Innovation in Oncology IE - Q2 - May 2019

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IRISH ASSOCIATION FOR CANCER RESEARCH Findings from the 55th IACR conference » p4

IPHA Stakeholder collaboration to ensure patient access to potentially life-saving clinical trials. » p4

ANN BAKER’S PATIENT STORY “How a cancer drug trial saved my life.” » p6

Innovation in ncology HEALTHNEWS.IE

As cancer research looks into new ways that screening can save lives from cancer, health systems like Ireland’s need to be ready to implement new screening tools as quickly as possible.”

- Irish Cancer Society

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Innovations in oncology – prevention and screening DR ROBERT O’CONNOR Head of Research, Irish Cancer Society

Just 20 years ago – the cusp of the millennium – cancer in Ireland looked very different. Now, we have much to celebrate, but we must be proactive in our approach to cancer.

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wo decades ago, four in ten people w ith cancer in Ireland survived their diagnosis. To the general public, the idea of preventing some cancer cases through vaccination was a distant dream. Cancer screening in Ireland was in its infancy, with breast screening in its early days.

Today, major innovations in oncology have changed all this.

Now, six in ten people with cancer in Ireland survive their diagnosis for at least five years.

HPV vaccine is hugely effective The safe and hugely effective HPV vaccine is saving lives of future generations from HPV-caused c a ncers. A nd, despite recent public controversies, our cancer screening services are saving more lives than ever since the expansion into cervical and bowel cancers.

Advances brought about by research empower us with the

knowledge to make choices to increase our chances of not getting cancer.

The Irish Cancer Society has been working to spread the benefits of these advances through public awareness since its inception more than 50 years ago. But we’re also the biggest voluntary investor in cancer research in Ireland.

Public donations are so beneficial for research The generosity of the public allows us to invest in research made vital because there is so much we still don’t know about cancer. Finding those answers is essential to stopping cancer, and as a well-educated and prosperous society, Ireland has the ability and duty to be front-and-centre in this work.

Mention of cancer often brings a sense of fear and foreboding but there is much in our own cont rol to st ack t he odd s i n our favour.

As a well-educated and prosperous society, Ireland has the ability and duty to be frontand-centre in this work.”

ARTUSH

Cancer screening saves lives Screening is life-saving because, by detecting the pre-cancerous

changes in our body that we know can lead to cancer, it gives us the chance to stop a cancer before it starts.

As cancer research looks into new ways that screening can save lives from cancer, health systems like Ireland’s, need to be ready to implement new screening tools as quickly as possible.

We could save an extra 350 lung cancer patients a year Lung cancer is a case in point.

Global research is pointing to CT screening as having the potential to spot lung cancer sooner among at-risk groups, thus potentially saving lives. By examining this research, the Irish Cancer Society believes that more than 350 lives in Ireland every year – effectively one person a day – could be saved by lung cancer screening.

As research in this area continues, we’re asking the government to put the infrastructure

in place that can seize on opportunities that innovations in oncology like this can bring. The promised National Screening Committee, re c om mende d i n D r G abr iel Sca l ly ’s scoping inquir y into our CervicalCheck programme, should give early consideration to the introduction of lung cancer screening.

A s research in the areas of prevention and early detection continue, hopefully more positive advances of potential benefit to patients will be made. Through the National Screening Committee, Ireland has an opportunity to evaluate and seize on these opportunities and ensure as many lives in Ireland are saved thanks to these advances.

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Date of preparation: April 2019 Item code: CP-89049 Janssen Sciences Ireland UC 2019

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From cancer therapy to survivorship; news from the 55th IACR Conference DR MARIA PRENCIPE PHD IACR, Council Member 2016-2019

Snapshot from the Irish Association for Cancer Research annual meeting. Ireland’s premier cancer research conference brings together top Irish and international cancer researchers and patients to discuss progress.

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hile conventional cancer treatments such as surgery, radiotherapy and chemotherapy have been combined, for decades, in an effort to treat cancer patients, the emergence of novel fields of cancer research have led to a renewed interest in combining conventional treatments with more innovative approaches.

