The magazine for the UK’s only Biomedical Research Centre dedicated to cancer | Autumn/Winter 2018
Research made real
How we brought the pioneering MR Linac concept to fruition
Drug resistance
Patient experience
Digital diagnosis
A bright future
Detecting and tracking evolution in tumours
Assessing cancer’s impact on mental wellbeing
How we’re harnessing the power of big data and AI
One expert’s optimism about breast cancer treatment
DIRECTOR’S NOTES
The BRC in numbers
Contents 04 Forefront The latest research news 07 An absolute cure Professor Ian Smith on breast cancer treatment
A snapshot of the work of the NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research, London
08 How the MR Linac came to life The milestones in the journey of this groundbreaking machine
10bn+ £43m in funding has been awarded to the BRC by the NIHR for 2016-21
30 15,000
young patients at The Royal Marsden are treated on trials of molecularly targeted agents and immunotherapy every year
genomes have been tested at The Royal Marsden in 2018
12,000 78% tonnes of rubble was excavated to create a bunker for the MR Linac at our Sutton site
12 Smart work How big data and AI are improving treatment options
of women with breast cancer survive for 10 years or more, thanks to the advances made in treatment over the past 40 years
Cover photograph: Dr Alison Tree, Consultant Clinical Oncologist at The Royal Marsden and Team Leader at the ICR
data points, obtained through biomedical research and in the clinic, are in the ICR’s canSAR database
11 Q&A Dr Marco Gerlinger on drug resistance in cancers
14 The patient’s perspective Why a new study is looking at the emotional impact of cancer 15 In profile Radiotherapy researcher Dr Navita Somaiah
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 tell the story of our groundbreaking MR Linac – the third such machine in the world and the first in the UK – which combines MR imaging with radiotherapy. We have begun treating patients on the machine after many years of work to develop, build and prepare this pioneering technology. We explore the different stages of this journey, from the grant announcement in 2012 to treating the very first patient, Barry Dolling, this autumn. We also focus on our work in artificial intelligence and big data. We are using these advances in technology to help diagnose cancer earlier, personalise treatment and improve patients’ quality of life. 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
The Royal Marsden is a Centre of Excellence in the Roche imCORE Network, which unites the world’s experts to advance cancer immunotherapy research
Professor Udai Banerji led a trial of vistusertib with chemotherapy
DRUG COMBINATION TRIAL SEES EXCITING RESULTS he results of an early clinical trial, which combined a new targeted cancer drug with chemotherapy, have shown promise for patients with advanced ovarian or lung cancer. The trial, involving both ovarian and lung cancer patients, found that the combination of targeted drug vistusertib and paclitaxel chemotherapy caused tumours in over half of patients with ovarian cancer, and over a third with lung
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Over half of patients with ovarian cancer saw their tumours shrink with combined drug treatment
cancer, to shrink. It also stopped patients’ cancers growing for nearly six months. The results of the study, which was led by researchers at the ICR and The Royal Marsden along with teams at nine centres across the UK, far exceeded what is normally expected in patients with advanced disease undergoing standard treatment that is failing. The study was so successful that a Phase II trial began while the Phase I trial was still recruiting.
