Private Care AUTUMN/WINTER 2021
AIMING FOR EXCELLENCE Our Urology Unit goes from strength to strength under Mr Declan Cahill How we’re leading research into cellular therapies
AUTUMN/WINTER 2021
AWARD-WINNING CARE
THE FACTS
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times winning Best Hospital award in the past four years
WELCOME As the Managing Director of Private Care at The Royal Marsden, I’m pleased to introduce the latest issue of Private Care magazine. In this issue, we explore how The Royal Marsden is treating more patients using innovative cellular therapy techniques, which involves reprogramming the patient’s own immune cells to target the cancer. We highlight the different types of cellular therapies we offer, including CAR-T cell therapy. We also look at research presented at this year’s American Society of Clinical Oncology Annual Meeting in June, including breakthroughs in colorectal immunotherapy and what could be the first-ever targeted treatment for brain cancer. The front cover of this issue features Consultant Urological Surgeon Mr Declan Cahill, a UK expert in robotic prostatectomies now with clinics at Cavendish Square, our new Private Care diagnostic and treatment facility in central London. He describes how robotic surgery has improved outcomes for prostate cancer patients and the importance of his team’s multidisciplinary team ethos. I hope you enjoy this issue. Shams Maladwala Managing Director of Private Care ON THE COVER Mr Declan Cahill, Consultant Urological Surgeon and Head of the Urology Unit
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joint awards with Cromwell Hospital on RM Cancer Surgical Hub at the LaingBuisson Awards 2020
66
Royal Marsden surgeons involved in the RM Cancer Surgical Hub
436
award applications submitted in 2020
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leading COVID-19 research studies launched by The Royal Marsden and ICR were submitted in our award entry
FIND OUT MORE
For referrals and enquiries, call +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk Some of the photographs in this issue were taken prior to the COVID-19 pandemic and may not reflect current social distancing and PPE guidelines
U P DAT E
DOUBLE AWARD SUCCESS FOR PRIVATE CARE THE ROYAL MARSDEN Private Care won two prizes at the 2020 LaingBuisson Awards, which were held virtually in April. The Royal Marsden was awarded the Private Public Partnership award jointly with Cromwell Hospital for the Cancer Surgical Hub, which, thanks to the leadership and innovation of our staff, ringfenced COVID-protected
hospitals for the safe surgical treatment of vulnerable cancer patients during the pandemic. We were also awarded Best Hospital for the third time in four years. The Royal Marsden sees and treats more than 60,000 patients each year – including more private cancer patients than any other UK centre – and has an international reputation for
AWARDWINNING The Cancer Surgical Hub
pioneering the latest treatments. Shams Maladwala, Managing Director of Private Care, said: “These prestigious awards are a testament to our dedicated teams who have gone above and beyond throughout the pandemic, ensuring the continuation of care for thousands of cancer patients as well as contributing to national and global cancer research.”
TALKING POINTS “We'll soon be trialling CAR-T therapy in patients with plasma cell myeloma who aren’t able to have stem cell transplants” Page 7
“Our findings could be a key step in the development of the world’s first targeted brain cancer treatment” Page 10
“Patients who are properly prehabilitated can take a more active lead in their rehabilitation”
“Robotic surgery has allowed us to deliver improved care for prostate cancer patients” Page 15
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For referrals and enquiries, call +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk
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IN BRIEF One year of CyberKnife We recently celebrated the first anniversary of our second CyberKnife in Sutton. In the past year, more than 250 courses of radiotherapy have been delivered to over 200 patients across tumour types including brain and prostate cancer. The Royal Marsden is the only hospital in the UK to have this model of CyberKnife, which benefits from a multileaf collimator.
A NEW HOPE Researchers are aiming to make immunotherapy work for brain cancers
Epic transformation
As part of The Royal Marsden’s Digital Transformation Programme, we plan to work in partnership with Great Ormond Street Hospital to develop a new Digital Health Record to replace our current Electronic Patient Record system. The new Epic system will go live across the Trust in March 2023. The collaboration will mean shared expertise and reduced costs, as well as added patient and staff benefits.