The realisation that cancer progression is not exclusively due to changes in the cancer cells, but also involves changes in the tumour surroundings as well as in the immune system, has opened new avenues for combination treatments.

Among the novel treatment strategies, immune metabolism, epigenetic therapies and physical exercise were discussed. For example, the positive effect of physical exercise in combination with conventional therapies of cancer treatment, at all stages of the cancer survivorship pathway was highlighted.

In addition, novel technologies such as digital pathology and precision medicine, which will help to better tailor treatments to individual patients, were presented.

Several examples of these novel combinations were presented at the 55th IACR conference, a shared platform for patients, researchers and clinicians. Great emphasis was placed on survivorship and patients’ quality of life after treatment.

Patient and public involvement at the IACR annual meeting While clinicians have regular meetings with cancer patients, cancer researchers very rarely get the opportunity to meet them. At the same time, cancer research might seem difficult to grasp for the general public, including patients.

So, this years’ conference was opened with an award designed to encourage early-stage researchers to engage with the general public to talk about their research: ‘The Professor Patrick Johnston IACR Award for Excellence in Cancer Research Outreach’.

Six researchers were selected to present their findings. They had the hard task of presenting their research to the general public, including secondary school pupils. A judging panel and the audience then voted for the most accessible presentation.

Patients and researchers working together The great success of this public session was in no small part due to a public engagement workshop held two weeks before the IACR meeting. During this workshop, pairs of researchers and patient IACR mentors worked together to make science communication more accesThe Irish Association for sible to the general public.

Cancer Research (IACR) is This workshop was a great an all-Ireland, non-profit occasion for patients and researchorganisation that brings ers to meet and talk to each other. It together cancer researchers was especially useful for early-stage and healthcare professionals researchers who learnt to look at from all disciplines to share the bigger picture and to value what their expertise. really matters to patients.

The ultimate goal of the IACR is to improve the patient journey from Read more at diagnosis, through treatment to the healthnews.ie lived experience of cancer.

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Can Ireland become a leader in clinical research?

Collaboration with all stakeholders is needed to ensure patients don’t miss out on potentially life-saving clinical trials in Ireland.

DR ITZIAR CANAMASAS Strategy Board Member, Irish Pharmaceutical Healthcare Association (IPHA)

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reland can become a European leader when it comes to conducting clinical trials if we collaborate and focus on reducing delays and improving recruitment targets, according to the Irish Pharmaceutical Healthcare Association (IPHA).

Research recently conducted by IPHA shows that, despite being home to nine of the 10 largest pharmaceutical companies in the world, Ireland is not currently as strong a location for clinical trials in comparison to similar-sized countries, such as Denmark.

The research shows that, on average, it ta kes about eight months to recruit the fi rst patient into a clinical trial in Ireland. That figure is based on 90 trials set up between 2013 and 2018 across 11 therapy areas and all four phases of the clinical development process.

There is scope for us to further build Ireland’s credentials as a location for clinical trials.”

Clinical trials are vital for boosting innovation This delay has potentially far-reaching consequences, most importantly for patients who are missing out on opportunities to access what could be life-saving medication and contribute toward the development of improved detection techniques and diagnosis.

Dr Itziar Canamasas, Managing Director of global life sciences company, Bayer, and IPHA strategy b oa rd memb er, ex pla i n s t he importance of clinical trials: “As well as the positive impact for patients, clinical trials enhance the value proposition for innovation on which Ireland needs to keep working to secure future global investment in manufacturing and discovery activity against significant competition.”

numbers, it currently takes six months to recruit a patient into clinical trials in Denmark compared to eight months in Ireland.

Canamasas sees no reason why Ireland can’t emulate Denmark’s success and become a more attractive location for clinical research.

Following Denmark’s example Looking to Denmark, a country of similar size, it had approximately three times the number of registered studies at the end of 2018 compared with Ireland.

Notwithstanding these higher

KKOLOSOV

Working together to realise a shared ambition Canamasas is quick to point out that pharmaceutical companies alone can’t drive progress. Change requires commitment from a far broader cohort of stakeholders including, policymakers, hospitals, patient groups and university institutes.

