ADVANCE
The magazine for the UK’s only Biomedical Research Centre dedicated to cancer
Spring/Summer 2019
In our genes How Professor Ros Eeles’ work could change the way we diagnose prostate cancer
On target
Joint enterprise
Pioneering trial
Early diagnosis
Improving the precision of radiotherapy
Teaming up to enhance sarcoma research
First patients receive CAR-T cell therapy
Why it’s the key to successful cancer treatment
Contents 04 Forefront The latest research news 07 The sooner, the better Dr Richard Lee explains why earlier diagnosis is crucial
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.
08 To be precise Three ways we’re enhancing radiotherapy treatment 11 Q&A Professor Ros Eeles on genetic testing for prostate cancer risk 12 Teaming up against sarcoma How our new joint centre will boost sarcoma research
This is our ‘bench to bedside’ approach.
14 Researchers of the future Our PhD studentship programme begins 15 Profile Dr Katharina von Loga, Consultant Molecular Pathologist
Editorial advisory board Professor David Cunningham Director of the NIHR BRC
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.
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
The Biomedical Research Centre is a partnership between The Royal Marsden NHS Foundation Trust 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
Welcome to the latest edition of Advance, which highlights the worldleading 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 focus on the recent advances we have made in radiotherapy, culminating in the transformative technology of the MR Linac. The Royal Marsden and The Institute of Cancer Research (ICR) are leaders in the development of new radiotherapy techniques that both improve the precision of treatment and reduce side effects. We also look at our work in early diagnosis, which is central to treating more cancers successfully and giving patients a much better chance of survival. And we highlight our exciting new trial in the emerging area of cellular therapy, in which The Royal Marsden has begun treating lymphoma patients using CAR-T cells. I hope you enjoy reading this issue of Advance.
Richard Hoey Director of Communications, the ICR Published in partnership with Sunday: wearesunday.com
Cover photograph: Professor Ros Eeles, Professor of Oncogenetics at the ICR and Consultant in Clinical Oncology and Oncogenetics at The Royal Marsden © The Royal Marsden 2019. 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.
Professor David Cunningham Director of the NIHR BRC at The Royal Marsden and the ICR and Consultant Medical Oncologist CANCERBRC.ORG 3
FOREFRONT
IMRT reduces side effects in breast cancer patients
Dr Emma Nicholson, Consultant Haematologist
being returned to The Royal Marsden for reinfusion. These CAR-T cells target the surface antigen CD19, which is expressed on the surface of lymphoma cells. Following the infusion of CAR-T cells into the patient’s blood, the novel antigen receptor allows them to directly bind to CD19, triggering T cells to kill the lymphoma cells.
A Phase III trial at The Royal Marsden, ZUMA-7, is comparing CAR-T cell therapy
Patients begin CAR-T cell treatment in pioneering trial The Royal Marsden has been approved by NHS England to deliver a new type of immunotherapy for patients with relapsed or refractory diffuse large B-cell lymphoma. Chimeric antigen receptor T cell (CAR-T cell) therapy uses the patient’s own immune system to fight cancer. It involves 4 ADVANCE
T cells are modified to enhance their ability to target and kill cancer
collecting patients’ own T cells, genetically modifying them to express a novel antigen receptor to enhance their ability to target and kill cancer cells, and then reinfusing them into the patient. The T cells are transferred to a manufacturing centre in the USA where they undergo genetic modification, before
with the current standard of care in patients with diffuse large B-cell lymphoma that has relapsed or has been resistant to treatment. Thomas Romain, 27, was randomised to the CAR-T cell arm of the ZUMA-7 trial after his non-Hodgkin lymphoma became resistant to standard first-line chemotherapy. He said: “When I found out that not only was I eligible for this trial but it may also give me the chance to go into remission, I knew I had to give it a go.” Dr Emma Nicholson, Consultant Haematologist at The Royal Marsden, said: “CAR-T cell therapy has shown effectiveness in patients with multiply relapsed diffuse large B-cell lymphoma, who are resistant to standard chemotherapy and have limited curative options.” The Royal Marsden will be expanding the use of T cell therapies for patients with solid tumours later this year, with trials opening in renal carcinoma and melanoma.
