Fighting cancer: Tomorrow's world, today

Centres of excellence working round the clock in the UK have created a revolutionary fast-track approach to drug trials and therapies

By Nina Lakhani
Sunday 23 October 2011 03:16

Scores of life-saving treatments for cancer patients are being developed through a unique network of hi-tech centres making Britain a world leader in the fight against the condition.

Cancer specialists have made giant leaps in the understanding of, for example, adult leukaemia, bowel cancer and follicular lymphoma since NHS hospitals and university scientists were brought together in 19 Experimental Cancer Medicine Centres (ECMCs) across the UK.

Many lives have already been saved by the centres, which test new experimental drugs and therapies on terminally ill patients as soon as they have been declared safe within their own laboratories.

Doctors, nurses, scientists and patients are unanimous in their praise for the £35m five-year project that has accelerated the development of new therapies for patients who cannot be helped by existing treatments.

Seven of the ECMCs, jointly funded until 2011 by Cancer Research UK (CRUK) and the four Departments of Health of England, Scotland, Wales and Northern Ireland, will present exciting new research at the National Cancer Research Institute conference on Tuesday.

Dr Sally Burtles, director of drug development at CRUK, said: "These 19 centres have brought together the best people from the NHS and our universities. Improving the infrastructure by bringing in more nurses, lab technicians and data managers has increased the number of patients entering experimental trials and allowed us to develop more biomarker tests and clever imaging techniques by reducing the bottlenecks. These are all parts of the personalised medicine jigsaw; the future in cancer. Within 10-20 years we will each have a card with a chip that contains our genetic code, telling doctors which combination of treatments each person will respond to. This genetic card is definitely coming, and the UK is now a big player with a great reputation in this work."

Making the leap from something that seems promising in the lab to the first trials in patients is the most challenging, time-consuming and expensive step in drug development; for every new drug, there are many that never make it. These phase 1 trials usually recruit healthy people, but the ECMCs tend to test experimental treatments on sick cancer patients for whom there are no other options.

Having more staff means each centre can carry out far more trials, on more patients, at any one time. This helps filter out ineffective drugs more quickly, saving millions of pounds in the long term.

Drug companies and scientists from around the world are thus increasingly looking to Britain for help in testing promising new agents they have developed in the lab. Safe and effective ones are then fast-tracked to larger phase 2 trials, speeding up the whole process of drug development.

Cardiff ECMC has developed a new trial design which can rapidly test the effectiveness of promising new drugs for acute myeloid leukaemia (AML) – a cancer that affects 2,000-3,000 adults every year. The "pick a winner, dump a loser" system means a new drug combination can be introduced in patients within two to three months of successful lab tests; if it doesn't work, it can be quickly replaced.

Elderly patients have the worst outcomes for AML because their frailty means they are often excluded from existing chemotherapy treatments. The Cardiff studies are the first in the world to include elderly patients for whom there is currently no other treatment. As a result, there are patients given months to live who have been in remission for more than a year.

Professor Alan Burnett from Cardiff University said: "There has been no 'eureka' moment yet, but we are looking at new agents much more quickly, which helps drive costs down. "

The Leicester ECMC is the largest centre for cancer prevention in Europe. Scientists focus on trying to discover and develop naturally occurring chemicals in food that delay or prevent the onset of certain cancers. Active ingredients in curry, linked to the delay of bowel cancer, and red wine, linked to skin cancer, have been extracted and developed into capsules, ready for testing in humans.

According to Will Steward, professor of oncology at Leicester University, research into prevention is not considered as "sexy" as the search for a wonder drug, but the ECMC money has enabled them to make huge breakthroughs that could revolutionise cancer prevention in the next few years.

As well as drug development, the 19 centres are also driving progress in the discovery of biomarkers. Measured in blood or tissue, disease-related biomarkers give an indication of whether there is a threat or risk of disease. For example, mutation of the genes BRCA1 and BRCA2 significantly increase the likelihood of a person developing breast, ovarian or prostate cancer.

In contrast, drug-related biomarkers indicate whether a drug will be effective in a specific patient. There is already a genetic test for breast cancer patients, which predicts the likely benefit of the drug Tamoxifen.

Research at the ECMCs will help this kind of test become the norm for many more cancers over the next few years, saving lives and potentially millions of pounds. A genetic card will be in all our wallets soon.

The doctor

Dr Udai Banerji is a senior lecturer in medical oncology at the Royal Marsden Hospital in London

"We have 30 phase 1 trials at any one time, with patients in London, New York and Amsterdam; this is truly the cutting edge. Every year we get referred 500 patients who have exhausted all other options. Nearly 300 are given experimental treatments; some have survived on trials for two or three years now. We are currently working on several inhibitors that target gene mutations important in the cancer pathway; a scientist's dream."

The nurse

Chloe Cowan is a senior nurse at the Glasgow ECMC and manages a team of seven research nurses

"Nurses are crucial to the functioning of trials which are getting more complex. Early-phase trials require a lot of 1:1 nursing as they usually involve patients with advanced disease. They monitor patients, but also collect and process samples for the lab. We are important in recruiting patients, making sure they understand how the trial may or may not help them. A more intelligent use of new drugs means we see far more patients getting better."

The patient

Joanna Leach, 72, from Devon, was diagnosed with an aggressive form of ovarian cancer in 2002. The cancer returned four times and chemo finally sent her body into anaphylactic shock. There were no more options. But doctors at the Royal Marsden discovered she has the faulty BRCA2 gene, and in October 2007 she started on the experimental drug Olaparib

"Instead of exhausting chemo, I now take four capsules, twice a day. The side-effects are nil. My daughter, about to have a mastectomy, also has the faulty gene; I hope she qualifies for the trial soon."

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