A focus on collaboration
The Royal Marsden’s Sarcoma Unit is working with specialist centres around the world to improve the treatment of these rare cancers.
COLLABORATION IS VITAL when it comes to treating sarcomas. Because they affect connective tissue, sarcomas can appear in any part of the body so are often difficult to diagnose, and their rarity – making up just one per cent of all adult cancers – means developing new treatments can be challenging. The Royal Marsden’s Sarcoma Unit works with international centres to improve the care and treatment of these diseases. The unit is one of the largest in Europe, registering around 1,000 new patients each year, and is recognised worldwide for its strength in sarcoma research – supported by The Royal Marsden Cancer Charity – and in diagnosing and treating soft-tissue sarcomas.
Researching new treatments
“Securing approval for new drugs to treat rare cancers like sarcomas is difficult as there often won’t be enough patients for a clinical trial within a single country, so recruiting with other centres is vital,” says Professor Robin Jones, Consultant Medical Oncologist and Head of the Sarcoma Unit. Last year, Professor Jones worked with researchers from 22 centres in countries such as Italy, Taiwan and the USA to recruit patients with advanced epithelioid sarcoma (which comprises less than one per cent of all sarcomas) to a clinical trial for tazemetostat, an experimental drug that targets molecular abnormalities, and secured FDA approval as a result. The unit is also developing treatments to treat rare subtypes of gastrointestinal stromal tumours (GISTs). Researchers are working with teams from the USA and Europe on the Navigator trial to explore the benefits of avapritinib, a drug that targets the PDGFRA D842V gene mutation, for a molecular subgroup of GISTs. “This trial has shown promising results in this treatment-resistant subgroup of GISTs,” says Professor Jones. “Both treatments exemplify personalised medicine, as only a handful of patients develop these types of sarcoma each year.”
As sarcomas can develop in any part of the body and grow to large sizes, surgery can be challenging. So The Royal Marsden, works with international research bodies to innovate in this area. Mr Dirk Strauss, Consultant Surgeon, is the UK’s Principal Investigator for the STRASS2 trial, working with specialist sarcoma units across Europe, North America and Australasia to optimise the benefits of surgery for retroperitoneal (the area at the back of the abdomen) sarcomas. “This trial is examining if chemotherapy before surgery can reduce the risk of the cancer coming back,” says Mr Strauss. “We also collaborate with international oncologists in the Transatlantic Australasian Retroperitoneal Sarcoma Working Group, which is helping to standardise and improve care for patients.”
The unit recently worked with The Institute of Cancer Research, London and other international collaborators to secure a £2.5-million Cancer Research UK Accelerator Award to develop the world’s largest digital hub of sarcoma clinical and research data. Using artificial intelligence to analyse the data, researchers will predict and test patient response to drugs for high-risk sarcomas. “AI requires ‘big data’, and you can’t gather extensive data on sarcomas without collaboration,” says Dr Christina Messiou, Consultant Radiologist. “With this project, the global sarcoma research community is assembling a wide variety of information, including imaging, pathology and genetics, which will feed into developing new treatments for patients with metastatic sarcomas, who currently have poor outcomes.”
Sarcoma is complex disease with more than 100 known types and many subtypes. Dr Khin Thway, Consultant Histopathologist, plays a central role in diagnosing patients and has worked with other international pathologists to develop the World Health Organization’s classification of sarcomas. “The classification of sarcomas is always evolving and, compared with more common cancers like breast and lung, very little is known,” she says. “International collaboration is really important as The Royal Marsden may only see three to four cases of a certain type each year. Working together, we can build a picture of how each tumour type behaves so clinicians can tailor treatment to manage the disease more effectively.”
A patient’s perspective
Jason Hutchinson, 46 “I was originally diagnosed with a GIST in 2013 after finding a lump on my stomach and experiencing a lot of pain. My local hospital referred me to The Royal Marsden, where I was treated with oral chemotherapy and surgery. “After finishing treatment, my wife and I moved from London to Norwich for a quieter life. Unfortunately, the GIST came back in 2018 and, this time, was metastatic. I was absolutely devastated. “I was able to join The Royal Marsden’s Navigator trial and I’ve been on avapritinib ever since. The trial feels like a miracle as it’s given me extra time that I didn’t think I’d have. Without it, I probably wouldn’t be here today. “Over the years, the care and treatment I’ve received from The Royal Marsden’s Sarcoma Unit has been second to none. They’re absolutely brilliant.”
Dr Silvia Stacchiotti, Medical Oncologist at the National Cancer Institute of Milan, regularly works with The Royal Marsden, including recently recruiting for the tazemetostat trial and applying for the Accelerator grant. She says: “It’s impossible to work in sarcoma research without making international connections. From sharing expertise and information, to trial recruitment and applications for funding, collaboration means we are able to achieve so much more.”