsden
14 Gut reaction Studying gut bacteria to reduce radiotherapy’s side effects 15 In profile Clinical trials statistician Professor Judith Bliss
EDITORIAL ADVISORY BOARD Professor David Cunningham Director of the NIHR BRC Professor Paul Workman Chief Executive and President, the ICR Professor Nicholas Turner Team Leader, the ICR, and Consultant, The Royal Marsden Dr Naureen Starling Associate Director of Clinical Research, The Royal Marsden Rachael Reeve Director of Marketing and Communications, The Royal Marsden Elaine Parr Head of PR and Communications, The Royal Marsden Richard Hoey Director of Communications, the ICR Published in partnership with Sunday: wearesunday.com
Welcome
to the latest edition of Advance, which highlights the world-leading work carried out through the National Institute for Health Research Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London – the only BRC in the UK dedicated solely to cancer. In this issue, we take an in-depth look at the work we’re doing in paediatric cancers. The Royal Marsden and The Institute of Cancer Research (ICR) are leaders in research and drug development for childhood cancers, ensuring that our young patients get new treatments faster. We also focus on the latest surgical research, in particular new procedures undertaken using the da Vinci surgical robot. The Royal Marsden has the largest and most comprehensive programme of robotic surgery for cancer in the UK. As the only centre to carry out some of these procedures, we are committed to developing and sharing best practice so more patients can benefit. I hope you enjoy reading this issue of Advance.
Professor David Cunningham Director of the NIHR BRC at The Royal Marsden and the ICR and Consultant Medical Oncologist
© The Royal Marsden 2018. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor. The Royal Marsden and Sunday accept no responsibility for the views expressed by contributors to the magazine. Repro by F1 Colour. Printed by Pureprint.
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FOREFRONT
Professor Nicholas Turner led a key trial of palbociclib
BREAKTHROUGH DRUGS APPROVED FOR ADVANCED BREAST CANCER he National Institute for Health and Care Excellence (NICE) has approved a new class of breast cancer treatment for NHS use, bringing new hope for women diagnosed with advanced disease. Palbociclib and ribociclib are two new drugs that are designed to home in on specific faults in cancer cells. They were developed with the help of researchers at the ICR and The Royal Marsden.
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“In trials, these two drugs have made a huge difference to women’s lives” Professor Nicholas Turner, Professor of Molecular Oncology at the ICR and Consultant Medical Oncologist at The Royal Marsden
Women with oestrogenreceptor-positive breast cancer who were diagnosed after the disease had started to spread will be eligible to receive palbociclib. And women who meet these criteria, and who have gone through the menopause, will be eligible for ribociclib. Both drugs will be prescribed alongside an aromatase inhibitor, a type of hormone therapy that blocks oestrogen production.
The ICR and The Royal Marsden led the PALOMA-3 trial of palbociclib in women with advanced breast cancer, in collaboration with colleagues from 144 international research centres in 17 countries. The trial found that the drug in combination with fulvestrant – a hormone therapy that prevents cancer cells from binding to oestrogen – stopped the cancer progressing for an average of 9.2 months, compared with 3.8 months with fulvestrant alone. Professor Nicholas Turner, Professor of Molecular Oncology at the ICR and Consultant Medical Oncologist at The Royal Marsden, led the trial and participated on the NICE panels for both drugs. He said: “The development of this brand-new class of cancer drug is one of the most important breakthroughs for women with advanced breast cancer in the past two decades. “In clinical trials, we see that palbociclib and ribociclib make a huge difference to women’s lives – slowing down their tumour growth for nearly a year and delaying the need for chemotherapy, with all its potentially debilitating side effects. These drugs are allowing women to live more normal lives for longer.” Further reading: nejm.org/doi/full/10.1056/ NEJMoa1505270
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The ICR and The Royal Marsden are helping to make genetic testing a part of routine cancer care through the Mainstreaming Cancer Genetics programme
OFFER GENE TESTS TO MORE BREAST CANCER PATIENTS, SAY EXPERTS esearchers are recommending new, simpler criteria for determining breast cancer patients’ eligibility for genetic testing, based on information that is routinely available at diagnosis, such as their age and sex. Identifying if a breast cancer is due to a BRCA gene mutation is vital to selecting the right treatment, and could help widen access to new precision drugs that are designed to target these faulty genes. It also gives the relatives of patients with the mutation the opportunity to be tested for an increased risk of cancer before they get the disease, enabling them to take preventive steps. The National Institute for Health and Care Excellence (NICE) recommends that anyone with a 10 per cent chance of having a BRCA mutation should be offered genetic testing. But doctors need to apply complex criteria, based on a person’s family history of cancer, to work out who reaches this threshold.