Researchers at the ICR had previously observed that chemotherapy-resistant ovarian cancer cells have high levels of a molecule called p-S6K, which enables the cells to grow quickly and may help them withstand the effects of chemotherapy. Vistusertib works by targeting those proteins that ‘turn on’ p-S6K, preventing cancer cells from using p-S6K to grow and resist chemotherapy. The study, which was published in the Annals of Oncology, was funded by AstraZeneca, with support from the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and the Experimental Cancer Medicine Centre (ECMC). Study leader Professor Udai Banerji, Deputy Director of the Drug Development Unit at the ICR and The Royal Marsden, said: “We combined chemotherapy with a targeted drug which blocks the way cancer cells react to treatment in order to survive. The results we saw were very exciting. “We collaborated with multiple ECMC sites and delivered the study in record time, so it could seamlessly move into a randomised Phase II trial. This is a testament to all the high-quality research infrastructure in our ECMC and NIHR centres, along with the commitment and altruism of our patients in the UK.” Further reading: doi.org/10.1093/annonc/mdy245
IMMUNOTHER APY BREAKTHROUGH FOR PROSTATE CANCER clinical trial led by a team at the ICR and The Royal Marsden is the first to show the benefits of immunotherapy for some men with advanced, otherwise untreatable prostate cancer. Researchers found that a subset of men who had exhausted all existing options for treatment survived much longer than expected when receiving the checkpoint inhibitor pembrolizumab – with many of them showing impressive remissions and prolonged disease control. The landmark international trial could lead to a subset of prostate cancers being treated with immunotherapy. Of the 258 men with advanced prostate cancer who took part in the trial, 38 per cent were still alive a year after immunotherapy treatment and 11 per cent were still receiving the treatment a year after the trial began and had not seen their cancer grow. The study, which was funded by Merck Sharp & Dohme and presented at the American Society of Clinical Oncology’s annual
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38%
of patients with advanced prostate cancer were still alive a year after immunotherapy treatment
meeting in Chicago, also revealed vital clues for identifying the subset of patients who could especially benefit from immunotherapy. Five per cent of men saw their tumours shrink or disappear after treatment, and researchers found this response was higher in those whose tumours had mutations in their DNA repair genes. Professor Johann de Bono, Director of the Drug Development Unit at the ICR and The Royal Marsden, said: “Immunotherapy Professor Johann de Bono
has changed the way we treat many advanced cancers but up to now, no one had demonstrated a benefit in men with prostate cancer. “We are planning a new clinical trial, specifically in men with prostate cancer whose tumours have mutations in their DNA repair genes, to see if immunotherapy can become part of their treatment.” Further reading: meetinglibrary.asco.org/record/ 160540/abstract
New blood test shows when prostate treatment isn’t working A blood test developed at the ICR that detects trace levels of tumour cells could be used to spot the early signs of drug resistance in the treatment of prostate cancer. Researchers at the ICR and The Royal Marsden studied blood samples from 511 men with advanced prostate cancer to measure any changes in circulating tumour cells (CTCs) 12 weeks after treatment. Men with zero CTC counts in their blood lived, on average, for 27 months after treatment, while men with an increase of just three or four CTC counts in their blood lived for 15 months. The blood test could be used to rapidly assess how men with advanced prostate cancer are responding to their treatment, and whether they should switch to different therapies. The study was published in the journal Annals of Oncology and was funded by Prostate Cancer UK, Movember, the Medical Research Council, the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and Cancer Research UK. Further reading: doi.org/10.1093/ annonc/mdy172 CANCERBRC.ORG 05
FOREFRONT
EXPERT VOICE
MINI TUMOURS TEST FOR PERSONALISED DRUG TREATMENTS reating miniature replicas of a patient’s tumour and testing cancer drugs on them could help doctors tell in advance which treatments will work, say researchers. This exciting new technique involves growing ‘mini tumours’ from patients’ biopsy samples, and could reduce trial and error in selecting the best cancer treatments for patients when genetic testing is not predictive. Researchers at the ICR and The Royal Marsden compared how 55 established or new drugs performed when tested on mini tumours, with how well patients responded in clinic. They found that testing drugs on mini tumours was 100 per cent accurate at identifying those that wouldn’t work in patients, and correctly
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“This new technique gives us an extremely promising way to predict if a drug will work for a patient” Dr Nicola Valeri, Team Leader in Gastrointestinal Cancer Biology