Academic accolades Three Royal Marsden members of staff have been awarded personal Chairs by The Institute of Cancer Research. Congratulations to Dr Nick van As, Medical Director and Consultant Clinical Oncologist; Dr Ian Chau, Consultant Medical Oncologist; and Dr Michael Hubank, Head of Clinical Genomics, on being awarded the title of Professor.
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BRAIN CANCER BREAKTHROUGH COMBINING IMMUNOTHERAPY WITH an experimental cancer drug could offer a new way of treating some patients with aggressive brain cancers, according to early results from the Phase 1 Ice-CAP trial, led by researchers from The Institute of Cancer Research, London, and The Royal Marsden. Two of the first 10 patients treated for glioblastoma on the trial responded to the immunotherapy drug atezolizumab in combination with ipatasertib, a new precision drug. It was particularly effective for patients with defects in the PTEN gene.
Study leader Dr Juanita Lopez, Consultant Medical Oncologist, said: “Until now, immunotherapy has not worked for brain cancer. But by uncloaking the disease using ipatasertib, we could make some brain cancers vulnerable to atezolizumab.” Hamish Mykura, 59, was diagnosed with glioblastoma in August 2018 and joined the trial after chemotherapy and radiotherapy stopped working. Two years on, he has no visible cancer. He said: “The cutting-edge science that has informed my treatment and care is truly remarkable – it’s astonishing that I’m still here.”
U P DAT E
Patients to benefit from new pain relief system THE PAIN MANAGEMENT team has launched a new implantable drug infusion system to help patients control the pain that is commonly associated with cancer and improve their quality of life. The device consists of a small pump that is inserted under the patient’s skin to store pain relief medication and dispense it at regular intervals. Dr Matt Brown, Consultant in Pain Medicine, has led the development and implementation of this service, establishing The Royal Marsden as one of the lead UK centres for this type of pain management within the
OUR COMMITMENT TO OUR PATIENTS
newly established National Cancer Pain Network. He said: “This is all about improving patients’ quality of life and functional levels. By using this specialist pump, we can deliver medication directly into the patient’s spinal fluid, where the pain-nerve receptors are located. We can use smaller doses of targeted pain medications, often without the side effects experienced from taking stronger oral painkillers. “We now offer a pain treatment that was previously only available at leading cancer centres in Europe and North America.”
The Royal Marsden has developed a patient experience commitment with help from patients, carers, members of the public and staff. Patient experience refers to what the process of receiving care feels like for the patient, their family and carers. A positive patient experience is defined by the Department of Health as “getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way; having information to make choices, to feel confident and in control; being talked to and listened to as an equal; and being treated with honesty, respect and dignity”.
FIND OUT MORE
Read our patient experience commitment at royalmarsden.nhs.uk/ patient-experiencecommitment
EASING PAIN Dr Matt Brown has led the launch of the new service with international pain fellow Dr Saweda Cuthbert
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INFUSED WITH POTENTIAL Using the body’s immune cells to target cancer, cellular therapies are showing great promise – and The Royal Marsden is at the forefront CELLULAR THERAPIES ARE emerging forms of immunotherapy that harness the power of T cells – a key infection-fighting immune cell – to target both blood cancers and solid tumours. These complex therapies use a technique known as adoptive cell transfer, in which the patient’s own T cells are harvested to be grown or modified in a laboratory to boost their ability to attack cancer, before being given back to the patient. The Royal Marsden’s cellular therapy programme has grown significantly since we treated our first patient in 2019. We now offer chimeric antigen receptor T-cell (CAR-T) therapy, and are set to use tumour-infiltrating lymphocyte (TIL) therapy and T-cell receptor (TCR) therapy in clinical trials.