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people were identified as having faulty BRCA genes after a total of 1,020 people were deemed eligible for genetic testing under new, simpler criteria
In a new study, funded by the NIHR BRC at The Royal Marsden and the ICR, the team applied five simple criteria to help decide who should be tested. Some 1,020 people who met the new criteria were tested as part of the study, with 110 identified as having BRCA faults. If the existing family history criteria had been used, only 53 patients would have been tested – so half of those with mutations would have been missed.
The study shows that bringing BRCA gene testing into the cancer patient pathway and using simple criteria is more patient-centred and effective, and a more efficient use of NHS resources, than existing practice. It allows more cancer patients to benefit from precision medicines, and helps to prevent cancer occurring in healthy people. We are now working with other centres in the UK, Europe and the USA to roll out the new system.
Big data predicts risk of radiotherapy side effects Analysing ‘big data’ from trials of prostate cancer treatments can predict the risk that men will suffer side effects from radiotherapy, researchers report. Research led by Dr Navita Somaiah, Senior Researcher at the ICR and a Clinical Oncology Consultant at The Royal Marsden, and Professor Emma Hall, Deputy Director of the Cancer Research UK-funded Clinical Trials and Statistics Unit at the ICR, applied big-data analytics to information from more than 700 men who were given radiotherapy to treat their prostate cancer. The data covered medical history, genetics, radiotherapy dose and reported side effects. Using state-of-the-art artificial intelligence, the research team was able to highlight which information might predict sensitivity to the side effects of prostate radiotherapy. Dr Somaiah said: “This has been a huge collaborative effort between clinicians, physicists, biologists, statisticians and data scientists. “We hope that our method can be used to personalise radiotherapy for patients based on this risk, improving the chances of a cure and also minimising the side effects suffered.” CANCERBRC.ORG 05
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FOREFRONT
MR LINAC SCANS FIRST HEALTHY VOLUNTEER Ross Lydall is prepped for his scan on the MR Linac by therapy radiographers Dr Cynthia Eccles (left) and Dr Helen McNair
he Royal Marsden and the ICR have scanned the first healthy volunteer on the pioneering MR Linac radiotherapy machine, marking another step on its journey to becoming fully operational. The MR Linac combines an MRI scanner and a linear accelerator to precisely locate tumours, tailor the shape of X-ray beams in real time, and accurately deliver doses of radiotherapy to moving tumours. Ross Lydall, the Evening Standard’s Health Editor and Chief News Correspondent, was
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the first volunteer to be scanned as part of the PRIMER study, which is assessing the visibility and value of the MR imagery. Our researchers will use the scans to optimise the quality of the images and determine the best ways of using the imaging capabilities of the MR Linac. This will help us design and plan treatments in the future. Ross said: “It was an honour to be the first healthy volunteer, and amazing to be immersed in technology like this and understand how my images will help
research. I’m happy to have helped people with cancer who may need this machine as a part of their treatment in the future.” The MR Linac was funded by a £10-million grant from the Medical Research Council, with additional support from The Royal Marsden Cancer Charity and the ICR. Physicists at the ICR and The Royal Marsden are developing the clinical protocols as part of an international consortium initiated and co-ordinated by Elekta, which makes the MR Linac, and MR partner Philips.