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predicted which drugs would shrink a patient’s tumour 88 per cent of the time. Researchers believe each patient could have mini tumours grown and tested for drug sensitivity before starting treatment – allowing doctors to design a personalised regimen. The research was carried out on patients with bowel, stomach and other gastrointestinal cancers, and was published in the journal Science. It was supported by the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and Cancer Research UK. Study leader Dr Nicola Valeri, Team Leader in Gastrointestinal Cancer Biology and Genomics at the ICR and Consultant Medical Oncologist at The Royal Marsden, said: “Once a cancer has spread around the body and stopped responding to standard treatments, we face a race against time to find patients an alternative drug that might slow the cancer’s progression and help to extend their lives. “We discovered that recreating tumours in the laboratory using this new technique gave us an extremely promising way to predict whether a drug would work for a patient.” Further reading: science.sciencemag.org/ content/359/6378/920
Professor Ian Smith
100% 88% accuracy in identifying which drugs wouldn’t work in patients
Dr Nicola Valeri
accuracy in predicting which drugs would shrink a patient’s tumour
AN ABSOLUTE CURE Huge advancements in breast cancer treatment give Professor Ian Smith, Consultant Medical Oncologist at The Royal Marsden, hope for the future wouldn’t be surprised if, within the next decade, almost all patients with breast cancer can be cured. This may seem like a strong statement to make, but the advancements in the field since I first started working in the NHS more than 40 years ago have been staggering. In the early 1970s, when I first took up a position at The Royal Marsden and the ICR, breast cancer treatment had a very poor prognosis, with more than
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70 per cent of patients dying. Effective treatment was still in its infancy and there was no general standard of care. I was excited to be in a team at the forefront of investigating new treatments and was lucky enough to be involved in the development of some important new drugs. Several of these are now widely used in clinical practice, including letrozole, carboplatin and trastuzumab (Herceptin). This pioneering research has been an important factor
in improving the cure rate for breast cancer patients to 70-80 per cent. And there are plenty of reasons to be optimistic for the future. In breast cancer, as in other cancers, there is nowadays much more emphasis on evidence-based medicine, with patients understanding the importance of clinical trials and wanting to be involved in them. We also now understand much more about molecular abnormalities in cancer cells.
This is allowing for the rapid development of targeted therapies, leading to individualised, personalised medicine, with reduced toxicity in treatments and better outcomes for patients. In the past two or three decades, I have become increasingly involved in so-called neoadjuvant, or preoperative, therapy as a research approach towards individualised treatments for early breast cancer. This involves giving the patient medical treatment before surgery to test whether it is likely to work. As Chief Clinical Investigator of the UK POETIC trial – the largest of its kind in the world, involving 4,500 patients – I’m leading a team that is investigating this further to determine whether molecular changes before and after two weeks of treatment can predict the need for chemotherapy in each individual patient. I am honoured to be a recipient of this year’s William L. McGuire Memorial Lectureship at the San Antonio Breast Cancer Symposium. I follow in the footsteps of colleagues Professor Mitch Dowsett and Professor Trevor Powles, my mentor; together, we join only a small group around the world to have won both the McGuire and the Susan G. Komen for the Cure Brinker awards. These prestigious accolades reflect the pioneering approach that lies at the heart of The Royal Marsden and the ICR. We are at the forefront of advancing treatment for breast cancer, and the Breast Unit will continue with this ambitious, patient-centred approach until we can cure everyone. CANCERBRC.ORG 07
MR Linac
Birth of an idea
HOW THE MR LINAC CAME TO LIFE The Royal Marsden and the ICR have made history by treating the first patient in the UK on the MR Linac, a groundbreaking machine that combines MR imaging with radiotherapy. Here are the key stages in the journey from conception to completion
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For decades, the radiation oncology community had dreamed of combining magnetic resonance imaging (MRI) and radiotherapy in order to see cancers in real time as they treat them. Such technology would be particularly effective for patients with tumours that change position when they breathe, their bladder fills, or they have changes in the bowel. Professor Uwe Oelfke, Head of the Joint Department of Physics at the ICR and The Royal Marsden, says: “We knew that if we wanted to fully unlock the potential of radiotherapy by making it even more precise in targeting the cancer and avoiding healthy tissue, we needed to be able to see a patient’s tumour while we delivered treatment.” In 2012, University Medical Center Utrecht in the Netherlands, cancer treatment technology manufacturer Elekta and its MR technology partner Philips formed an international consortium of seven globally renowned cancer centres, including the ICR and The Royal Marsden, to make the dream of a magnetic resonance linear accelerator – or MR Linac – a reality. Two years later, the ICR and The Royal Marsden successfully applied for a £10-million grant from the Medical Research Council’s (MRC) Enhancing UK’s Clinical Research Capabilities and Technologies programme. “The MR Linac is our flagship project in a programme of research to apply state-ofthe-art technology to create smarter, kinder forms of radiotherapy,” says Professor Paul Workman, Chief Executive of the ICR. “We were delighted that the ICR and The Royal Marsden was jointly one of the first centres in the world to have access to this technology, and extremely grateful for the support of the MRC in making it happen.”
