Uncommon cancers: Committed to high-quality care
Radiotherapy is key to the treatment of bladder cancer
Together, breast, prostate, bowel and lung cancers account for more than half of all new cases of cancer in the UK, making them the most common types. However, there are more than 200 further types that occur less frequently and can thus be termed as ‘uncommon’ cancers. These diseases still make up 25 per cent of all cancer diagnoses and disproportionately affect younger people, so it’s vital that The Royal Marsden continues to invest in new treatment options for patients diagnosed with these diseases.
of all new cancer cases occur in the bladder
bladder cancer cases occur in men
Three strands of research our Urology Unit is developing a three-pronged approach to tackling bladder cancer, according to specialist Professor Robert Huddart, Consultant Clinical Oncologist at The Royal Marsden and Clinical academic Radiotherapy Team Leader at the ICR.
“We’re seeking to improve our treatment of bladder cancer through radiotherapy and immunotherapy, and improve our ability to match patients to the most appropriate treatment for their cancer through genetic testing,” he says. “The ‘holy grail’ is to identify someone’s cancer type through a blood test, then offer them the most appropriate treatment, based on the genetics of their cancer. “We’re studying the genomics of our bladder cancer patients to see if there are subtypes of the disease, as in breast cancer. It has been reported that two-thirds of patients have a mutation that could potentially be targeted with a specific treatment.”
Inspired by the success of immunotherapy in melanoma, the PLUMMB trial – funded by the NIHR Biomedical Research Centre and supported by MSD – combines immunotherapy and radiotherapy, an approach never before tried with
“Laboratory data has demonstrated that combining immunotherapy and radiotherapy can make the treatment more powerful,” says Dr Alison Tree, Consultant Clinical Oncologist. “When a cancer has spread, radiotherapy can be used to treat the cancer locally while immunotherapy can treat cancer cells wherever they are in the body.”
In the IDEAL study, bladder cancer patients received a novel ‘adaptive’ radiotherapy treatment. Professor Huddart says: “On each day of treatment, we selected one of three pre-prepared radiotherapy plans. This significantly improved the accuracy of treatment compared with standard radiotherapy, and allowed us to increase dosage with a low risk of side effects and excellent control rates. We hope that new technical developments, such as the MR Linac, will lead to further improvements.”
We’re seeking to improve our treatment of bladder cancer through radiotherapy and immunotherapy
of all cancers are soft-tissue sarcomas
different subtypes of soft-tissue sarcoma
Sarcomas are tumours of connective tissue that can affect any part of the body, making them hard to diagnose and treat. The Royal Marsden has one of the largest soft-tissue sarcoma units in Europe, with more referrals than any other UK organisation.
Surgery, with or without radiotherapy, remains the mainstay of management for most localised sarcomas. The surgical team is now exploring minimally invasive surgery, depending on the tumour’s location and biology, to improve recovery time.
“As well as our surgical research, we’re also looking into new medical treatments,” says Dr Robin Jones, Consultant Medical Oncologist and Head of the Sarcoma Unit at The Royal Marsden. “We’re leading a study assessing the immunological features of sarcoma subtypes, and will be working on this project with colleagues in Europe and North America. We’re particularly excited about a trial for olaratumab, a drug for soft-tissue sarcomas that has shown promise in Phase II trials.
“We are also researching and developing new diagnosis methods, and we have studies looking into the molecular features of sarcomas and the impact of a family history of cancer. By finding genetic indicators, we hope to deliver personalised therapy for each individual patient and their specific type of sarcoma.”
women are diagnosed with ovarian cancer in the UK each year
of all new cancer cases are ovarian cancer
Pioneering imaging techniques The Royal Marsden is exploring new imaging techniques to ensure that ovarian cancer patients don’t receive unnecessary invasive surgery.
Recent developments in magnetic resonance imaging (MRI) have led to a new technique known as multiparametric MRI (mpMRI), which has the potential to provide additional information that may help decisions about how a patient is treated.
Funded by the National Institute for Health Research, the national MR in Ovarian Cancer (MROC) study has recently opened at The Royal Marsden. It involves patients with suspected or confirmed ovarian cancer undergoing an MRI scan in addition to the normal staging CT scan, in order to compare the staging of cancers and treatment plans based on the different imaging techniques.
“We hope that this trial will improve the radiological assessment of the extent of the disease compared with the current standard of CT scans,” says Professor Andrea Rockall, Consultant Radiologist at The Royal Marsden. “The information will potentially help clinicians in multidisciplinary meetings to select a personalised treatment pathway for patients.”