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EXPERT VOICE
Professor Vinidh Paleri
ROBOTIC REVOLUTION Pioneering new robotic procedures and proving their efficacy is our responsibility, says Professor Vinidh Paleri, Consultant Head and Neck Surgeon at The Royal Marsden obotic surgery offers patients less invasive, shorter operations compared with open surgery, leaving them with fewer scars and enabling a quicker recovery. The Royal Marsden has the largest and most comprehensive programme of robotic surgery for cancer in the UK, so patients travel long distances to come here. Our aim, and our responsibility, is to inform and shape standard practice throughout the UK and beyond so that patients everywhere can
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benefit from minimally invasive surgery closer to home. As one of the few centres in the world to offer transoral robotic surgery (TORS) for patients with radiorecurrent and radioresidual cancer in the head and neck, we have devised a new technique for resection of these cancers. Our research has shown that the TORS technique has equivalent long-term oncologic outcomes to open surgery – without the need to split the jaw and perform extensive reconstruction – and I expect
this to lead to a new standard of management for this disease. Other published research includes a multicentre study that has led to the adoption of robotic tongue base mucosectomy as a diagnostic technique for unknown primary cancers of the head and neck. By using surgical robots to remove the mucosal lining of the tongue base, researchers detected more than 50 per cent of tumours that would otherwise have been classified as cancers of unknown primary. Being able to identify the primary tumour has
implications for treatment planning and outcomes. We have now accrued national consensus from professional bodies for multicentre work to fully explore the role of robotic-assisted tongue base mucosectomy, and will be submitting a clinical trial application to national funding bodies in the near future. I’m also involved in the ComPARE multi-arm Phase III clinical trial, which is comparing different combinations of chemotherapy, radiotherapy and surgery for patients with oropharyngeal cancer. But pioneering new treatments and proving their efficacy isn’t enough. To ensure that our work can be rolled out to other trusts so that more patients can benefit, we are also training surgeons from elsewhere. The Royal Marsden has seven proctors who train other surgeons to set up a robotic surgery programme and perform robotic surgery at their centres. Surgeons from across the UK and Europe come to us to observe and learn from our procedures, and we visit other centres to provide one-on-one teaching. To date, my team and I have proctored 10 centres in the UK as well as the first centre for transoral robotic surgery in the Nordic region. We’ve seen a revolutionary change in the management of head and neck cancers over the past decade, thanks to the advance of robotic surgery and new treatments such as immunotherapy. Now it’s time to fulfil the full potential of robots for the benefit of patients everywhere. Further reading: doi.org/10.1002/hed.25032 or doi.org/10.1111/coa.12860 CANCERBRC.ORG 07
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Paediatric cancers
PROVIDING MORE OPTIONS, EARLIER
MEETING THE COMPLEX NEEDS OF YOUNG PATIENTS The ICR and The Royal Marsden are leaders in the research and development of new drugs to tackle childhood cancers
The BRC increases young patients’ access to the latest treatments and clinical trials
n the UK, about 1,800 children aged 14 or under are diagnosed with cancer each year. The partnership between the ICR and The Royal Marsden is therefore crucial, as it increases young patients’ access to the latest treatments and clinical trials for particularly hard-to-treat paediatric cancers. Our researchers, with the support of the BRC and Oak Foundation, are also UK leaders in developing personalised treatment strategies, helping to improve survival rates and reduce side effects from treatment for children and young people. Ultimately, we want to empower families by providing patients with the widest possible range of options that can make all the difference.
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Personalised treatments
Professor Louis Chesler leads the Paediatric Solid Tumour Biology and Therapeutics Team in the ICR’s Clinical Studies Division, and is an Honorary Consultant Medical Oncologist at The Royal Marsden. He leads an ambitious precision-medicine programme to match each child diagnosed with cancer in the UK to clinical trials of targeted cancer medicines. This is guided by individualised genomic testing, which Professor Chesler developed together with Dr Mike Hubank, Joint Head of Clinical Genomics in the NIHR Centre for Molecular Pathology at The Royal Marsden and the ICR.
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The number of Phase I and II paediatric drug trials conducted at The Royal Marsden increased from seven in 2009 to 23 in 2016 Thanks to funding from the BRC, the ICR and the UK charity Christopher’s Smile, Professor Chesler and his team are trialling this approach in several hundred children with cancer, through innovative clinical trials conducted at The Royal Marsden’s Oak Centre for Children and Young People. The idea is to use next-generation sequencing technologies on blood and tumour tissues to rapidly obtain a genetic profile of the key changes occurring in each patient’s tumour. In 2016, a national pilot began in 21 hospitals in the Children’s Cancer and Leukaemia Group network, and approximately 275 children have been tested for molecular changes. A much larger national trial of multi-platform genomic testing will begin in 2018 and run for three years through the Cancer Research UK Experimental Clinical Medicines Centre Network, funded by Cancer Research UK and Children with Cancer UK.
