Royal Marsden Private Care - Autumn 2022

As the Managing Director of Private Care at The Royal Marsden, I’m pleased to introduce the latest issue of Private Care magazine.

Everyone at The Royal Marsden was deeply saddened by the passing of Her Majesty The Queen in September. As Patron of The Royal Marsden for 70 years, the Queen was a wonderful supporter of our work and visited Chelsea and Sutton over the years. We pay tribute to Her Majesty in this issue.

Elsewhere, you can hear from Royal Marsden staff who have been sharing their knowledge and skills with colleagues around the globe, to ensure that as many people as possible can benefit from their expertise.

The front cover of this magazine features Dr Susana Banerjee, who is internationally recognised as a world-leading expert in gynaecological cancers. She is a Consultant Medical Oncologist and Research Lead for the Gynaecology Unit at The Royal Marsden and sees patients in Sutton, Chelsea and Cavendish Square. You can read more about her career highlights to date in our Consultant Focus feature. I hope you enjoy this issue.

Shams Maladwala Managing Director of Private Care

Dr Susana Banerjee, Consultant Medical Oncologist

TREATMENTNECKINBREAKTHROUGHHEADANDCANCER

A STUDY PART-LED by researchers at The Royal Marsden has found that a new adaptive radiotherapy technique could offer a better treatment option for patients with head and neck cancer.

The new technique, which is known as ATS-Lite, can deliver a more robust treatment plan and requires less time spent on the MR Linac

radiotherapy machine. Benefits for patients include a more tailored and accurate treatment approach, improved comfort and reduced side effects.

Study lead Dr Kee Howe Wong, Consultant Clinical Oncologist, said: “Although we’re at an early stage with ATS-Lite, we have seen great results so far, with patients responding very well to treatments.”

RESULTSPROMISING

Study lead Dr Kee Howe Wong

Andy Johnstone, 65, was diagnosed with head and neck cancer last May and referred to The Royal Marsden. He was one of the first patients to be treated with the ATS-Lite technique.

He said: “I was treated five days a week, for six weeks. A follow-up scan in December showed no sign of cancer. I’m so glad I had this treatment –it probably saved my life.”

TALKING POINTS

“Many colleagues and patients across The Royal Marsden have been touched and saddened by Her Majesty’s passing”

“It was amazing to see how hard clinicians in India are working to get patients access to treatment and care”

“The Royal Marsden pushes boundaries. We offer leadingedge surgery that you can’t elsewhere”get

“It’s exciting to be part of the revolution improving treatment for women cancers”gynaecologicalwith

IN BRIEF

Super Surgeons

The Royal Marsden’s surgical team was filmed by a documentary crew for almost a year for the series Super Surgeons: A Chance at Life. Airing on Channel 4 in July, the three-part series is available on demand at channel4.com Also, listen to the Twitter Space recording on the future of cancer surgery with Professor Nicholas van As and Professor Vinidh Paleri at spaces/1yNxaYNapoXxjtwitter.com/i/

GP events

The Royal Marsden runs a programme of events that aims to help GPs to spot the signs of cancer quickly and confidently. Our next GP event, which will focus on early diagnosis and innovative surgery, as well as including a Q&A with some of our Super Surgeons, will be on Thursday 24 November. Register at royalmarsden.nhs.uk/ information-gps/ gp-education-series

New appointment

Professor Vinidh Paleri has been appointed as Clinical Director of The Royal Marsden Private Care at Chelsea.

Professor Paleri, who is a Consultant Head and Neck Surgeon, has accrued the most experience in transoral robotic surgery in the UK, as well as pioneering a new robotic technique to remove radiorecurrent and radioresidual cancers.

REDUCED RISK

Professor Ros Eeles showed the benefits of routine screeninggenomic

NEW TRIALS REVEAL PROMISING RESULTS

RESEARCHERS FROM The Royal Marsden and its academic partner, The Institute of Cancer Research, London, presented their latest research at this year’s American Society of Clinical Oncology (ASCO) conference. Results from the Phase 3 Dysphagia-Aspiration Related Structures (DARS) trial, presented by Professor Christopher Nutting, revealed the benefits of a new precision radiotherapy technique for treating head and neck cancer. Of the 112 patients involved, 40 per cent of those treated with dysphagiaoptimised swallowingradiotherapyintensity-modulatedreportednormalfunctionaftertwo years, compared with 20 per cent of those treated with standard intensitymodulated radiotherapy.