Targeted or reduced doses of radiotherapy after surgery can significantly reduce side effects for women with breast cancer, a clinical trial has shown. The Phase III IMPORT LOW trial – led by researchers at the ICR, The Royal Marsden and the University of Cambridge – is changing clinical practice after finding that modified radiotherapy regimes were as effective as higher doses to the whole breast. During the trial, women received intensity-modulated radiotherapy (IMRT) – a technique pioneered by the ICR and The Royal Marsden, which shapes radiotherapy to the tumour. Compared with directing a high dose of radiation to the whole
Women with breast cancer benefit from fewer side effects following IMRT
breast, targeting IMRT to part of the breast reduced the incidence of side effects by 23 per cent. The trial showed that some patients are more likely than others to experience side effects, including younger women, women with larger breasts, or women who were feeling anxious before beginning treatment. Women at higher risk could be offered extra support, monitoring or alternative treatment options, helping doctors to personalise patient therapy. The study was published in the Journal of Clinical Oncology and funded by Cancer Research UK. Further reading doi.org/10.1200/JCO.18.00982
23% reduction in side effects for breast cancer patients who received IMRT compared with those who had high-dose radiotherapy
New ‘Trojan horse’ drug treatment shows promise A new type of drug that acts like a ‘Trojan horse’ has shown early promise in patients with six different cancer types. A team at the ICR and The Royal Marsden led a global clinical trial of the drug in 147 patients with solid tumours that had stopped responding to standard treatments. The innovative drug, called tisotumab vedotin, releases a toxic substance to kill cancer cells from within. Over a quarter of patients with advanced, drug-resistant cervical and bladder tumours, and nearly 15 per cent with ovarian and lung tumours, responded to the new treatment, with tumours either shrinking or stopping growing. The results were so positive that the drug is now being trialled in other cancer types, as well as in a larger trial for cervical cancer. The study was published in The Lancet Oncology and funded by Genmab and Seattle Genetics. Further reading doi.org/10.1016/ S1470-2045(18)30859-3
CANCERBRC.ORG 5
FOREFRONT
Trial improves treatment for rare type of cancer A new approach to treating advanced anal cancer is safer and more effective than the current treatment, according to the first-ever randomised clinical trial in this group of patients, led by The Royal Marsden. Each year in the UK, about 1,300 people are diagnosed with anal cancer – a number that is rising by around three per cent annually – and around 30 per cent of those will develop advanced disease that cannot be treated surgically. Due to small patient populations, there is very limited evidence to guide treatment decisions, and international consensus among clinicians is lacking. The findings from the InterAACT study, which were presented at the European Society for Medical Oncology Congress in October,
12.3 Cisplatin and 5-fluorouracil
20 Carboplatin and paclitaxel
Overall median survival in months for patients with advanced anal cancer
Consultant Medical Oncologist Dr Sheela Rao led the study
showed that a combination of the chemotherapy drugs carboplatin and paclitaxel is a better option than the current standard. Study leader Dr Sheela Rao, Consultant Medical Oncologist, said: “We now know that carboplatin and paclitaxel is more effective and better tolerated than cisplatin and 5-fluorouracil. In our study, these patients lived seven months longer overall.
“This study shows the benefit of international collaboration within the International Rare Cancer Initiative, and provides the backbone for future trials into novel treatments for advanced anal cancer, including immunotherapy.” Further reading doi.org/10.1093/annonc/ mdy424.022
Prestigious award for radiographer Dr Helen McNair, Lead Research Radiographer at The Royal Marsden and the ICR, has been named as UK and London Radiographer of the Year by the Society and College of Radiographers. Dr McNair, who recently received a Health Education England/National Institute for Health Research Senior Clinical Lectureship grant, said: 6 ADVANCE
“It’s both a privilege and humbling to represent radiographers in this way. I feel very proud that my colleagues went to the effort to nominate me. “Making real-time adaptive radiotherapy possible with the MR Linac and developing the skills and knowledge our radiographers require to deliver research is really exciting.”