Professor Louis Chesler
Innovative trials
As well as developing tests that can guide precise treatment, Professor Chesler also works with the Oak Paediatric and Adolescent Oncology Drug Development Team at The Royal Marsden. Dr Lynley Marshall leads this team, which has been generously supported by Oak Foundation for more than 15 years. Together, Professor Chesler and Dr Marshall conduct innovative clinical trials of drugs discovered by the ICR, and of drugs initially developed for adult cancers, to help find new treatments for hard-to-treat childhood cancers. Increasing the number of clinical trials available is key to the team’s ambition to offer children the same opportunities for personalised cancer treatment as adults have. Combined with advanced molecular testing, targeted molecular medicines maximise the chance of successful treatment and avoid the use of more toxic chemotherapies. The European ITCC-eSMART trial is the first paediatric trial of this type, using a multi-armed ‘basket trial’ approach, with a patient’s treatment based on molecular testing. One of the drugs being tested for the first time in children as part of this trial is vistusertib, identified by Professor Chesler’s laboratory as a drug that targets the MYCN gene, which drives poor outcome in several children’s cancers. The trial is being led in the UK by Dr Marshall.
Professor Chesler is also the UK lead of the USA-EU trial of lorlatinib, which targets ALK – another important gene that is altered in childhood cancers. “Children deserve the very best treatments for cancer, but for too long there have been delays in applying molecular techniques and biomarker testing to clinical trials, to personalise their treatment and maximise the chance that these drugs can work,” he says. “We face major barriers in obtaining targeted cancer drugs for children and using them in advanced clinical trials. But I hope that through this initiative, we can drive forward the best possible use of targeted drugs in children and make the case very clearly that they should be more widely available, as they have been for adults.”
CASE STUDY NEUROBLASTOMA FOCUS
Dr Sally George is a Clinical Research Fellow at the ICR and a Paediatric Oncologist The Royal Marsden. Her PhD research focuses on the childhood tumour neuroblastoma, and in particular on a poor-outcome group of neuroblastoma patients that have mutations in the ATRX gene. Her research has identified novel targeted therapies that are more effective in neuroblastoma models with ATRX mutations. Through her work as a member of the European neuroblastoma research consortium SIOPEN, she hopes to translate these findings directly into clinical trials. In order to match gene alterations with targeted therapies discovered in the laboratory, it is essential that we drive next-generation sequencing technologies into routine clinical practice for children with cancer. Dr George implemented the BRC-funded pilot sequencing study at The Royal Marsden, and has set up the UK’s first paediatric molecular tumour board between The Royal Marsden and Great Ormond Street Hospital. Crucially, this provides a forum for professionals across multiple specialities from both clinical and research settings to discuss sequencing results and interpret them in the context of the individual patient, so that results that could alter patient management are fed directly back to the clinic.
Increasing access to treatments
Through comprehensive clinical and academic collaboration between the ICR and The Royal Marsden in paediatric cancer research, more children treated at the hospital are enrolled in Phase I and II clinical trials than at any other centre in the UK. Many also participate in larger international Phase III trials that compare new treatments with existing standard options.
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Paediatric cancers
“We have a highly committed team who go to great lengths to provide the best possible clinical care, while offering the most promising new treatment options for our young patients,” says Dr Marshall. “Our centre has contributed to the development of new drugs in increasingly sophisticated studies, with real impacts on the lives of our patients and their families. “One-third of our patients now come from outside our catchment area, which is mainly due to the fact that we offer more new drug trials than any other centre, while offering high-quality clinical care, hope and support to families. “It’s incredibly rewarding when a patient has a good response to a new drug. Like in adult drug development, we can have patients who move from trial to trial with an excellent quality of life over long periods of time.”