SUPPORTING PATIENTS Dee Moloney, Clinical Nurse Specialist
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CAR-T therapy In CAR-T therapy, T cells are isolated from the patient’s blood using an apheresis machine. They are modified so that they produce proteins called chimeric antigen receptors that allow them to recognise and lock onto cancer cells, and these CAR-T cells are then reinfused into the patient’s bloodstream. This promising treatment is approved for patients with relapsed diffuse large B-cell lymphoma and relapsed mantle-cell lymphoma (a rare type of non-Hodgkin lymphoma), as well as patients aged up to 26
CELLULAR THERAPIES
with relapsed B-cell acute lymphoblastic leukaemia. “The three available CAR-T products target the CD19 antigen biomarker,” says Dr Emma Nicholson, a Consultant Haematologist who leads on the development of cellular therapies for blood cancers in the Cancer Biotherapeutics Unit. “A clinical trial is due to open soon that will target a marker called BCMA and will recruit patients with plasma cell myeloma who aren’t able to have stem cell transplants.” Patient support Patients who undergo CAR-T therapy are supported by a multidisciplinary team of doctors, nurses, psychologists, allied health professionals, pharmacists, and specialists in critical care and palliative care. “Waiting up to a month for their personalised CAR-T product to be manufactured is a stressful time for patients and their families,” says Dee Moloney, a Clinical Nurse Specialist who focuses on cellular therapy treatments. “We offer bridging therapy – such as further chemotherapy, radiotherapy or steroids – as a means of keeping their disease under control until they can receive CAR-T therapy. We have an excellent team who monitor, treat and help patients recover after the infusion.” Solid tumours TIL therapy is being explored for use against solid tumours, with trials in advanced melanoma demonstrating promising results. Here, part of the
“Our team helps patients recover after the infusion”
EMERGING APPROACHES Dr Andrew Furness (above) and Dr Emma Nicholson (right) are leading research into cellular therapies
tumour is surgically removed in order to harvest T cells that are naturally capable of infiltrating the cancer. These are then activated and grown in large numbers before being reinfused into the patient. Dr Andrew Furness, a Consultant Medical Oncologist who is leading on cellular therapies in solid tumours for the Cancer Biotherapeutics Unit, says: “TIL therapy appears to offer the potential for durable control for a proportion of patients with advanced melanoma that is resistant to standard approaches. “We are now looking to extend this therapy to patients with other tumour types, including advanced lung and head and neck cancers, at an earlier stage in their treatment.” TCR therapy This year, led by Dr Furness, The Royal Marsden will open its first trial of TCR therapy for patients with a rare type of sarcoma. Like CAR-T therapy, TCR therapy involves modifying T cells with a receptor so they recognise specific targets in a tumour.
KEVIN MCNULTY Patient, 71 “I was diagnosed with stage 4 diffuse large B-cell lymphoma in 2019 and had been through two lots of chemotherapy when I was told it was not working. “I’d never heard of CAR-T cell therapy, but I had run out of options. I had my T cells taken from my blood in early May. I had some holding treatment to keep me going for the month while I waited for my cells to be modified and infused back into me. “I was in hospital in Chelsea for a month following the infusion – and for a few of those days, I was in the CCU. But on day 28, a scan showed I was clear of disease. I could not be more grateful.”
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PRESENTING PROGRESS We highlight the notable research breakthroughs showcased by our experts at the recent American Society of Clinical Oncology Annual Meeting
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ASCO
IN JUNE, EXPERTS from The Royal Marsden presented the results of their research to a global virtual audience at the American Society of Clinical Oncology (ASCO) Annual Meeting, the world’s largest cancer conference. With our researchers presenting across a range of topics and tumour groups, The Royal Marsden continues to hold an international reputation for revolutionising the way we provide cancer treatment and care. Breakthrough treatments for oesophageal cancer There was positive news on the benefits of two new immunotherapy treatment options that have shown significantly improved long-term survival rates for patients with advanced oesophageal cancer. Led by Consultant Medical Oncologist Dr Ian Chau, the global randomised Phase 3 CheckMate 648 study enrolled 970 patients with previously untreated, unresectable advanced, recurrent or metastatic oesophageal squamous-cell carcinoma. It found that patients who received immunotherapy treatment – either nivolumab and chemotherapy, or nivolumab with ipilimumab – survived longer overall than those who received chemotherapy alone. ENCOURAGING RESULTS Mr Aadil Khan’s review highlighted the benefits of vascularised lymph node transfer
“We’ve found new immunotherapy treatment options”
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EXTENDING LIVES Dr Juanita Lopez (left); Dr Ian Chau (below left)
that are often diagnosed when their disease has already spread. This could have a practice-changing impact for patients globally in the future.”