Under construction
Prestigious guests
“We wanted to fully unlock the potential of radiotherapy by making it even more precise”
Opposite page: Professor Uwe Oelfke. Left column: the MR Linac at concept stage. Centre column: the bunker is constructed (top), and the magnet is lowered into position. This column: London Mayor Sadiq Khan with Dr Alison Tree (top), and HRH The Duke of Cambridge with Professor Oelfke
Building work to accommodate the new MR Linac in Sutton began in January 2015. Almost 12,000 tonnes of rubble was excavated to create a bunker – large enough to hold 24 double-decker buses – to house the machine. A year after building began, the gantry and, a few months later, the five-tonne magnet, were lowered carefully through the skylight in the hospital’s car park. “This was a hugely complex and ambitious project,” says Sunil Vyas, The Royal Marsden’s Director of Projects and Estates. “The build required collaboration between my department, physicists and clinicians to ensure we created the ideal environment for this pioneering machine.”
In November 2016, the Mayor of London, Sadiq Khan, officially opened the MR Linac facility and met the clinicians and physicists working on the project. “Our team of doctors, physicists, diagnostic MR radiographers and therapeutic radiographers had been working so hard up until this stage,” says Dr Nicholas van As, Consultant Clinical Oncologist and Medical Director at The Royal Marsden. “The opening gave everyone a real boost and provided the team with opportunities to share their excitement about the project.” And in May 2017, HRH The Duke of Cambridge, the President of The Royal Marsden, visited to see behind the scenes of the MR Linac and learn how the machine would benefit patients.
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MR Linac
Testing it out
By February 2017, the MR Linac was ready to be tested. The team needed to scan an object to see if the image quality changed when the radiation beam was turned on and off. They chose to scan a dead crab in a nod to Hippocrates’ description of the disease as carcinos, the Greek word for crab – later translated into Latin as cancer. Dr Simeon Nill, Head of Translational Radiotherapy Physics at the ICR and The Royal Marsden, says: “Crucially, the two identical scans showed that the radiation did not affect the quality of the image.” Then in November 2017, we scanned the first healthy volunteers, including Paul Scully MP and Ross Lydall, the Evening Standard’s Health Editor, in a clinical study to test the scanning element of the MR Linac. Dr Helen McNair, Lead Research Radiographer at The Royal Marsden, says: “Seeing the images for the first time was a pivotal moment as it reinforced everything we were working towards.” Dr Katherine Aitken, Consultant Clinical Oncologist at The Royal Marsden and Honorary Lecturer at the ICR, thought that the quality of the images was exceptional. ”Pancreatic cancer is very difficult to treat effectively with standard radiotherapy, so the fact that we were able to visualise the pancreas and nearby organs so clearly was very exciting,” she says. “We hope the MR Linac will enable us to safely increase the dose of radiation we use to treat pancreatic tumours without damaging the surrounding healthy tissues such as the small bowel and stomach.”