PATIENT CASE STUDY SOPHIE ARMITAGE, 14
Read more about the BRC’s work in paediatric and other uncommon cancers at cancerbrc.org/ our-research/uncommon-cancers
Dr Lynley Marshall
Sophie was diagnosed with a rare solid inflammatory myofibroblastic tumour in 2013. She came to The Royal Marsden for a clinical drug trial that targeted a protein in her tumour. The tumour was due to a faulty ALK gene, which creates a chemical signal that drives the growth of abnormal cells. The experimental drug being trialled, LDK378, blocks those messages. When Sophie started the trial, the tumour was the size of a plum and was growing around her airways, making it difficult to treat. She had been facing the prospect of having surgery to remove one of her lungs. But the first scans showed that the drug had shrunk the tumour by 60 per cent, and it now remains the size of a pea. Her dad, Tom, says: “Sophie’s response to the drug has been incredible. She is now 14 and studying for her GCSEs, and hopes to be a doctor one day. “It is remarkable that, at one stage, she could have lost a lung, and she now enjoys diving. Despite six-weekly hospital visits, Sophie is doing activities you would expect a healthy teenager to do.”
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Q&A
On average, it takes 10-12 years to bring a new cancer drug to market, as it needs to be tested thoroughly in clinical trials is it taken up, distributed or broken down by the body); and pharmacodynamics (what the drug does to the body – for example, how does the drug affect certain proteins or other building blocks of cancer like RNA or DNA?).
Professor Udai Banerji
Are there any other benefits to early trials? In addition, we identify and test biomarkers of response to help us understand which subsets of a patient group are likely to respond best to a treatment. This helps us to demonstrate impact earlier on and speeds up our ability to progress a drug through clinical development. Most importantly, it also allows us to develop personalised approaches to treatment that benefit patients. We also study how tumours develop resistance to cancer drugs, and important ways of overcoming this.
THE NEED FOR SPEED Professor Udai Banerji, Deputy Director of the Drug Development Unit at the ICR and The Royal Marsden, talks about how smarter early-stage trials could help bring new drugs to patients sooner What is the process for testing cancer drugs? Bringing innovative drugs and treatments to cancer patients is a lengthy and expensive process. On average, it takes 10-12 years to bring a new cancer drug to market, as it needs to be tested thoroughly in clinical trials. These trials comprise several phases: to first test for safety in a small
number of patients (Phase I), and then to find out whether they are effective and better than the current standard treatment in larger groups of patients (Phases II and III). How has that process changed over time? Over the past decade, there has been an important shift in the emphasis of early-phase studies, where the effectiveness of drugs is being established much earlier as part of Phase I and Phase II studies. Where this happens successfully, we have seen examples of drugs being licensed for use in Phase I or Phase II studies. This has enabled drugs to be licensed for treatment
up to five years earlier than they would have been in previous years. Can you tell us about your approach to running trials? In the Drug Development Unit at the ICR and The Royal Marsden, my team is looking for ways to run smarter trials to get more information from the earliest stages of testing. We’re aiming to speed up the process so we can get the most promising treatments to patients faster. We use this to answer important questions at the early stages of testing related to toxicity (the side effects of the drug); pharmacokinetics (what the body does to the drug and how
What is special about working in the Drug Development Unit? We are very privileged to work in a multidisciplinary environment. We conduct a lot of the tests for the clinical trials ourselves in adjoining laboratories in the NIHR Centre for Molecular Pathology. And we have close working relationships with scientists who are specialists in biology, chemistry, physics, mathematics and statistics at the ICR and are co-located on our campus. Also, we are very lucky to work with clinical teams at The Royal Marsden that include world-leading experts in the treatment of individual cancer types. This cross-pollination of ideas and specialities is the perfect environment for groundbreaking research that will change the lives of cancer patients.
