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.”
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