The Royal Marsden

Treatment on trial

Acoustic cluster therapy uses microscopic clusters of bubbles and liquid droplets to enhance the delivery of chemotherapy drugs to tumours. We meet some of the team involved in trialling this innovative new treatment – and the first patient in the world to receive it – at The Royal Marsden

Professor Udai Banerji,
Deputy Director of the Oak Drug Development Unit

“This new therapy could improve the effectiveness of simultaneously administered routine chemotherapy drugs by better targeting the tumour, reducing exposure to the rest of the body, and hopefully lowering the rate and severity of treatment side effects.

“My role is to bridge the pre-clinical and clinical drug discovery work by leading on the design and co-ordination of this Phase I trial. It’s exciting to be involved in this unique project, and we’re lucky to have this opportunity through working in collaboration with scientists at The Institute of Cancer Research, London and Phoenix Solutions, which invented the technology.”

Dr Nina Tunariu,
Consultant Radiologist

“Every project needs imaging, but this trial is unique as it uses advanced imaging in the actual delivery of treatment. My role in the process is performing the ultrasound examinations, choosing a suitable lesion for treatment and ensuring that same lesion is targeted every time the acoustic cluster therapy is delivered.

“Once the patient is receiving their chemotherapy, I use the ultrasound probe to identify the lesion in the patient’s liver; the microbubbles and droplets are then administered, and I can visualise the microbubbles in the tumour on screen.

“I work with the patient and the team to keep the patient relaxed, which is particularly important at this stage of treatment – ensuring the lesion remains targeted while the ultrasound frequency output is changed to activate the clusters in the microbubbles.

“I’m currently supervising and training sonographers in the team so that more staff will be able to operate the ultrasound equipment in this clinical trial setting.”

This treatment is all about timing, so communication is key

Mark O’Leary and Nigel Bush,

“We are responsible for preparing the ultrasound system for use with the patients and leading the process that delivers the acoustic outputs from the imaging machine.

“The ultrasound process is made up of three phases, which must be kept to specifi c timings. The fi rst is a localisation phase; this allows the radiologist to refamiliarise themselves with the patient and identify the target lesion before the clusters are administered. We then switch to activation mode, which optimises the ultrasound output to bring about the conversion of the injected microbubblemicrodroplet clusters into large bubbles within the lesion. We observe the ‘wash in’ of the clusters to the lesion, then a fixedtime after that, we switch to enhancement mode, where the imaging ultrasound is supplemented by an additional beam at a much lower frequency.

“These lower-frequency waves cause the activated bubbles in the tumour blood vessels to vibrate, potentially increasing the permeability of the vessel walls and leading to more of the chemotherapy drug being delivered to the cancer cells in the imaged tissue.”

Sumita Gurung,
Lead Trial Nurse

“It’s an absolute privilege to be looking after patients on this clinical trial. It’s the first live, active trial I’ve been assigned to, and my key responsibilities include preparing and monitoring both the patient and the treatment.

“The microbubble drug supply is collected from the research hatch, which I then prepare by mixing together a powder and liquid – these are the microscopic clusters of bubbles and droplets that are then administered to the patient at a specifi c point while they are receiving their standard chemotherapy; this process is repeated three times during each visit. Delivering this treatment is all about timing and co-ordination, so communication among the team is absolutely key.”