EXPERT VOICE
New gene test may predict cancer relapse A new test could improve care for patients with stomach or oesophageal cancer by predicting the likelihood of relapse after surgery and chemotherapy. In the MAGIC trial, a team at the ICR and The Royal Marsden linked seven genes to survival outcomes for patients with these cancers, including whether they were likely to relapse after treatment. The researchers looked at these genes in tests of patients who had undergone both chemotherapy and surgery. Patients who tested as being at low risk of relapse lived twice as long as those judged at high risk. Doctors could use the genetic test to select high-risk patients for clinical trials of new treatments, or to use less-intensive treatment after chemotherapy and surgery for those at lower risk. The study was funded by the ICR and was published in the journal Annals of Oncology. Further reading doi.org/10.1093/annonc/ mdy407
The sooner, the better Discovering cancers earlier is the key to treating patients successfully, says Dr Richard Lee, Consultant in Early Diagnosis at The Royal Marsden
We know that by diagnosing more cancers early, we could save thousands of lives every year. When cancer is caught sooner, we have a much greater chance of being able to treat it successfully, often with less-invasive procedures and fewer long-term side effects. It’s not just detecting the cancer that’s important. At this stage, if we can accurately identify the genetic make-up of an individual’s tumour, we can start moving to the most effective treatment personalised for that patient. We also monitor patients for signs of relapse; the earlier we can pick up cancer returning, the better our chances of managing it successfully.
But we are faced with challenges. Some cancers – such as pancreatic, ovarian and lung cancers – don’t cause any symptoms until they become advanced. People can also be too embarrassed to talk about their symptoms, or too scared of what they might find. Equally, many cancers cause vague symptoms that are more likely to be something less serious, so it can be difficult for GPs to know when to refer patients to us. That’s why I joined The Royal Marsden, in a role funded by The Royal Marsden Cancer Charity, in 2018. I’m a champion of the early diagnosis of cancer, working across all tumour types and investigating how we can improve clinical practice and research in this field. We’re working on a range of initiatives to help. For example, with RM Partners, the West London Cancer Alliance, we’re carrying out ‘lung health checks’ and low-dose CT scans for people at risk of lung cancer. Another project – the awardwinning RAPID (Rapid Assessment Prostate Imaging and Diagnosis) pathway – aims to detect prostate cancer faster. We’ve also developed a new streamlined journey from GP to treatment for patients with symptoms of colorectal cancer, and are promoting a telephone reminder service to encourage participation in the national bowel screening programme. It’s important that we engage with our GP colleagues, supporting them to spot the signs of cancer through our education events and online learning resources. With our colleagues at Imperial College Healthcare NHS Trust, we are exploring how breath tests could be used to diagnose certain
cancers, such as those that affect the stomach and oesophagus. This method focuses on chemical changes in the breath caused by bacteria in the gut and linked to the presence of cancer in the body. If our research has positive results, we could diagnose some cancer types early through this quick and non-invasive method. With our combined expertise in research, diagnosis and treatment, we aim to make a difference to people’s lives across London and the UK, ensuring that no-one gets left behind.
“We are exploring how breath tests could help to diagnose some cancers”
CANCERBRC.ORG 7 CANCERBRC.ORG 07
R ADIOTHER APY
To be precise The ICR and The Royal Marsden are pioneers in developing new radiotherapy techniques. Recently, we have made great strides in enhancing the imaging of tumours to deliver more targeted radiation. We look at three strands of research that aim to provide more accurate and kinder treatment for patients
Enhanced imaging for targeting cervical cancer Expanding the use of the MR Linac Six months after prostate cancer patient Barry Dolling became the first person in the UK to be treated on the MR Linac, we are now using this pioneering radiotherapy machine to treat a second tumour type. The PERMIT study is evaluating the benefits of using the MR Linac rather than conventional radiotherapy for localised rectal cancer. The MR Linac combines two technologies – an MR scanner and a linear accelerator – to precisely locate tumours, tailor the shape of X-ray beams in real time and accurately deliver radiation to moving tumours. The locations of tumours and organs can change over time. For example, a tumour in the lung will move up and down as a person breathes, while a tumour in the prostate or rectum may move from day to day, depending on what the patient has eaten or how full their bladder is. Professor Robert Huddart, Consultant Clinical Oncologist 8 ADVANCE
at The Royal Marsden and Reader at the ICR, who is the Principal Investigator of the PERMIT study, says: “We know rectal cancer responds to high-dose radiation but is hard to focus treatment on. It is difficult to see using standard imaging techniques, and moves and changes shape day to day.