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Patient and public involvement
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IN DISCUSSION
MAKING THEIR VOICES HEARD Dedicated representatives play a valuable role by providing a patient’s perspective on the BRC’s plans for future cancer research nvolving patients and the public in the design of cancer research is a priority for the BRC at The Royal Marsden and the ICR. Each of the six individual research themes, the two ‘cross-cutting’ themes and the BRC Steering Committee now have a dedicated patient representative to ensure that the views of patients, their families and carers, and members of the public are represented in all our research. The representatives attend and participate in theme meetings to provide a layperson’s perspective on the matters discussed. They can also represent the BRC in external meetings, and lead training events for researchers and clinical teams on how best to engage patients and the public in research. Professor David Cunningham, Director of the NIHR BRC at The Royal Marsden and the ICR and a Consultant Medical Oncologist, says: “The contribution of patients can be extremely valuable, providing alternative views to those of the research team. “Patients are able to make judgements based on their understanding of their condition and
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“Patients, families and carers should be at the heart of what the BRC does” Dr Peter Lewins, patient representative
may have different thoughts about health outcomes that academics and researchers may not have considered. It’s extremely useful to have such a committed group of patients who
are willing to give their time to support our research in this way, and I’m incredibly grateful to them for their input.” Dr Peter Lewins (pictured, top right of previous page) is one of two patient representatives on the BRC Steering Committee, which oversees the management of all eight themes. He says: “I worked for almost 25 years as a GP in southeast London with patients, their families and carers on their cancer journey. “When my father was diagnosed with bowel cancer, I experienced the journey from the viewpoint of a carer. Five years ago, my viewpoint changed again when I became a patient myself. My experiences have led me to appreciate the importance of research in developing treatments, but particularly in the prevention and early detection of cancers. “I feel strongly that the public should be involved at all stages of the research pathway, in particular, helping formulate the questions to be answered, collecting and analysing data, and presenting the results of the research to others. Patients, families and carers should be at the heart of what the BRC does.” Margaret Perkins, the patient representative for the cross-cutting Genotypes, Phenotypes and Cancer Evolution theme, was motivated to get involved because she and a number of her relatives have been affected by cancer. “I was treated at The Royal Marsden for earlystage breast cancer in 2016 and was hugely impressed by the quality of care provided, as well as the depth of knowledge and expertise of the staff,” she says. “I also became aware of the huge amount of research that is going on and the exciting developments that have
Our patient representatives Breast Cancer Mairead MacKenzie Digital Della Dolapo Ogunleye Genotypes, Phenotypes and Cancer Evolution Margaret Perkins Gastrointestinal Cancers Pete Wheatstone Novel Cancer Therapeutics Christine Gratus Prostate Cancer Eric Deeson Targeted Physical Therapies Neil Lunt Uncommon Cancers Alison Allam BRC Steering Committee Dr Peter Lewins and Maggie Powell
resulted for patients, and I’m pleased to be able to support that process in this way. “Also, through my academic background in health and social care policy, I have an understanding of the process of getting research proposals together – not least the time it takes to develop well-considered proposals, as well as the competitive nature of funding – so I thought that perspective would also be helpful. “It is important that clinicians and people affected by cancer come together to further our understanding of the impact of the disease – not just the clinical, but also the practical and emotional impacts of cancer on people’s lives.” Find out more about public and patient involvement at the BRC at cancerbrc.org/ public-patient-involvement CANCERBRC.ORG 13
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Kinder treatments
GUT REACTION A study of gut bacteria could help reduce the side effects of radiotherapy and improve patients’ quality of life any cancer patients will undergo radiotherapy to the abdomen or pelvic area as part of their treatment. It is an effective way to kill cancer cells, but it can also lead to unpleasant side effects, such as diarrhoea and other gut and bowel problems, that can affect quality of life. These symptoms can be short-term, during or shortly after treatment. However, they can also affect patients chronically, with a long-term impact on wellbeing. A new theory is that some of these side effects could be caused by the effects of radiation on the patient’s gut bacteria. In the first clinical study of its type, researchers at the ICR and The Royal Marsden, alongside colleagues from Imperial College London, are studying how each individual patient’s gut bacteria make-up could affect how they respond to radiation treatment. Funded by the NIHR BRC at The Royal Marsden and the ICR, and the MRC-NIHR National Phenome Centre at Imperial, the study, which started in 2014, follows men with high-risk prostate cancer who are being treated with pelvic radiotherapy. Using faecal samples taken during treatment, researchers are measuring the types and numbers of bacteria to build up personalised
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“Our study aims to reduce the severity of bowel problems after pelvic radiotherapy” Professor David Dearnaley, Professor of Uro-Oncology at the ICR and Honorary Consultant at The Royal Marsden
profiles of patients’ gut ecosystems. By analysing these data, the teams aim to establish whether certain populations of bacteria may offer protection against both the shortand long-term side effects of radiotherapy. They also collected other samples, which will allow them to understand if changes in gut bacteria have a metabolic and inflammatory impact on patients with side effects. “By shedding light on whether patients with a particular make-up of bacteria respond differently, we hope this information could be used to modify the amount of radiotherapy they are offered, to improve patient outcomes and quality of life after treatment,” says Professor David Dearnaley, Professor of Uro-Oncology at the ICR and Honorary Consultant at The Royal Marsden. “Our study aims to reduce the severity of bowel problems after
pelvic radiotherapy and to find out if changing the make-up of the gut flora in individual patients could be beneficial.” The ultimate aim of the research is to use this information to find ways of changing the make-up of gut bacteria to benefit patients – for example, through changes to diet or supplements prior to treatment, or through innovative treatments such as transplanting faeces from healthy donors. Supported by a programme organised by the Calouste Gulbenkian Foundation, Dr Miguel Reis Ferreira, Clinical Research Fellow at the ICR and The Royal Marsden, designed and managed the project as part of his PhD. He says: “At the moment, we treat patients for side effects from radiotherapy by managing their symptoms until the body recovers. We have already identified differences in the microbes of patients who have side effects. The gut microbiome could be a cheap and effective way to either predict or stop side effects in the first place. “Our study was designed to find out which changes occur, and results are encouraging. We will need further research to understand how we could use or modify our gut bacteria to improve outcomes for our patients.”