The 90S study, led by Professor Ros Eeles, showed that screening patients for defective genes at GP practices is feasible and could detect or prevent disease. A quarter of people in the study had potentially ‘actionable’ genetic alterations, increasing their risk of conditions such as cancer and heart disease.

Meanwhile, Dr Anna Minchom presented data from a Phase 1 trial investigating the effects of a new drug combination in advanced cancers with mutations in the KRAS gene.

Led by Professor Udai Banerji, the trial used two drugs, VS-6766 and everolimus, to target two pathways in KRAS-driven cancers. This benefited patients with a range of KRAS mutations, especially those with advanced non-small-cell lung cancer.

At the forefront of genomic testing for cancer

PRIVATE PATIENTS AT The Royal Marsden can benefit from our Clinical Genomics Service, which aims to accurately profile solid tumours and haematological malignancies to help bring personalised treatment strategies to patients sooner.

Using the latest genomic-testing technology and working closely with oncologists at The Royal Marsden and across the North Thames Genomic Laboratory Hub, our scientists can identify diagnostic markers, treatment targets and potential resistance mutations as

part of a comprehensive overview of the tumour profile.

Later this year, in partnership with precision oncology company Guardant Health, we will open a state-of-the-art liquid biopsy testing facility. This will allow us to rapidly spot cancers by analysing patients’ blood samples for genetic changes in fragments of circulating tumour DNA, using innovative technology with improved sensitivity and turnaround times. This will ensure many more patients’ cancers are detected and diagnosed earlier and allow clinicians to personalise treatments more accurately.

FIND OUT MORE Visit

private-patientsmarsden-clinical-genomics-service/royalmarsden.nhs.uk/royal-

SMALL WONDER Liquid biopsy testing will form part of our Clinical Genomics Service

SETTING THE TONE

For the first time in the UK, lightweight fabric prostheses offered to women following a mastectomy will now match a wider range of skin Sometones.women use the prostheses (also known as ‘softies’) temporarily following their operation – although many use them long-term, as they can be more comfortable than other available options.

Supported by funding from The Royal Marsden Cancer Charity, Natalie Johnson, Oncoplastic Surgeon (above), and Sarah Adomah, Breast Unit Lead Clinical Nurse Specialist, decided to create the more inclusive range to improve the care women of colour receive following a mastectomy.

It was developed in partnership with Nubian Skin, a lingerie and hosiery brand that specialises in nude skin-tone products for women of colour. There are four new skin-tone options in eight different sizes.

Our service helps bring personalised treatments to patients sooner

IT WAS WITH GREAT SADNESS that we learned of the death of Her Majesty The Queen on 8 September.

The Queen became Patron of The Royal Marsden in 1952 and was a wonderful supporter of our work. We were privileged that she honoured both our Chelsea and Sutton hospitals with visits over the years, meeting staff and patients.

In 1963, the Queen opened our Sutton hospital and met Frieda Sandwith, the great-granddaughter of William Marsden, who founded The Royal Marsden. More recently, the Queen visited the Chelsea hospital in 2001 to open the Markus Rehabilitation Centre.

Dame Cally Palmer, Chief Executive of The Royal Marsden, says: “Many of our staff will have memories of these wonderful occasions and remember them with pride and fondness.

“Her Majesty led the country and the Commonwealth with dignity, compassion and strength for 70 years, and many colleagues and patients across The Royal Marsden have been touched and saddened by her “Ourpassing.thoughts are with our President, HRH The Prince of Wales, and the Royal Family at such a sad time.”

MEMORIES OF HER MAJESTY

During the Queen’s visit to Chelsea in 2001, she met Dr Natalie Doyle – who was Sister for the Markus Centre at the time and is now The Royal Marsden’s Nurse Director for Patient Experience – who showed her around the new Markus Rehabilitation Centre.