“After decades of little progress in using chemotherapy for oesophageal cancer, this study has found not one but two new treatment options using immunotherapy to extend life for these patients,” says Dr Chau. “The clinically meaningful improvements in survival of the two treatment regimens highlight immunotherapy’s impact on cancer care. This should bring new therapeutic options to a group of patients
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Early promise for targeted brain cancer drug Dr Juanita Lopez, Consultant Medical Oncologist, presented encouraging early results from the Phase 1 BAL101553 trial that could lead to the first-ever targeted brain cancer treatment. Results showed that two of the first 20 patients treated for glioblastoma, a highly aggressive type of brain cancer, responded to the targeted drug lisavanbulin. One patient’s tumour shrank by more than 90 per cent. “We are in a new era of personalised medicine, with markers in cancer cells offering vital clues to what treatment
could target an individual’s disease,” says Dr Lopez. “We believe that our findings could be a key step in the development of the world’s first targeted brain cancer treatment, offering hope to some patients with aggressive glioblastoma. People with brain cancer currently have very poor survival rates and lack treatment options, so this could be a welcome addition to our limited arsenal of tools to combat the disease.” A step forward for advanced melanoma treatment Professor James Larkin, Consultant Medical Oncologist, presented promising results from the Phase 2 C-144-01 trial, which showed that lifileucel, a tumour-infiltrating lymphocyte (TIL) therapy, could stop or reverse the progression of advanced melanoma in some patients. More than a third of patients on the trial responded well to TIL therapy, which uses the patient’s own immune cells to fight cancer. “These results show that TIL therapy could offer sustained benefits to some patients with advanced melanoma that can improve over time, which could provide a new treatment for people who have no other options,” says Professor Larkin. “Along with potentially extending patient’s lives, this one-off treatment also means less time in hospital compared to treatment with other immunotherapies.” Promising surgery cuts lymphoedema swelling A meta-analysis conducted by the plastic and reconstructive
ASCO
ROY NORWOOD
Patient, 76, on the CheckMate 648 trial
“I was diagnosed with oesophageal cancer in 2019 and went on the trial as I had no other options. Last summer, after a year of treatment, I was cancer free. The disease came back a few months later, but I am still on treatment and have a good quality of life. I’m lucky, as without the trial I wouldn’t be here.”
surgery team reported that vascularised lymph node transfer (VLNT) reduces swelling and risk of infection in patients who develop lymphoedema following cancer treatment and significantly improves their quality of life. VLNT is a promising microsurgical procedure that reconstructs lymphatic function by taking tissue containing lymph nodes (a lymph node flap) from an unaffected part of the body and transplanting it into the affected limb. Data from 581 patients and 31 studies from 15 countries
“TIL therapy could help patients with no other options”
showed that the technique reduced excess limb volume by 40 per cent in patients who had undergone VLNT in the upper limb and 34 per cent for those with lowerlimb lymphoedema. “Our review is the first to quantify the potential therapeutic benefit of VLNT in reducing both limb volumes and the risk of infection in patients with lymphoedema after cancer treatment,” says Mr Aadil Khan, Consultant Plastic Surgeon and joint senior author for the study. “We are encouraged by the findings of our meta-analysis and are currently developing a randomised clinical trial to formally evaluate the benefit this technique might bring to patients with lymphoedema.”
NEW POSSIBILITIES Professor James Larkin presented news on TIL therapy
PAUL NICHOLSON Patient, 37, on the BAL101553 trial
“When I was diagnosed with glioblastoma in 2017, my estimated life expectancy was just over one year. The initial treatment didn’t work, so it was a relief to join this trial. I was told there was a five per cent chance the drug would work. But three years on, my scans still look good and my cancer has shrunk by over 90 per cent.”