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Treating the first patient
Our efforts came to fruition in September 2018, when we treated the first patient in the UK on the MR Linac. Prostate cancer patient Barry Dolling, 65, made history as part of the PRISM (Prostate Radiotherapy Integrated with Simultaneous MRI) clinical trial. “This treatment will give me a better quality of life and minimal side effects in comparison to other treatments,” Barry says. “I want to be able to keep swimming and cycling.” Dr Alison Tree, Consultant Clinical Oncologist at The Royal Marsden, Team Leader at the ICR and Chief Investigator on the trial, says: “Prostate cancer responds most effectively to large doses of radiation delivered over a short period. However, high doses risk damaging the nearby rectum and increasing side effects. “With the MR Linac, we can better target the prostate while avoiding the rectum. It is possible that this groundbreaking precision will one day make it possible for us to cure prostate cancer in a single treatment.”
Left: the test scan of a crab. Top: Barry Dolling becomes the first patient to be treated on the MR Linac. Above: the team targets Barry’s treatment using real-time scans
Q&A
The BRC aims to develop innovative molecular diagnostic techniques to better understand responses to treatment and cancer evolution after resistance develops to make them attack the tumour cells. We are also working closely with pharmaceutical companies to trial new drugs, as well as to understand through detailed molecular analysis how resistance to these agents develops and how it can be stopped, reversed or prevented.
Dr Marco Gerlinger
MOVING TARGETS Dr Marco Gerlinger, Leader of the Translational Oncogenomics team at the ICR and Consultant Medical Oncologist at The Royal Marsden, talks about the problem of drug resistance and how tracking changes in tumours could help combat it What is drug resistance? In recent years, targeted cancer therapies have brought significant benefits to patients, and many tumours respond well to drugs. But these responses don’t last for long – most cancers start growing again after only a few months of treatment with a targeted drug, as they evolve to develop resistance. We are trying to find the molecular
switches in cancers that allow tumours to become resistant. My team’s work focuses on gastrointestinal cancers, looking at how their genomic landscapes evolve over time and during tumour expansion, and how these genetic and molecular changes drive resistance to drugs. What causes resistance? Cancer cells are bad at looking after their genomes. So when a tumour grows, new mutations constantly occur. This way, tumours acquire millions of new mutations and a few of these will allow cancer cells to survive treatments that would otherwise kill them. Many cancer cells will die, but not those
that carry resistance mutations. When we treat a tumour with drugs, these cells are then able to grow, proliferate and become dominant within the tumour. How are the ICR and The Royal Marsden combating this? Identifying the molecular changes that cause drug resistance can allow us to develop new strategies to directly block the resistance mechanisms. One approach that we’re trying in clinical trials is to turn against cancers some of the changes that happen in them when they are treated and resistance occurs. For example, we’re trying to unleash the immune cells that accumulate in some bowel cancers
How will understanding tumour evolution lead to better cancer treatments? Our work on tumour evolution has shown that it’s not only the evolution of cancer cells but also the coevolution of the microenvironment that seems to drive drug resistance. Such insights are important as they show that we need to think about the whole ecosystem and the interactions within it. There are several drugs available or currently in development that can be used to target cancer stroma – the connective tissues that support a tumour – and I’m convinced that we will soon start testing to see if these can prevent resistance. My team is also interested in an approach called synthetic lethality, which takes advantage of cancer cells’ overreliance on a limited number of genes in order to stay alive. By detecting and tracking the evolution of cancer cells within tumours, we can stay one step ahead and design better therapies that prevent drug resistance.
“When a tumour grows, it acquires millions of new mutations and a few of these will lead to the cells acquiring drug resistance” CANCERBRC.ORG 11
Big data and AI
SMART WORK
“Using AI, we hope to predict how a cancer will evolve in order to intervene at an earlier stage”
Harnessing the power of big data and artificial intelligence enables us to make earlier diagnoses, provide bespoke treatments and improve our understanding of cancer
arlier this year, Prime Minister Theresa May put artificial intelligence (AI) and big data in the spotlight when she called for technology to transform how the UK diagnoses, treats and prevents cancer. Big data is often described as the fuel that powers AI, and partnerships between research institutions and healthcare providers are ideally placed to make use of large amounts of data from patients to enhance our understanding of disease. At The Royal Marsden and the ICR, our experts are exploring the latest advances in technology to help diagnose cancer earlier, personalise treatment, and improve patients’ quality of life.