To further the discussion on collaboration, Canamasas presented the IPHA survey findings at the Health Research Board - Clinical Research Coordination Ireland (HR B CRCI) conference on 13 May. Reporting on the conference feedback, she says, “There was a strong consensus that there is scope for us to further build Ireland's credentials as a location for clinical trials and that this will require active collaboration among us all.”

As a starting point, IPHA are proposing we look to implement standardised clinical trial agreements, that are already in place in a number of other EU countries; that we protect research time for clinicians and hospital staff; and that we use more realistic targets when starting clinical trials, this means meeting a lower recruitment target is better than partially meeting a higher target.

Overcoming challenges The task in hand is considerable, but Canamasas believes Ireland has all the ingredients for success.

“We have all the major international pharmaceutical innovation companies in Ireland. We also have highly regarded health professionals who are seen globally as key opinion leaders and there are positive signs that the public policy environment is shifting favorably to supporting this ambition for Ireland,” she says confidently.

ECRIN represents huge opportunity Her posit ion is buoyed by Ireland’s recent decision to join the European Clinical Research Infrastructure Network (ECRIN), opening opportunities for panEuropean clinical trials, which has the potential to give us access to large populations of patients and collaborations across countries.

On a broader scale, there has never been a more exciting time for innovation within the pharmaceutical industry. Across the industry, new technologies, such as artificial intelligence, are opening up opportunities within clinical research.

Such developments could help to support the new wave of clinical trials that Canamasas hopes to see in Ireland very soon.

Byline: Kate Sharma

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Surface guided radiation therapy now available in Limerick Surface guided radiotherapy (SGRT) is a technique that uses non-ionising and noninvasive camera technology to track patients’ surface in 3D for both set-up and motion management during radiotherapy treatment delivery.

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GRT is a rad iot herapy tech n ique desig ned to improve the accuracy of patient treatment. During the treatment, a camera shines a red speckled pattern on the body surface of the patient to monitor exac t posit ion s for prec i sely targeted radiation. This process ensures that the treatment area receives the maximum dose of radiation therapy while the surrounding, healthy tissue receives a much lower dose.

I n it ia l ly t h i s te ch n ique i s available to certain categories of patients. Eligibility for this technique is determined according to particular diagnosis.

All radiotherapy patients currently require permanent tattoos on their skin to mark the area(s) where the radiation treatment needs to be delivered.”

Fewer permanent tattoos All radiotherapy patients currently require permanent tattoos on their skin to mark the area(s) where the radiation treatment needs to be delivered. During radiotherapy treatment, it is vital that radiation is administered to the same area each time, therefore, marking the planned positions with a per ma nent tat too el i m i nates

potential errors in relocating the planned positions for future treatments.

Replicating exact positions on the body using cameras The SGRT system will allow for a reduction in the number of tattoos given to patients as the exact planned positions can be reproduced by the SGRT cameras. This system allows for real time monitoring of patient position so, if the patient moves during treatment, the radiation can be automatically paused until they are back in the planned position.

The aim in the future is to become a tattoo-less centre for

SHARON KIERCE Acting Clinical Specialist Radiation Therapist, Mid-Western Radiation Oncology Centre, Mater Private Healthcare, Limerick

certain treatment sites. This would significantly reduce treatment time and improve the overall patient experience by taking away these permanent reminders of their treatment and also their disease.

Sponsored by

Read more at materprivate.ie/limerick/

This innovative new technology (AlignRT, Supplied by VisionRT Ltd), used to aid radiotherapy treatment delivery is now available at the Mid-Western Radiation Oncology Centre, Mater Private Limerick, serving patients throughout the Mid-West region.

For more information, please contact us at: Tel 061 425 901 or email: limerickradiotherapy@ materprivate.ie

Personalised medicine is now a reality An explosion of technological advances and data gathering is taking personalised medicine to the next level.

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hen it comes to treating p a t i e n t s , t h e r e ’s a general consensus that holistic care, where a patient’s complete needs are taken into consideration, is preferable. Until recently, this has been little more than wishful thinking.