“It was my responsibility to introduce Her Majesty to 35 members of staff and patients, which was a huge honour,” Dr Doyle recalls. “By visiting, it was an acknowledgement from Her Majesty that helping people live with and beyond cancer is important.

“It was a wonderful testament to the work we were doing at the time, and a day I’ll never forget.”

A MOMENTOUS DAY On her visit in 2001, the Queen met Shelley Dolan, then Nurse Consultant in Critical Care (top); saw the Markus Centre, escorted by Natalie Doyle, then Sister (above); and greeted staff, with Royal Marsden Chief Executive Cally Palmer (below)

“It was an honour to introduce Her Majesty to staff”

We honour Her Majesty The Queen, who was Patron of The Royal Marsden for 70 years and whose visits to the Chelsea and Sutton hospitals during her reign left patients and staff alike with abiding memories

A DECADE RESEARCHPIONEERINGOF

We highlight 10 ways in which the Centre for Molecular Pathology has helped to transform cancer diagnosis and treatment since 2012

IT’S BEEN 10 YEARS since the Centre for Molecular Pathology (CMP) opened in Sutton, bringing together researchers from The Royal Marsden and The Institute of Cancer Research, London (ICR), under one roof.

The £18.2-million facility, which is dedicated to the research of personalised cancer treatment, was financed through capital funding awarded by the Department of Health to the National Institute for Health and Care Research specialist Biomedical Research Centre, the Wolfson Foundation and The Royal Marsden Cancer Charity.

To mark this milestone, here are 10 ways in which the CMP has transformed how we treat cancer.

1The Genomes100,000Project

The Royal Marsden collected and decoded genomes from patients as part of this project, which sequenced 100,000 genomes from 85,000 people with cancer and rare diseases, helping to develop a genomic medicine service for the NHS and transform patient care.

2

Taking part in major trials

We played a crucial role in the Cancer Research UK Stratified Medicine programme and the National Lung Matrix trial, the largest clinical trial of precision medicine for non-small-cell lung cancer patients, both as a major recruiting site and one of the centres that carried out molecular profiling.

As part of the North Thames Genomic Laboratory Hub –which supports the NHS’s Genomic Medicine Service –The Royal Marsden now undertakes the majority of genomic testing for cancer patients in northeast and west London. hubgenomicsforLondon

partnershipsEstablishing4

Working with pharmaceutical companies means our patients benefit from the most advanced technologies. Thanks to a new partnership with Guardant Health, our new in-house liquid biopsy testing facility will allow us to offer bespoke diagnostic testing to many more patients.

Illustrations: Fernando Volken Togni

forDiagnosticsmillions

Using the CMP’s infrastructure and expertise has provided an integrated diagnostic service for haemato-oncology patients, both at The Royal Marsden and across a catchment area of 3.5 million people.

An PathologyIntegratedUnit

Funded by The Royal Marsden Cancer Charity and the ICR, the unit is a pioneer in the burgeoning field of digital pathology. It uses sophisticated computing tools and artificial intelligence to analyse tissue and learn crucial information about cancer.

A culture collaborationof8

Working closely with oncology experts, we use innovative genomic testing to bring personalised treatments to patients sooner. Our large clinical trial portfolio and repertoire of genomic tests means we can profile cancers quickly and accurately.

Better sequencinggenomic

Thanks to a generous donation from the Denise Coates Foundation to The Royal Marsden Cancer Charity, we invested in state-of-the-art DNA sequencing technology in order to make diagnostic sequencing more efficient and cost-effective than ever. In addition, our gene-sequencing panels comprehensively detect all currently cancer-relatedactionablemutations.

cancersChildhoodstudied9

As part of the Cancer Research UK-funded Stratified Medicine Paediatrics programme, tumours were sequenced using DNA and RNA panels developed at The Royal Marsden, enabling researchers to learn more about genetic changes in children’s cancers.

liquidPioneeringbiopsies

Our development and application of circulating tumour DNA testing has resulted in improved outcomes for patients. The process, which tests blood samples for DNA shed by the tumour, is minimally invasive and can help detect and diagnose cancer as well as inform treatment plans.