“The groundbreaking precision of the MR Linac will allow us to adapt the treatment each day to better target the rectum so we can safely deliver higher doses of radiation. We hope this will improve the effectiveness of treatment with fewer side effects.”
Above: Dr Susan Lalondrelle, Consultant Clinical Oncologist (left), in conversation. Left: Professor Robert Huddart, Principal Investigator on the PERMIT trial, with the MR Linac
Using a combination of imaging techniques while treating gynaecological tumours has been the focus of recent research at The Royal Marsden and the ICR. A multidisciplinary team explored the benefits of combining ultrasound and cone-beam computed tomography (CBCT) – an imaging technique used just before treatment in which the X-rays form a cone shape – in order to target the uterus and cervix with image-guided radiotherapy (IGRT). Experts – including Dr Emma Harris, Imaging for Radiotherapy Adaptation Team Leader at the ICR, and Consultant Clinical Oncologist Dr Susan Lalondrelle and Lead Research Radiographer Dr Helen McNair of The Royal Marsden and the ICR – compared images from patients using ultrasound and CBCT with those using ultrasound or CBCT alone. The results will be published in the International Journal of Radiation Oncology, Biology, Physics. Gynaecological cancer patients are normally asked to have a full bladder when having radiotherapy
to maintain a consistent target position and reduce the dose to the bowel and bladder. However, patients’ bladders can’t always fill the same way each day. “In a patient having standard treatment for cervical cancer in around 25 daily sessions, we would expect the cervix and the uterus to be in a different position each day,” says Dr Harris. “We wanted to see if ultrasound and CBCT would give enhanced images of the uterus and surrounding soft tissue, allowing us to target the radiation more accurately to minimise damage to healthy tissue. Using ultrasound and CBCT together gave users more confidence about the location of the target.” Dr Lalondrelle says: “The next step is to bring these exciting technologies together into everyday practice. We will shortly start recruitment on a new clinical trial that further evaluates the real benefit to patients.” Further reading doi.org/10.1093/annonc/mdy245 CANCERBRC.ORG 9
R ADIOTHER APY
Establishing the safety of SBRT Stereotactic body radiotherapy (SBRT) delivered over a shorter period is as safe as conventionally fractionated radiotherapy in men with low- or intermediate-risk localised prostate cancer, early findings from the international randomised PACE trial show. Principal Investigator Dr Nicholas van As, Medical Director at The Royal Marsden and a Reader at the ICR, presented research from the PACE B arm of the trial at the Genitourinary Cancers Symposium, held in San Francisco in February. The trial compared patients who received five sessions, or fractions, of SBRT with those who received standard radiotherapy in either 20 or 39 fractions. SBRT treatment resulted in acute genitourinary toxicity rates of 22 per cent, while conventional radiotherapy resulted in rates of 27 per cent. According to Dr van As, these were “very acceptable rates of acute toxicity – lower than we expected – and importantly, [there was] no statistical difference between the SBRT arm and the conventionally fractionated arm”. PACE B is now closed for recruitment, but PACE A remains open. In this arm, patients who are candidates for surgery will either have a prostatectomy or receive prostate SBRT delivered in five fractions. Meanwhile, PACE C is due to open to intermediate- or high-risk patients who refuse surgery or are not suitable for it. These patients will receive either 20 fractions of conventional radiotherapy or prostate SBRT in five fractions. “There has been considerable discussion and analysis of the risks versus the benefits of different radiation treatment techniques, especially in patients with low- or intermediate-risk 10 ADVANCE
Dr Nicholas van As in the CyberKnife suite
prostate cancer – in large part because the side effects of treatment can affect quality of life,” says Dr van As. “One of the clinical trial’s goals was to find whether SBRT or a more conventionally fractionated radiotherapy schedule would provide a safer treatment choice. These early trial results are
promising and help us to better understand the effect of different radiation therapy techniques on the treatment of prostate cancer. We look forward to analysing additional trial data.” Further reading ascopubs.org/doi/abs/10.1200/ JCO.2019.37.7_suppl.1
Q&A