Technology is opening up the potential to completely rethink patient care. The catalyst driving this major shift is ‘big data’ or, as Mary Maguire from Roche - a pharmaceutical company innovating in the field of personalised medicine more accurately calls it, meaningful data.

There is a growing number of electronic medical records and patient repositories, so we have more i n for m at ion t h a n ever before at ou r f i nger t ips. But information in isolation is meaningless.

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Intelligent analytics It’s the advent of machine learning and artificial intelligence that has opened up the opportunity for digital pathology and advanced analytics to better understand the links between genetic mutations, disease and the relevant treatments.

“It’s all about asking the right questions and then linking these mass repositories so, when we look at these data sets, the insights we’re getting can be applicable to a lot of patients,” says Maguire.

Such information has already led to a shift in the way disease is categorised. In terms of cancer, we genera l ly t h in k about its location in the body - bowel, skin and breast, for example. However, with greater insights, physicians are now looking at the underlying genetic signature of the cancer and

There is a growing number of electronic medical records and patient repositories, so we have more information than ever before at our fingertips.” how that can be treated. This, in turn, is opening up new treatment possibilities.

Wearable tech and apps to support patients’ treatment plans The personalisation of medicine has the potential to go even further than assisting diagnositics and treatment planning. There is now a plethora of wearable technologies and medical apps that have made it much easier to track a patient’s ongoing health and response to medication

MARY MAGUIRE Group Medical Manager, Roche

A physician may only see a patient every month, and yet, with wearable technology, they can track fluctuations in their health continuously. Such information can then be used to make appropriate adjustments to a patient’s treatment plan. “ We ’r e t r y i n g t o l e ve r a g e different sources of information that are available, so care is optimised at every stage for the patients,” confirms Maguire.

been deployed, but until there is connectivity - across hospitals, phar maceut ica l compan ies, research institutes and beyond - its potential won’t be optimised.

“It c a n be over whel m i ng,” acknowledges Maguire. “But fundamentally we’re trying to make the patient journey and the physician’s journey with the patient as easy as possible.”

Sharing information across the health care sector is vital M a ny he a lt hc a r e te a m s a r e already taking a more personalised approach to care, but Maguire is under no illusion that industry-wide adoption will be easy.

The technolog y is indeed available, and much has already

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How a cancer drug trial changed my life ANN BAKER Lung cancer patient

When Ann Baker was diagnosed with stage four lung cancer, she was told that chemotherapy was not a treatment option. However, a drug trial was — and has yielded positive results.

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ne night in 2016, 70-year-old Ann Baker developed severe pain in her shoulder. “I went to my GP who sent me for a chest X-ray,” remembers Ann. “That's when it was discovered that I had a tumour on my right lung.” It was devastating news and a complete shock, because Limerick-based Ann — a regular at the gym — wasn't displaying the symptoms of breathlessness or coughing usually associated with the disease.

Worse was to come. Unfortunately, after having part of her lung removed, it was discovered that the cancer had spread to the pleura (the thin membranes covering the outside of the lungs), which meant the disease was stage four and unsuitable for conventional chemotherapy. “My brother and sister had survived cancer,” says Ann. “So I assumed I would sail through it, too.”

Experience of a cancer drug trial Her oncologist suggested the possibility of receiving treatment from a trial drug; but more worry followed when Ann began developing double vision. At first she put this down to macular degeneration, but an MRI showed it was due to a small tumour on her brain. “Before I could receive the trial drug, I was told I needed radiotherapy to shrink the brain tumour,” she says.

“Which it did, thankfully.”

Ann admits that she didn't know much about cancer trial drugs, but had read about the experience of former US President Jimmy Carter, who had seen huge improvement in his cancer after going on a trial for a new immunotherapy drug.

She agreed it was the way forward and received her first treatment with a trial drug in January 2017. “It meant going to University Hospital Limerick every three weeks, which I was supposed to do for three years,” she says. “But after 13 months, I started experiencing side-effects including nausea and dehydration so I stopped receiving the treatment in March 2018.”