ARRIVALSOURMEETNEW

Professor Dae Kim Consultant Head and Neck and Thyroid surgeon

Professor Dae Kim has a special interest and expertise in complex thyroid cancer and thyroid surgery, but treats patients with all head and neck problems. He sees patients at Chelsea, Sutton and Cavendish Square.

Unusually, Professor Kim is ‘dual-qualified’ – in medicine, from the University of Edinburgh, and in dentistry, from the University of Birmingham. He trained at Edinburgh and Cambridge teaching hospitals and completed an advanced fellowship in both head and neck surgery and endocrine (thyroid and parathyroid) surgery in North America. He also trained to perform ‘keyhole’ thyroid and parathyroid surgery and robotic scarless thyroid surgery.

Professor Kim is a ‘surgeonscientist’. After comprehensive research training at Harvard

University and the University of Birmingham, he continues to undertake an active research programme in thyroid cancer and surgery. This includes studies into the role of immunotherapy in aggressive thyroid cancers, circulating DNA as a novel biomarker,

and qualitative research in surgical outcomes and patient experience.

He says: “The Royal Marsden pushes boundaries. Using molecular information based on our extensive clinical trials, we aim to do more for patients who may have no other options.

APPROACHDUAL interestedDaeProfessorKimis in how therapies can work withcombinationinsurgery

“I am passionate about surgical innovation, with a clinical interest in scarless robotic and minimally invasive endoscopic thyroid surgery”

Introducing the latest members of The Royal Marsden’s team of world-leading consultants

“I am passionate about surgical innovation, with a clinical interest in scarless robotic and minimally invasive endoscopic thyroid surgery. We are hoping that The Royal Marsden will be the first hospital in the country to offer scarless transoral surgery, which offers patients the same outcomes with no visible scar.

“I am also passionate about embracing new biology, such as immunotherapy and targeted therapy, and looking at how these can work in combination with surgery for otherwise palliative cases.

At The Royal Marsden, we offer leading-edge surgery that you can’t get elsewhere.”

Dr Alison ConsultantRangerClinical Oncologist

After completing her specialist oncology training in London, predominantly at The Royal Marsden, Dr Ranger now sees breast cancer patients at Chelsea and Cavendish Square.

As a Consultant Clinical Oncologist, she specialises in providing Royalandradiotherapyoligometastaticstereotacticheart-sparingThesepatientsradiotherapyleading-edgetreatmentstowithbreastcancer.treatmentsincluderadiotherapy,radiotherapyfordisease,andforadvancedmetastaticdisease.Shesays:“WorkingatTheMarsdeninChelseais

an

exciting opportunity. We often get challenging, complicated cases that we are fortunate enough to have the technology and expertise to treat. With a strong multidisciplinary team of experts to draw from, we can offer patients the best treatment options.”

Dr Ranger graduated from University College London Medical School in 2005. She has a master’s degree in Oncology from the University of London and a research degree from The Institute of Cancer Research, London.

Dr Ranger’s research focuses on complex radiotherapy techniques to maximise the radiation dose delivered to the breast and lymph nodes while reducing the dose to the heart and lungs. In 2016, she was awarded the Proton Beam

TECHNIQUEPRECISION

Dr healthythatradiotherapyinspecialisesRangerAlisoncomplexsparestissue

Visiting Fellowship from the Royal College of Radiologists and spent time at MD Anderson Cancer Center in Texas learning about this new technique.

“My special interest areas include looking into how we can use complex radiotherapy techniques to target a patient’s cancer while avoiding toxicity in surrounding healthy tissue,” she says. “We know that many women do very well after breast cancer treatment – these techniques enable more women to live well beyond cancer.”

“We often get challenging, complicated cases that we are fortunate enough to have the technology and expertise to treat”

SHARED CARE

A OFWORLDGOOD

INTERNATIONAL COLLABORATION

is key to driving improvements in cancer care. When new, less-invasive surgical techniques are developed or game-changing drug discoveries are made, sharing these innovations with as many people as possible changes lives. Here, we highlight some of the ways in which Royal Marsden experts are sharing the benefits of the hospital’s world-leading knowledge and practices globally.