For referrals For referrals andand enquiries, enquiries,call call 020 020 7811 78118111 8111 oror email email privatepatients@rmh.nhs.uk privatepatients@rmh.nhs.uk
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FITNESS FIRST Our prehabilitation service ensures that patients are physically and mentally ready to undergo cancer treatment such as surgery WHEN A CANCER patient needs surgery, it’s important that they are fit and healthy enough to withstand the physical rigours of the procedure and ensure the best outcome. The Royal Marsden’s prehabilitation service encompasses a range of therapies and medical support to put high-risk patients in the strongest position to be considered eligible for surgery. This means we can avoid cancelling or postponing their operations and enables them to recover more quickly. Our upper gastrointestinal (GI) team has implemented SUMMIT, a multidisciplinary meeting where surgeons, anaesthetists, physiotherapists, dietitians, psychologists and anaemia nurses come together to make a full physical assessment of patients. This involves considering any existing medical conditions, such as diabetes, anaemia or high blood pressure. “We know these can affect patient outcomes, so identifying them with enough time to take action and control them is vital,” says Dr Susanna Walker,
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EXERCISE CLASSES Adrian Fautly works with patients to improve their fitness before surgery
Consultant Anaesthetist and Clinical Lead for Surgical Prehabilitation Pathways. Personal plan The team’s patient plans include help from dietitians and physiotherapists, guidance to reduce smoking and alcohol consumption, and psychological support. In the first year of the programme, postponements of upper GI surgery decreased by 60 per cent.
But the benefits for patients continue after surgery. “Patients who are properly prehabilitated can take a more active lead in their rehabilitation,” adds Dr Walker. Exercise therapist Adrian Fautly works with patients one-to-one and in group classes, and makes weekly calls to check their progress and keep them motivated. He also offers virtual fitness classes and video guidance.
P R E H A B I L I TAT I O N
“If someone is very inactive when they go through treatment – which a lot of people are because of the side effects – their physiology will change dramatically,” Adrian explains. “Then, when considered for surgery, their recovery is likely to be affected because of the level of deconditioning and muscle weakness. Our work is about reducing any further deconditioning, but the key is to ensure they’re fit for surgery.” The main challenge for patients is motivation. “People are worried that with low energy, any kind of exercise is going to be taking more of that energy away,” Adrian says. “Actually, that isn’t the case: it will help to release energy.” Eating well Physical activity must go hand in hand with nutrition to give the patient the greatest benefit, says Natalie Harris, a Senior Specialist Dietitian working on prehabilitation: “Growing evidence supports the work of dietitians to prepare cancer patients before – and optimising them during – treatment with good nutrition, particularly before surgery. “It can be difficult for patients to make the best food choices when faced with a new and changing set of symptoms and circumstances, so having the support of an expert in nutrition and cancer is highly valued.” Alongside this, a psychological wellbeing
“Patients value the support of a nutrition expert”
HEALTH CONSCIOUS Dr Susanna Walker (above) and Natalie Harris (right) are part of our prehabilitation service
LYNDA NASH Patient, 65
team helps patients to cope with their diagnosis, motivate themselves and learn techniques to improve their mental health. In the future, the prehabilitation team hopes to broaden the service to all cancer patients. “More and more people are surviving cancer,” says Dr Walker. “Prehabilitation provides people with the knowledge and autonomy to help themselves in the long run.”
“I was diagnosed with oesophageal cancer in 2019. As a smoker with diabetes and COPD [chronic obstructive pulmonary disease], I was considered high risk and not fit enough for the operation. But I was determined that cancer wouldn’t take me. “Everyone at the hospital was marvellous – they helped me get fit enough for surgery. I gave up smoking and started the exercise programme. It was hard, but I kept going for my grandchildren. “I had my operation in January 2020, and the team are still there for me. I’m not diabetic any more, and I still do my exercises regularly.”