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Professor Bissan Al-Lazikani
Processing big data
Professor Bissan Al-Lazikani, Head of Data Science at the ICR, is leading the development of software tools to help in the discovery of new cancer drugs. Her team is processing large volumes of data obtained through biomedical research and in the clinic, including genetic, radiotherapy, chemical and pharmacological data; images of cells, tissues and the whole body; and clinical notes. Professor Al-Lazikani’s team has built a huge database on cancer known as canSAR, which already has more than 10 billion data points. It is one of a range of computational approaches
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that are increasingly allowing us to share and integrate diverse sets of data, uncovering knowledge that could not be observed by working on smaller, individual subsets. For example, researchers at the ICR have used canSAR to identify 46 potentially ‘druggable’ cancer proteins that had previously been overlooked. Professor Al-Lazikani says: “We are starting to see results where computational research, innovative machine learning and big data are not only exciting developments, but are beginning to have a huge impact on our understanding of cancer.”
Analysing MRI scans
Researchers at the ICR and The Royal Marsden are also working at the cutting edge of AI, which involves creating intelligent systems that can ‘think’ like people. One of the most exciting areas in AI is machine learning – developing artificial intelligences that are able to learn for themselves. Researchers like Professor Al-Lazikani are creating programs that can learn, through trial and error, and then apply that learning to the growing set of data available, analysing it over and over again to give progressively more accurate and reliable results. As part of a groundbreaking project, Dr Christina Messiou, Consultant Radiologist at The Royal Marsden and Reader in the Division
Dr Andrea Sottoriva
of Radiotherapy and Imaging at the ICR, is working with Imperial College London to develop machine learning that will assist radiologists in reporting whole-body magnetic resonance imaging (MRI) scans in patients with myeloma. The aim is to develop a computer that can independently identify scans that show evidence of cancer. “If we truly want to understand a patient’s cancer, we often need to assimilate vast amounts of information, drawing on huge and complex datasets,” says Dr Messiou. “We’re developing state-of-the-art technology that will enable us to analyse this information much faster.”
Predicting cancer’s evolution
Scientists at the ICR are also using AI to predict how cancers will evolve. Together with colleagues at the University of Edinburgh, they have developed a powerful AI tool called REVOLVER (repeated evolution of cancer),
which picks out patterns in DNA mutation within cancers and uses this information to predict the disease’s next move. Dr Andrea Sottoriva, Team Leader in Evolutionary Genomics and Modelling at the ICR and Leader of the REVOLVER project, says: “With this tool, we hope to remove one of cancer’s trump cards – the fact that it evolves unpredictably, without us knowing what is going to happen next. By giving us a peek into the future, we could potentially use this AI tool to intervene at an earlier stage.” Thanks to advances in computing power and the sheer volume of data available, AI has captured imaginations. The possibilities for harnessing big data and AI in cancer care are endless, and we are just beginning to explore them at The Royal Marsden and the ICR.