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Hospital news
IN PROFILE
Curriculum vitae 1985 Obtains Master’s degree in Medical Statistics & Information Technology from the University of Leicester 2003 Appointed Director of the Cancer Research UK-funded Clinical Trials and Statistics Unit at the ICR, and Head of Section of Clinical Trials 2006 Appointed Professor of Clinical Trials at the ICR 2011 Becomes Deputy Head of the Division of Clinical Studies at the ICR 2017 Receives NIHR Senior Investigator Award
PROFESSOR JUDITH BLISS Director of the Clinical Trials and Statistics Unit and Deputy Head of the Division of Clinical Studies at the ICR rofessor Judith Bliss is a clinical trials statistician with more than 30 years of experience. Her professional interests are in the design and analysis of clinical trials for cancer. She is driven by a desire to make trials more efficient and robust, and to provide results that can influence clinical practice internationally. Much of Professor Bliss’s work involves trials that aim to maximise benefit in breast cancer treatment. This has included work comparing different chemotherapeutic agents and refining radiotherapy, as well as optimising the scheduling of hormone therapy. Under her directorship, the ICR’s Cancer Research UKfunded Clinical Trials and
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Statistics Unit (ICR-CTSU) has made major contributions to trials that have led to changes in clinical practice. These include the START and CHHiP trials, which showed that giving fewer but larger doses of radiotherapy was as safe and effective as standard care at reducing the risk of recurrence in breast and prostate cancers. Professor Bliss has played a national leadership role through chairing the National Cancer Research Institute’s Cancer Clinical Trials Units Group and as a member of UK Clinical Research Collaboration’s Clinical Trials Units Network Executive Group. As well as receiving support for some of the ICR-CTSU trials from the BRC, Professor Bliss
“It’s a privilege to be awarded the NIHR Senior Investigator Award and to help shape health research nationwide to face the challenges of the future”
also won an NIHR Senior Investigator Award last year. This recognises her trials leadership, her contribution to UK clinical research and the impact of her research on patient outcomes, as well as her efforts to involve patients and the public in her work. Professor Bliss will become a member of the NIHR College of Senior Investigators, acting as a leader within the NIHR and a key source of advice to the Department of Health and Social Care’s Chief Scientific Adviser. Professor Bliss said: “It’s a privilege to be awarded the NIHR Senior Investigator Award and to help shape health research nationwide to face the challenges of the future.” CANCERBRC.ORG 15
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As the UK’s only Biomedical Research Centre dedicated to cancer, our mission is the rapid translation of advances in research to improve the outcomes for patients with cancer through precision treatment. This is our ‘bench to bedside’ approach.
Groundbreaking research
World-class facilities
Training and development
Patient and public involvement
Across eight themes, we translate our findings into advances in treatments for cancer patients.
Including the Drug Development Unit, Centre for Molecular Pathology and West Wing Clinical Research Centre.
We are the UK’s largest training centre for oncology, with a proud history of championing women in medical research.
We incorporate and integrate the perspectives of patients, carers and the public into our research.
The Biomedical Research Centre is a partnership between The Royal Marsden and The Institute of Cancer Research, London. Together, we receive funding from the National Institute for Health Research. Find out more: cancerbrc.org | royalmarsden.nhs.uk | icr.ac.uk | nihr.ac.uk
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