“We know of more than 150 common genetic changes that, when inherited, can increase a man’s risk of prostate cancer”
Q&A
Professor Ros Eeles The Professor of Oncogenetics at the ICR and Consultant in Clinical Oncology and Oncogenetics at The Royal Marsden explains how a genetic test could spot men at risk of developing prostate cancer
What is oncogenetics? Broadly speaking, oncogenetics is the study of genetic variants that may increase a person’s risk of cancer or have implications for cancer treatment. For example, people who carry mutations to their DNA repair genes may have a higher risk of developing cancer and may respond to certain targeted agents. In my team, we’re particularly interested in looking for DNA changes that affect a man’s predisposition to prostate cancer.
We’re also working to take these findings into the clinic, by applying cancer genetics to the way we manage the disease.
How can genetics affect a person’s risk of prostate cancer? That’s what we’re trying to find out. More than 47,000 men are diagnosed with prostate cancer in the UK every year, making it the most common male cancer. But there isn’t one ‘prostate cancer gene’ that tells us
whether a man will or won’t develop the disease. We do know of more than 150 common genetic changes that, when inherited, can increase a man’s risk of prostate cancer. Each of these common individual genetic variants only increases a man’s risk slightly, but inheriting many can raise this risk substantially.
What is the OncoArray? The OncoArray is a test that can look at more than half a million single-letter changes in DNA. We used it to compare the DNA of nearly 80,000 men with prostate cancer and more than 61,000 men without it, and found 63 new variants in DNA that increase a man’s risk of developing the disease. According to our findings, a man in the top one per cent of risk is almost six times more likely to develop prostate cancer than the average. That’s a one-in-two chance compared with the average of about one in 11 by the age of 80.
How could your work lead to better outcomes for patients? Based on the results from our OncoArray work, we have uncovered vital new information about the genetic factors that can predispose someone to prostate cancer. We are now conducting a small study in GP practices to establish whether genetic testing using a saliva sample can identify men at the highest risk of developing prostate cancer. We’ve already taken samples from 300 men, and we will ask those identified as being at high risk to come back in for further testing. If this pilot study shows that this spit test can pick out men who either have, or will go on to develop, prostate cancer, it could change the way we diagnose the disease. We could use that information to develop a monitoring programme to catch the disease early – or even prevent it altogether. CANCERBRC.ORG 11
SARCOMA
Sarcomas in numbers
Teaming up against sarcoma
1% of all cancer cases are sarcomas
80+ different subtypes of sarcoma
The ICR and The Royal Marsden have together launched a new centre for sarcoma research, which aims to make practice-changing discoveries that improve the lives of patients with these rare cancers
Sarcomas – a group of rare cancers that can affect any part of the body – are diseases of unmet need. Compared with other cancer types, a high proportion of patients with sarcomas are children and young people, and survival rates have improved little despite decades of research. Aiming to improve outcomes for these patients, the ICR and The Royal Marsden have begun a new partnership that will pool their strengths in sarcoma research. Co-directed by Professor Janet Shipley, Head of the ICR’s Division of Molecular Pathology, and Dr Robin Jones, Head of The Royal Marsden’s Sarcoma Unit and Reader in Sarcoma Clinical Trials at the ICR, the new Joint Sarcoma Research Centre brings together all sarcoma-related research across the two organisations. The centre will feature 13 investigators from four ICR divisions and two clinical units at The Royal Marsden, working 12 ADVANCE
together in an integrated and collaborative manner. The vision is to make game-changing discoveries that will result in more sarcoma patients surviving their disease. Professor Shipley says: “There is a breadth of clinical, translational and preclinical sarcoma research currently being undertaken across the ICR and The Royal Marsden, but there remains untapped potential for a more integrated and closer partnership between the two organisations. “With this new joint centre, we hope to propel our sarcoma research to the next level, with the ultimate goal of delivering practice-changing discoveries for patient benefit.”