Above left: Dr Christina Messiou. Above: Dr Andrea Sottoriva
Visit cancerbrc.org/our-research for more about our digital work
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Hospital news
Living with cancer
IN PROFILE
Curriculum vitae 2005 Appointed Fellow of the Royal College of Radiologists in Clinical Oncology 2013 Awarded DPhil in Radiation and Cancer Biology from the University of Oxford 2013 Becomes the first recipient of a Clinician Scientist Fellowship at the ICR 2016 Elected as committee member of the Association for Radiation Research 2018 Appointed as Career Development Faculty at the ICR
THE PATIENT’S PERSPECTIVE
DR NAVITA SOMAIAH
Our researchers are evaluating how cancer and its treatment affects patients’ mental wellbeing and quality of life esearch into new treatments is key to ensuring that more patients survive cancer for longer. But for researchers at the ICR and The Royal Marsden, survival alone is not enough. The impact of cancer is more than just physical – it affects patients emotionally and socially, and the toll it takes can be overwhelming. As treatments become more sophisticated, how patients live with cancer is becoming increasingly important to us – and studying their experience could lead to even better treatments. Dr Olga Husson is a Staff Scientist in the Division of Clinical Studies at the ICR and a Research Fellow at The Royal Marsden. She is researching the impact of cancer and its treatment from the patient’s perspective – a unique new role that puts patients at the heart of our research. Her work is helping to embed patientreported outcome measures (PROMs) in clinical research practice. PROMs provide a multidimensional picture of patients’
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wellbeing, including their perception of the impact of the disease and its treatment on their physical and mental health, and on their day-to-day life. The measures are increasingly being used to complement traditional ways of evaluating treatment success, such as response and survival rates. PROMs could also have benefits beyond assessing treatment. Incorporating them into clinical practice can make it easier for patients and doctors to talk to each other, improve symptom control, increase patient satisfaction and even reduce hospital admissions. Dr Husson is implementing a digital tool called PROFILES (patient-reported outcomes following initial treatment and long-term evaluation of survivorship), which enables our researchers to incorporate the collection of PROMs into everyday practice. The PROFILES tool could be used in every stage of a clinical study: from inviting patients to participate in studies to collecting PROM data via questionnaires and, finally, linking these data to the patient’s clinical records.
Clinician Scientist at the ICR and Consultant Clinical Oncologist at The Royal Marsden The PROFILES team is leading several studies to trial use of PROMs, working with cancer centres across the UK and in Europe. These studies are, for example, assessing the quality of life in patients with sarcoma receiving chemotherapy, or in young adults with cancer. “PROFILES was developed to increase knowledge of the impact of cancer on people’s lives across the cancer continuum, and to give a window into how patients are coping with their treatment over time,” says Dr Husson. “My work is the start of the journey to embed PROMs across clinical studies to benefit both patients and research.”
The impact of cancer is more than just physical – it affects patients emotionally and socially
r Navita Somaiah was the first recipient of a prestigious Clinician Scientist Fellowship at the ICR, and her research has gone on to help show how radiotherapy can be personalised for each individual patient, to improve treatment outcomes and overall effectiveness. As a clinician scientist at the ICR and a consultant at The Royal Marsden, she is afforded a unique perspective, working both with patients in her clinics and cancer cells in her lab to make radiotherapy more effective for patients. Radiotherapy kills cancer cells by causing damage to their DNA. Dr Somaiah’s team works to identify biomarkers in cells that can indicate the effect of
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the treatment, which can then be used to choose the most appropriate dose of radiotherapy to kill cancer cells while minimising damage to the surrounding healthy tissues. She is also interested in the long-term side effects of radiotherapy and identifying biomarkers that can predict a patient’s risk of developing often debilitating reactions. Her goal is to enable the personalisation of radiotherapy doses to maximise the effectiveness of treatment while reducing side effects. Rapidly growing tumours are often deprived of oxygen – a condition known as hypoxia, which is associated with resistance to radiotherapy. Dr Somaiah’s team is investigating innovative approaches for tackling tumour
“I am working to understand the complexities of radiation-induced DNA damage and immune responses, with the aim of developing truly personalised radiotherapy”
hypoxia by combining novel drugs with radiation. Her team is also evaluating how to optimise doses of radiation when radiotherapy is delivered alongside treatments such as immunotherapy. She is Translational Leader of the PRADA trial at The Royal Marsden, which will provide invaluable insights into the best way to combine radiotherapy with immunotherapy for high-risk breast cancer patients. Dr Somaiah says: “My work is helping to understand the molecular complexities of radiation-induced DNA damage and immune responses, and to develop smarter, kinder treatments with the aim of truly personalised radiotherapy for patients.” CANCERBRC.ORG 15
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