Joint Annual Research Report 2004 - The Royal Marsden

Professor Stan Kaye
who heads the new
Drug Development Unit.
Research volunteers in the
hyperbaric oxygen chamber
at the Institute of Naval
Medicine at Haslar
productive collaboration with Vernalis Ltd, and it was
a significant step forward when the major
pharmaceutical company Novartis licensed this
technology in order to take it forward into the clinic.
The initial stages of the clinical development of a
new anti-cancer drug depend upon Phase I trials, in
which the safety and pharmacokinetic properties of
the molecule are assessed, although with the new
generation of molecularly targeted therapies, efficacy
data may also be gathered at this stage. In order to
significantly increase our capacity for Phase I trials
the Royal Marsden, with the most generous support
of the Oak Foundation, has constructed a new Drug
Development Unit which will be headed by Professor
Stan Kaye, the Cancer Research UK Professor of
Medical Oncology. New treatments can be developed
much more rapidly if their pharmacology, localisation
and molecular targeting can be verified and early
responses assessed sensitively, and new functional
imaging techniques offer the opportunity to do this
efficiently and non-invasively. The Royal Marsden has
installed a new PET-CT facility, and an additional MRI
machine has been purchased.
Once there is evidence that a new drug induces
clinically significant responses, before it can be
marketed and widely prescribed its value must be
rigorously evaluated in large Phase III trials. Ms Judith
Bliss, the Chairman of the Section of Clinical Trials,
co-ordinated a major international trial which showed
that the aromatase inhibitor exemestane is of
significant benefit to post-menopausal women who
have had breast cancer. Last year we reported that
Professor Ian Smith, Head of the Breast Unit, had
led the initial trial of another aromatase inhibitor,
letrozole, now shown to be of great benefit. This new
class of drug, which acts by blocking the synthesis of
the female hormone oestrogen, will markedly change
the clinical management of breast cancer. Professor
David Cunningham, Head of the Gastro-Intestinal
Cancer Unit, was a leader in trials which showed that
Capecitabine, an oral pro-drug of 5-Fluorouracil, and
the monoclonal antibody Cetuximab, are agents that
can be highly effective in colorectal cancer patients.
Large, randomised trials of surgical procedures
are not common but Mr Meirion Thomas, Consultant
Sarcoma Surgeon at the Royal Marsden, led a trial,
again co-ordinated by Ms Judith Bliss, which showed
clearly that the excision width, ie the amount of tissue
surrounding the tumour that is removed with it, is a
highly influential factor in the survival of patients with
malignant melanoma. Perhaps even more unusual was
a trial led by Professor John Yarnold which explored
the use of hyperbaric, ie high pressure, oxygen in the
treatment of lymphoedema. Swelling of the arms
is a common side-effect in women who have had
surgery and radiotherapy for breast cancer and it can
have a real effect on their quality of life. Sitting in a
hyperbaric chamber, of the sort used to help deepsea
divers recover from the bends, appears to bring
great benefit and further, larger trials are now
being planned.