Taking trials to India

In May, Consultant Breast Radiographer Victoria Sinnett travelled to India to facilitate collaboration on a clinical trial for advanced breast cancer patients. Led by researchers from The Royal Marsden and The Institute of Cancer Research, London, the Phase 2 KORTUC trial is exploring whether a gel injection of hydrogen

peroxide can make tumour cells more sensitive to radiotherapy.

“In India, there are often difficulties accessing and paying for healthcare. As the country has a good volume of radiotherapy machines and hydrogen peroxide is easily accessible and inexpensive, we thought it would be a suitable place to open the trial,” Victoria says. “It was amazing to be involved and see how hard clinicians in India are working to get their patients access to treatment and care. One of the centres I visited is recruiting patients to the trial, and the other is due to start soon.”

From left: Victoria Sinnett, Emma Foreman, DrandRavishankarRaoBaikadyProfessorVinidhPaleri

“I saw how hard clinicians work in India”

Royal Marsden staff have been sharing their knowledge and skills with colleagues around the globe to ensure that as many people as possible can benefit from their expertise

Benefits of biosimilars

Biosimilars are near-identical replicas of vital drugs that are just as effective as the originals, but cost far less – and Consultant Pharmacist Emma Foreman has supported The Royal Marsden’s drive to make biosimilar drugs available to more patients.

In 2018, she volunteered to chair the International Society of Oncology Pharmacy Practitioners’ Biosimilars Taskforce, which includes representatives from North and South America, Europe, Asia and Africa. Its aim is to identify the barriers that prevent the implemention of biosimilars and to create a toolkit of resources that local oncology pharmacists and medics can use to help overcome“Biosimilarsthem.are cheaper than the original drugs and bring competition into the market, which drives down prices while encouraging innovation,” explains Emma. “Each country has unique obstacles to adopting these products, from complex regulatory pathways to anticompetitive practices, and we hope to help address these problems.

“I’ve presented in the USA and Belgium and, thanks to COVID-19, at conferences in Saudi Arabia and Thailand from my bedroom.”

Better blood management

Dr Ravishankar Rao Baikady, Consultant in Anaesthesia and Perioperative Medicine, has a special interest in patient blood management (PBM) and regularly collaborates with colleagues in the UK and abroad to find ways to better manage anaemia and haemorrhage in cancer surgery.

Dr Rao Baikady has exchanged ideas about PBM with experts in Denmark, India, Australia and the USA. Since 2005, he has organised an annual seminar on the management of anaemia and haemorrhage during surgery, which is attended by clinicians from around the world.

“Half of patients are affected by anaemia and, because many require surgery as part of their treatment, there is a risk of haemorrhaging, which leads to blood transfusions,” Dr Rao Baikady explains. “Anaemia and transfusions can impact patient outcomes, so researching PBM in a cancer setting, including developing collaborations,internationalisessential.”

Teaching the TORS technique

Professor Vinidh Paleri, Consultant Head and Neck Surgeon, has travelled around the UK and beyond training surgeons in transoral robotic surgery (TORS), a technique he helped to pioneer.

TORS uses robotic technology to treat head and neck cancers. In select patient groups, it has shown improved functional outcomes, including with swallowing and speech. Professor Paleri has demonstrated TORS in several countries – including Norway, Scotland and India – and plans to train surgeons in Denmark, too.

“It was a privilege to assist these cases, which was the first time TORS has been used in these locations,” Professor Paleri says.

TRAINING TOMORROW’S SURGEONS

The Royal Marsden launched the Robotic Surgery Fellowship in 2017 with funding from The Royal Marsden Cancer Charity. We’ve trained seven surgeons from the UK and abroad to use the da Vinci surgical robots. Led by Consultant Surgeons Mr Pardeep Kumar, Ms Marielle Nobbenhuis and Mr Shahnawaz Rasheed, the fellowship aims to ensure that surgeons can operate on multiple tumour types using robotic technology.

DR BANERJEESUSANA

Consultant Medical Oncologist

DR SUSANA BANERJEE is internationally recognised as a world-leading expert in gynaecological cancers. She is a Consultant Medical Oncologist and Research Lead for the Gynaecology Unit at The Royal Marsden and a Reader in Women’s Cancers at The Institute of Cancer Research, London (ICR).