For referrals and enquiries, call 020 7811 8111 or email privatepatients@rmh.nhs.uk
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MR DECLAN CAHILL Consultant Urological Surgeon and Head of the Urology Unit
MR DECLAN CAHILL specialises in the diagnosis and management of patients with prostate cancer at The Royal Marsden. After qualifying in London, he trained as a surgeon and was awarded the Hallett Prize Gold Medal in the Royal College of Surgeons of England fellowship exams. Subsequently, he won the Keith Yeates Gold Medal in his urology specialist examination. He trained in Paris to specialise in laparoscopic radical prostatectomies, before spending 12 years as a Consultant Urological Surgeon at Guy’s and St Thomas’ NHS Foundation Trust, where he transitioned to performing robotic-assisted
radical prostatectomies. Mr Cahill joined The Royal Marsden in 2015, with a focus on augmenting the prostate cancer diagnostics and surgical service, and became Head of the Urology Unit in January 2016. He is one of the UK’s most prolific prostate surgeons, operating on a high number of patients each year. The results of his procedures are equivalent to the best in the world for cancer margins, precision and how quickly patients are able to recovery post surgery. Central to Mr Cahill’s ethos are the patient experience and care. He constantly audits his patient outcomes to use the data to drive improvement and provide the best possible care.
CAREER HIGHLIGHTS 1993 Qualified at Charing Cross and Westminster Medical School, now Imperial College, with distinction 1996 Awarded the Hallett Prize Gold Medal in the Royal College of Surgeons of England fellowship exams 2001-02 Fellowship at Institute Montsouris, Paris
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Q&A 2002 Awarded Keith Yeates Gold Medal in urology specialist examination 2003 Appointed Consultant Urological Surgeon at Guy’s and St Thomas’ NHS Trust 2015 Moved to The Royal Marsden as Head of the Urology Unit to lead the prostate cancer diagnostics and surgical service
Q What services do you provide at The Royal Marsden? A Our goal is to provide excellent care for patients with urological cancers, starting with a rapid diagnostics service. Many tests can be performed during the initial visit, and we offer advanced scanning technology. The unit has a multidisciplinary team ethos, and each patient is involved
C O N S U LTA N T F O C U S
“Treating patients as individuals and using advanced technology to provide rapid, accurate diagnoses is key” as an instrument, translating actions from the surgeon as they sit at a console, and provides well-lit and magnified images of the operating site on a screen. These better images and the dexterity of the robot facilitate more accurate and less-invasive surgery. This has improved outcomes for patients, including faster recovery.
in deciding on their own personalised treatment plan. Surgery is carried out by skilled teams, and we realise the importance of aftercare. Q Why is robotics important for prostate cancer surgery? A The prostate gland sits in the pelvis. Conventional operation in this area is limited by a lack of space to manoeuvre and difficulty in seeing clearly. The robot overcomes these technical obstacles: it acts
Q What areas of research are you involved in? A I act as an investigator in various trials looking at both high- and low-risk prostate cancer. In the METAL trial, we’re examining the biological effects of the drug metformin in patients with localised prostate cancer. In the PCASTt/SPCG-17 trial, we’re evaluating active surveillance. And in the PROTEUS trial, we’re looking into giving apalutamide with androgen deprivation therapy before surgery in high-risk disease. Q What have been the biggest changes in diagnosis and treatment for prostate cancer patients during your career? A There has been a renewed focus on the importance of the diagnostics pathway. Treating the presenting patients as individuals and using advanced technology
to provide rapid, accurate diagnoses is key. During my career, our confidence has grown in identifying those patients who can safely be managed with active surveillance. They have slow-growing tumours that will have no impact on their life. By monitoring them, we have the safety net of knowing we can spot any changes that indicate treatment is now necessary. My colleague Professor Ros Eeles is a world-leading oncogenetics consultant, which means she looks at men’s genetic predisposition to prostate cancer. Deciding who will develop prostate cancer is the earliest diagnostics service possible. The development of robotic surgery has allowed us to deliver improved care. By analysing my previous patients’ outcomes, I am now able to reliably guide patients with regards to their options and likely outcomes. And radiotherapy is increasingly effective. The Royal Marsden leads on many aspects of radiotherapy, with state-of-the-art technology, such as CyberKnife and the MR Linac, and pioneering trials that define how we should deliver this treatment.
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As Europe’s largest cancer centre, The Royal Marsden has the expertise, facilities and technology to provide the highest standards of personalised care, and we treat more private patients than any other UK centre. By choosing The Royal Marsden, you are ensuring the best possible treatment and care, at the moment a patient needs it most. Because where a patient goes first really matters.
Life demands excellence
To refer a private patient, contact our Central Referral and Information Line on +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk royalmarsden.nhs.uk/private