Clin­i­cal tri­als’

Irish Independent - Health & Living - - CANCER SPECIAL -

in ovar­ian can­cer and in Triple Neg­a­tive breast can­cer. We hope that im­munother­apy will im­prove out­comes,” he ex­plains. How­ever, Dr Mur­phy says, the big chal­lenge is to iden­tify the type of pa­tient who will ben­e­fit from im­munother­apy. Some pa­tients can be overly op­ti­mistic about its reach.

“I have peo­ple com­ing with tu­mours that have not yet proven to be sus­cep­ti­ble to im­munother­apy. They are des­per­ate to try it at huge ex­pense to them­selves and I coun­sel against that be­cause with­out any ev­i­dence to sup­port it, it is tak­ing ad­van­tage of peo­ple’s des­per­a­tion.”

÷IM­PROVED DE­TEC­TION TECH­NIQUES

It’s not just treat­ment tech­niques which have im­proved, how­ever. The on­col­ogy sec­tor has seen huge im­prove­ments in de­tec­tion tech­niques, ex­plains Dr Mur­phy. “Imag­ing and biopsy tech­niques are chang­ing be­yond all recog­ni­tion. We’ve seen a rev­o­lu­tion in imag­ing in the last 15 years. We now have Ul­tra High Def­i­ni­tion CT scans and PET/CT scans and other highly sen­si­tive im­agery which are much bet­ter at de­tect­ing can­cer more ac­cu­rately in the body.”

÷LIQ­UID BIOPSY

Biopsy tech­niques are also un­der­go­ing rad­i­cal changes, Dr Mur­phy re­veals. Cur­rently, a biopsy in­volves a core of tis­sue be­ing re­moved, like an ap­ple core, from a tu­mour — the prob­lem is that the sam­ple may not be rep­re­sen­ta­tive of other ar­eas of tu­mour in the body. How­ever, that’s about to change.

“We’re now get­ting to a point where we will be able to in­ves­ti­gate tu­mours by look­ing at tu­mour cells and DNA cir­cu­lat­ing in the blood­stream through a sin­gle blood test,” says Dr Mur­phy.

He pre­dicts that this tech­nique, which is called liq­uid biopsy, is poised to change the way doc­tors di­ag­nose and man­age tu­mours.

“There has been a huge change in imag­ing in the last 15 years. Tu­mours evolve con­tin­u­ally and with this tech­nique it will be pos­si­ble to carry out much bet­ter mon­i­tor­ing through a blood test which can be done reg­u­larly and with no great dis­tress for the pa­tient.” • CLIN­I­CAL tri­als drive med­i­cal break­throughs — they’re cru­cial to the de­vel­op­ment of im­proved de­tec­tion, di­ag­nos­tic and treat­ment tech­niques, em­pha­sises Pro­fes­sor Bryan Hen­nessy, con­sul­tant on­col­o­gist at Beau­mont Hospi­tal and clin­i­cal lead at Can­cer Tri­als Ire­land, the lead­ing vol­un­tary can­cer re­search tri­als or­gan­i­sa­tion in Ire­land.

How­ever, he says, clin­i­cal tri­als can­not be run with­out suf­fi­cient fund­ing, staffing and re­sources. Pro­fes­sor Hen­nessy says Ire­land needs more tri­als, more can­cer pa­tients will­ing to par­tic­i­pate — and, cru­cially — more gov­ern­ment fund­ing.

“Our goal at Can­cer Tri­als Ire­land is to dra­mat­i­cally in­crease the num­ber of tri­als here,” he says, adding that he wel­comes the Na­tional Can­cer Strat­egy’s ob­jec­tive of dou­bling to 6pc the num­ber of Ir­ish on­col­ogy pa­tients on clin­i­cal tri­als by 2020.

Cur­rently, just 3pc of all can­cer pa­tients, or about 6,000 peo­ple, are par­tic­i­pat­ing in clin­i­cal tri­als. In all there are 150 tri­als on­go­ing in 16 hos­pi­tals around the coun­try, about 50pc of which are can­cer tri­als.

Can­cer Tri­als Ire­land’s long-term aim is to have 10pc of on­col­ogy pa­tients on tri­als — which, Pro­fes­sor Hen­nessy points out, is the norm for many de­vel­oped coun­tries.

“The Na­tional Can­cer Strat­egy dic­tates gov­ern­ment pol­icy — and that means we’re likely to get more fund­ing to in­crease the num­ber of tri­als and get more new can­cer drugs to more peo­ple with can­cer,” says Hen­nessy. “Can­cer tri­als mean bet­ter treat­ment, longer sur­vival. They also bring an eco­nomic ben­e­fit in terms of em­ploy­ment.”

The big chal­lenge for those in­volved in can­cer tri­als, he em­pha­sises, is get­ting suf­fi­cient fund­ing. The Ir­ish Can­cer So­ci­ety pro­vides an­nual fund­ing to the work of Can­cer Tri­als Ire­land. In 2017, for in­stance, this amounted to €500,000. But more is needed.

“The more fund­ing we get, the more tri­als we run and the more treat­ments are de­vel­oped,” says Pro­fes­sor Hen­nessy. “Our fund­ing was cut by 20pc by the Health Re­search Board a few years ago and we want that to, at least, be re-in­stated be­cause it has had a sig­nif­i­cant neg­a­tive im­pact on our abil­ity to de­velop new tri­als and treat­ments.

He says that all ad­vances in can­cer treat­ment that are de­vel­oped or will be de­vel­oped emerge from can­cer tri­als. “The will is there and the ex­per­tise is there but with­out fund­ing we can­not build.”

To run tri­als you need a spe­cial depart­ment in each hospi­tal with qual­i­fied staff — re­search nurses, data man­agers and phar­ma­cists.

“We’re al­ready strug­gling with what we have be­cause of fund­ing cuts,” Pro­fes­sor Hen­nessy says.

De­tails on all can­cer tri­als open are avail­able on can­cer­tri­als.ie

Alva Cam­brils, re­search as­sis­tant who works with Prof Wil­liam Gal­lagher, a can­cer re­searcher at UCD

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