Dr Banerjee specialises in ovarian, endometrial (uterine) and cervical cancers and sees patients in Chelsea, Sutton and Cavendish Square. She has been involved in multiple international specialist groups, including the European Ovarian Consensus meeting. She is a Co-Chair of the European

Society for Medical Oncology’s (ESMO) Gynaecological Cancers Congress, and also teaches oncology to professionals internationally.

Dr Banerjee is global lead for a number of international clinical trials and also has national chief investigator roles. She has more than 170 peer-reviewed publications.

In addition, Dr Banerjee has acted as a clinical expert for the National Institute for Health and Care Excellence (NICE), as well as being a medical advisor for the Ovacome charity. She receives research funding from The Royal Marsden Cancer Charity, specifically from the Lady Garden Foundation.

CAREER HIGHLIGHTS

1997 Graduates from the University of Cambridge with first-class honours in Natural Sciences (Physiology)

2000 Graduates from Royal Free Medical School as a University of London Gold Medal finalist

2005 Receives Avon Breast Cancer Crusade Fellowship

2007 Receives San Antonio Breast Cancer Symposium Novartis Oncology Basic Science Scholars Award

2009 Receives PhD from the ICR and is awarded the McElwain Prize (Association of Cancer Physicians) and Pfizer British Oncology Association Young Investigator Award

2018 Serves as Scientific Chair at the ESMO Asia Congress

2019 Appointed Reader in Women’s Cancers, ICR 2020-22 Serves as ESMO Director of Membership

Q&A

Q What services do you provide at Cavendish Square?

A We aim to treat our patients with novel, targeted treatments that offer them the best possible outcomes and to help them live well during and beyond cancer.

I am passionate about improving treatment options and long-term survival for our gynaecological cancer patients.

I specialise in the treatment of ovarian, fallopian tube, primary

Q What is special about the services at The Royal Marsden?

A We deliver the most advanced, evidence-based treatments available. By participating in early trials, we can recognise promising treatment developments and ensure that our patients are receiving the best possible treatments for their individual needs. The Gynaecology Unit

at The Royal Marsden is a centre of excellence, drawing on an expert team that includes surgeons, medical and clinical oncologists, pathologists, radiologists and nurses.

Q What areas of research are you involved in?

A My focus is on developing new targeted treatments for gynaecological cancers. We are seeing enormous progress in research translating to better treatments in the clinic. Several new targeted drugs have been licensed in recent years, which gives more treatment options.

For example, the five-year follow-up results of the landmark SOLO-1 trial, on which I was lead author, was hailed as a new era for women with ovarian cancer. This treatment has been made available for women with newly diagnosed BRCA mutated advanced ovarian cancer and gives us real hope for more long-term survivors.

I am also involved in immunotherapy patients’sidemanagementalsotopatient’slookingmolecular-drivenresearch,trialsandatwhatmakesacancerresistanttreatments.Ourresearchfocusesonbetteroftreatmenteffectsandsupportingqualityoflife.

Q How have treatment options changed during your career?

A Treatment has changed radically over the past decade, from surgical and radiotherapy techniques to targeted therapies such as PARP inhibitors.

Previously, there were limited treatment options beyond chemotherapy. Immunotherapy is a landmark change in endometrial and cervical cancer treatment. I served as a NICE clinical expert, which led to the Cancer Drugs Fund making a drug called dostarlimab available for women with endometrial cancer, setting a new standard of care.

Q What does the future hold for gynaecological cancers?

A Thanks to breakthroughs over the past decade, there is a better future for our patients. We have the knowledge and resources to cure more women, have more patients in remission and have more long-term survivors, as well as to improve side effects and quality of life. This goes hand in hand with the importance of early diagnosis and prevention.

It is an exciting time to be working in cancer research and to be part of the revolution improving treatment for women with gynaecological cancers.

peritoneal, endometrial (uterine) and recurrent cervical cancers.

“Thanks to breakthroughs, there is a better future for patients. We can cure more women, have more patients in remission and have more long-term survivors”