Co-ordinated strategy Both the ICR and The Royal Marsden already have significant strengths in sarcoma research and treatment. For example, The Royal Marsden’s Sarcoma
Unit is one of the largest in Europe, treating about 20 per cent of the UK’s patient referrals every year. The unit is linked to one of the largest sarcoma tissue archives in the world, making it a rich resource for researchers. Several teams at the ICR conduct research to understand the genetics and biology of sarcoma. The two organisations carry out clinical trials across adult and paediatric sarcoma patients and already collaborate in several areas of study. However, bringing this work together into one virtual centre will help to ensure a more unified research strategy and promote multidisciplinary-team science. “This is a key research centre in the UK dedicated to the study of sarcomas,” says Dr Jones. “It will promote synergistic collaboration between the clinical research expertise at The Royal Marsden and the breadth of translational and biological research at the ICR.
55% of sarcoma patients will survive for five years
13 investigators from four ICR divisions and two Royal Marsden clinical units will collaborate in the new Joint Sarcoma Research Centre
“This will overcome some of the longstanding barriers hindering progress in the understanding of the biology of these rare cancers and translating findings to patients.”
The next generation The new centre will also make it easier to train a new generation of clinicians and scientists who are skilled in translational sarcoma research. This is
vital if we are to make and maintain progress in improving treatments for patients. Dr Paul Huang, Team Leader in the Division of Molecular Pathology and Deputy Director of the new centre, says: “Fostering a framework for training in stratified medicine and personalised therapy in sarcoma patients, the Joint Sarcoma Research Centre will seek to nurture multidisciplinary
researchers who are dedicated to the study of these rare cancers. “It also presents an opportunity to galvanise the sarcoma research across both organisations, catalysing the next stage of growth to bring about change in improving patient outcomes.” Further reading Learn about our work in uncommon cancers at cancerbrc.org/ our-research/uncommon-cancers
20 % of UK sarcoma patient referrals are treated at The Royal Marsden every year
Co-directors of the Joint Sarcoma Research Centre Professor Janet Shipley (top) and Dr Robin Jones (above) CANCERBRC.ORG 13
PHD STUDENTSHIPS
These PhD studentships will enhance our research capacity in key areas
Reda Stankunaite, one of the first three candidates on the studentship programme
Researchers of the future The first of up to 15 non-clinical translational PhD studentships supported by our NIHR BRC are now under way A priority for the BRC is improving our research capacity by developing and supporting the inter-disciplinary teams working across The Royal Marsden and the ICR. To address this, we have set up a programme to award up to 15 non-clinical translational PhD studentships over five years. These studentships will enhance our capacity in areas such as immuno-oncology, molecular diagnostics, imaging and physics, artificial intelligence and cancer genetics. Each PhD 14 ADVANCE
project will focus on improving patient outcomes and experience, and will be supervised by a clinician and a research scientist. The first three candidates – Nithya Paranthaman, Reda Stankunaite and Alice Newey – started in October last year. Their theses are expected to be submitted in September 2022. Nithya’s studentship focuses on improving the way multiple myeloma patients are monitored. Supervised by Professor Mitch Dowsett and Dr Martin Kaiser
of the ICR and The Royal Marsden, she will investigate whether dried blood spots can be used to measure the levels of key indicating factors such as heavy/light chains, calcium and C-reactive protein. These blood spots can be supplied remotely, meaning that multiple myeloma patients can avoid frequent trips to the clinic to give samples. Working with Dr Michael Hubank of the ICR and The Royal Marsden, and Dr Andrea
Sottoriva and Professor Louis Chesler of the ICR, Reda is developing a blood test to identify genetic mutations present in paediatric brain cancers and other solid tumours in children. This ‘liquid biopsy’ would detect tumour DNA circulating in the bloodstream and detect mutations that indicate drug resistance at an early stage. There are limited chances to monitor genetic changes and adapt treatment in young patients, because invasive tumour biopsies can be dangerous for them. Reda’s project aims to provide clinicians with a safer, easier method to better understand an individual patient’s tumour and their treatment needs. Under the supervision of the ICR’s Dr Marco Gerlinger, Alice is using patient-derived spheroids – multicellular tumourlike structures – to look at how cancer cells can evade the immune system and evolve to resist treatment with immunotherapies. She will also study the molecular ‘flags’ on cancer cells, to predict patients’ response to treatments and look at ways to make tumours more susceptible to immune attacks.