A way to help future generations Even so, Ann considers the trial to have been a complete success and “wouldn't hesitate” to do it again if necessary. “I'm stable and have been since the trial began,” she says. “And I feel great!

“I'm monitored with a CT scan every 12 weeks and a chest X-ray every six weeks. I'm 73 now and doing everything I did before. I don't have children myself, but I do have nieces and nephews and cancer is so prevalent these days. That was another reason I decided to go on a cancer trial: apart from saving my own life, I saw it as a way to help future generations.”

Byline: Tony Greenway

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20% funding cuts threaten cancer progress PROFESSOR BRYAN HENNESSEY Clinical Lead, Cancer Trials Ireland

We are standing on the cusp of a new dawn of personalised treatments that could revolutionise the way we treat cancer – but a lack of investment threatens to hold Ireland behind.

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apid advances in medical sc ience mea n we now understand more about cancer than ever, and a new generation of personalised medicine stands at the ready.

But as innovation comes to a global head, a lack of clinical trial investment means Ireland risks getting left behind, said Professor Br y a n Hen nes s y, Con s u lt a nt Medical Oncologist and Clinical Lead at Cancer Trials Ireland.

He says: “Cancer treatment is moving towards a position where it's based on a detailed understanding of the molecular abnormalities that drive cancer.

“C a nc er i s m a ny d i f ferent diseases and everyone’s cancer is unique. The more we see and understand these differences, the more targeted and personalised treatments we can develop.”

Clinical trials need more government funding The only way to develop these innovative new treatments, he went on, was by conducting robust clinical trials – but a lack of government and Department of Health funding is making that increasingly difficult to do in Ireland.

“The biggest barrier to carrying out cancer trials at the moment is funding; pure and simple. We have a National Cancer Strategy that aims to increase the proportion of people with cancer who go onto trials, but we are going in the wrong direction.

“We and ot her cancer tr ia l centres have seen significant cuts, of 20%, in funding since the economic recession. The percentage of people we are able to put onto

cancer trials is actually dropping.”

It means that Ireland risks being “left behind” in terms of the introduction of new treatments.

What’s more, it contributes to a disparity in the options available to people with the more common cancers, such as breast, lung and bowel, and those diagnosed with rarer forms of the disease, like pancreatic and kidney.

More focus on less common cancers is needed Professor Hennessy explains that Clinical Trials Ireland, which runs most of the country’s oncology studies, has two major funding sou rces: t he pha r m aceut ic a l industry and government.

“Industry funding ticks most of the boxes for common cancers, because that’s where they get the biggest bang for their buck. It's the government and Department of Health funding that allows us to keep the momentum going in less common cancers.

“So, we've got this new generation of innovative treatments coming out for a certain number of cancers, but it's not the case across the board,” said Professor Hennessy, whose department is currently working on treatments for common and rarer forms of cancer.

“People with cancer on cancer trials generally do better than those who are not” It’s not just about planning new treatments for the future but improving outcomes today, he went on. L ess money mea n s fewer trials, which has the effect

of blocking access to potentially life-saving treatments.

“If you've got a smaller proportion of people on cancer trials, you've got fewer people with access to brand-new, cutting-edge innovative treatments that have a good chance of improving the standard of care,” said Prof Hennessy.

“There's no question that people w it h cancer on cancer tr ia ls generally do better than those who are not, so the potential impact of this is that the outcomes of people with cancer in the country would suffer.”

Want to be part of a clinical trial? Just ask!

Raising public awareness of the importance of clinical trials is a vital plank of the organisation’s plan to overcome this issue.

Launched as part of 20 May’s Clinical Awareness Day, the “Just Ask Your Team” campaign encouraged cancer patients to speak to their healthcare team about getting involved in research, for example.

“Clinical trials are the only way that we improve cancer treatments, the only way that we can prove that new treatments are better than standard or older treatments.

“They're the only way to get new treatments safely and robustly evaluated in people with cancer so we can improve how we treat different cancers,” concluded Professor Hennessey.

Byline: Amanda Barrell Read more at healthnews.ie MEDIAPLANET

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