We are told that 1 in 2 of us will be affected by cancer; a ‘disease that touches every family’. In the UK cancer survival has doubled over the past 40 years, and ‘half of those diagnosed can now expect to live at least 10 years’. This is a staggering testament to the dedication of all involved in the study, development and understanding of treatments.
We have now reached an increasingly extraordinary technological era where treatment can ultimately be tailored to the genetic profile of a tumour.
“this is an unprecedented time of progress in the history of cancer medicine and cancer research”
BBC Panorama’s ‘Can You Cure My Cancer?’ shines a light on the work taking place at the Institute of Cancer Research and London’s The Royal Marsden Hospital which, at its inception in 1851 was the first specialist cancer treatment unit in the world and continues as a centre of excellence. Filmed over 18 months, it allows a window into the fascinating research and direction of innovative cancer therapy, those who commit their professional lives to advancing this field and the many incredible patients who make such progress possible.
One such patient, Tami, at age 30 became one of the over 7000 women diagnosed with ovarian cancer each year. Her prognosis was very poor. She underwent chemotherapy and surgery, but later became aware that her cancer had returned and spread. Tami had 18 sessions of chemotherapy before swapping to the experimental oral medications MEK162 and BYL719 as part of a clinical trial, her parameters closely monitored by her medical team. These innovative drugs are personalised; targeted to the specific oncogenic mutations identified in the patient’s cancer.
Such targeted treatments “are producing spectacular results” in a range of applications. John shares his story. John was diagnosed with prostate cancer which spread to his spine. Enrolled on an international drug trial led by the Marsden and involving more than 1000 patients, he has had good results.
“I’m so happy to be alive and may many more years of it come”
Professor Johann de Bono is a clinician scientist overseeing almost 40 such early drug trials in a partnership with the Royal Marsden and ICR where he heads the Drug Development Unit.
“I am very confident that with some of these drugs we will be giving patients many, many years of life. In prostate cancer, I’m seeing patients living 5, 10 years regularly. So you’re really now coming to making cancer a chronic illness that you can live with like blood pressure and diabetes for many years.
I do think increasingly we will cure a larger number of cancers, particularly if we can catch them early.”
Tami’s therapy delivered excellent results for a year before signs of resistance were detected. She was then selected to start on a new drug that had good early trial results. Resistance is a significant challenge. Adapting the treatment regime to the genetics and molecular biology of the individual and their cancer strategically over the course of the disease can tackle resistance – allowing such previously terminal cancers to become manageable as long term conditions.
“It’s a very, very exciting time” – Dr Amanda Swain
Some cancers however are particularly difficult. Mum-of-three Anne’s cancer was very hard to treat, having originated in her trachea before spreading and showing no response to conventional treatments. Her tumour was biopsied for genetic analysis at the ICR tumour profiling unit. Advances in rapid lower cost sequencing and knowledge through this step allow precision drugs to be targeted directly at the cancer.
Mice can be used in the lab to act as ‘cancer avatars’ to replicate the cancer’s genetic profile for drugs to be tested on both primary and secondary tumours. While not all treatments will be effective in halting progression of the disease, this approach promotes fast uptake of targeted therapies that are thought to have a likely acceptable safety profile and a chance of success.
“the idea around this approach is to try to avoid using people, patients, as the field of battle in which we test these drugs. When we try treatments, we want to be as certain as we possibly can be that there is a very good chance that it’s a good selection of therapy and that there’s a good chance that you’re going to respond to this treatment.” – Professor Kevin Harrington
Using precision approaches, targeting treatments to cancer genotype and morphology, switching and combining targeted treatments are extraordinary ways that cancer treatment and care has been advanced, tackling evolving mutations and resistance to therapy. Metastatic spread can now be monitored and detected earlier by blood tests. Another cutting-edge approach is immunotherapy, modulating the patient’s own immune response to the cancerous cells.
“With immunotherapy, you’ve reprogrammed the system so inside the patient you have an immune system that can recognise tumour cells. If a bit of the tumour does become resistant, the experience to date certainly seems to be that the immune system can still deal with that.”
Vicky’s melanoma was advanced at the time of detection, already having spread to her breast and lung tissue. Vicky took part in a clinical trial of monoclonal antibody therapies in combination. She was forced to stop the treatment early as she developed serious reactions to the immunomodulation. However, the time that she spent taking them was very effective and she is still cancer free.
“Life-affirming” – Dr Louis Chesler
An extraordinary response is seen in Sophie, 11, one of the 170 paediatric patients treated a year at the Marsden. Sophie was diagnosed with an especially unusual and aggressive inflammatory myofibroblastic tumour a few years ago; her condition without effective treatment would have been ‘incompatible with life’. Her cancer was caused by an ALK gene mutation promoting oncogenesis. Research undertaken at the ICR established targets for this specific mutation, testing the drugs in mice before trying them on children.
Sophie was accepted onto a clinical trial of a drug, LDK378 and, incredibly, at her first scan since starting the drug her tumour had shrunk by 60%. The bench-to-bedside approach used for Sophie sped the delivery of drugs to her targeted to the specific genetic mutation exhibited. Sophie has been able to take oral medication avoiding the side effects of chemotherapy, and her continued remission has ensured she has an excellent prognosis with a normal, full life ahead of her.
“It’s the goal of every paediatric oncologist to see that kind of response. It’s truly astonishing and miraculous to see”
“But of course, it’s not a miracle, it’s science?”
“It’s miraculous science”, replied young Sophie’s father.
The Institute of Cancer Research is calling for funding for trials and a change in the law to remove a loophole allowing ‘class waivers’ to pharmaceutical companies exempting them from testing drugs in children – so that important drugs can be tested and brought into use in children like Sophie. Read more here.