PROFILE
Dr Katharina von Loga Consultant Molecular Pathologist at The Royal Marsden
“We need to better understand how cancer cells ‘hide’ from the immune system”
Originally, Dr Katharina von Loga trained as a surgeon. But a desire to know more about how and why cancers spread through the body led her to specialise in pathology. After training in general pathology and histopathology, Dr von Loga moved into translational research. She wanted to deepen her knowledge about how cancer works at a molecular level and to develop the tests that could make the difference to new treatments. “You can see how cancer grows – although it’s static under the microscope, it feels like you can watch the cell spreading and multiplying,” she says. “Although no longer having direct patient contact was difficult, the knowledge that
pathology is vital to a patient’s treatment means you are still very closely involved in their care as a pathologist.” After training in Hamburg, Germany, Dr von Loga came to the ICR as a Clinical Research Fellow in February 2016, working in Dr Marco Gerlinger’s laboratory. In March 2018, she was appointed as a Consultant Molecular Pathologist at The Royal Marsden. As the use of immunotherapy in cancer treatment increases, Dr von Loga’s research looks at methods to monitor the immune system within the cancer. “We need to better understand how the immune system interacts with cancer and how cancer cells ‘hide’ from it,” she says. “It’s still early days for immunotherapy and we only understand a small part of how it works. My work is looking at what we can do to understand it better and identify why it works for some molecular settings and some tumour types, but not for others.” Dr von Loga is involved in two clinical trials, both in gastro-oesophageal cancer. The first compares patients who received standard chemotherapy alone or in combination with immunotherapy, and how the immune system affects the different outcomes. “While my current focus is on gastrointestinal cancers, the methods I’m working on aren’t limited to a specific tumour type,” she says. “My long-term goal is to support multiple trials across multiple tumour types and really understand the impact of the immune system on cancer, so more patients can benefit.”
CV 2008 Graduates in medicine from the University of Freiburg, Germany 2015 Completes specialist training in histopathology at University Medical Center HamburgEppendorf 2015 Appointed as a Consultant Histopathologist at University Medical Center HamburgEppendorf 2016 Appointed as a Clinical Research Fellow at the ICR 2018 Joins The Royal Marsden as Consultant Molecular Pathologist
CANCERBRC.ORG 15
Patient, Carer, Family and Friends event
Pioneering treatment: What does the future hold for gynaecological cancers and sarcoma? An evening of the latest clinical research innovations and what they mean for cancer care and treatment
Date Tuesday 8 October 2019 Time 16.00–19.45 Location The Royal Marsden Education and Conference Centre, Stewart’s Grove, London SW3 6JJ
Join us at our open evening to: • meet our world-leading clinicians and researchers • learn about gynaecological cancers and sarcoma, and your health and care • discover new treatments and technology being developed • ask your questions, share your thoughts and shape future research
To attend, you must register and receive confirmation. Places are limited, so please sign up early. For more information and to register, please get in touch: Online cancerbrc.org/gynae-and-sarcoma Telephone Lisa Leavey on 020 3186 5408 or Suzan Evans on 020 3186 5409 Email cancerbrc@rmh.nhs.uk