I am a Consultant Medical Oncologist and Professor of Thoracic Oncology, which means I'm an expert in the treatment of cancers that arise within the chest. Fundamentally, that means three types of cancers: lung cancer, which is actually a group of many, many different types of diseases; mesothelioma, a less common cancer of the lining of the lung; and a rare tumour called thymoma or thymic carcinoma, which is an unusual tumour of the thymus gland in the chest. Specifically, I focus on the drug treatment of these cancers and work out how best these should be treated. For example, should the patient undergo surgery, radiation or drug treatment, and in which order?
There are various types of drug treatments that we can give. Traditionally, one might have thought that an oncologist would only be giving chemotherapy, but nothing can be further from the truth for the typical patient I see with lung cancer. Although chemotherapy is useful for many patients, we often use immunotherapy either by itself or in combination with chemotherapy. Immunotherapy is a newer treatment that harnesses the patient's own immune system so that it attacks the underlying cancer.
Another group of drug treatments we give are molecular targeted therapies. In this scenario, we perform comprehensive molecular analysis on a sample taken from a patient and work out whether they are best treated with chemotherapy, immunotherapy, a combination of the two, or a molecular targeted therapy in tablet form. The latter matches a molecular or genetic signature within the cancer to a particular drug, meaning that the treatment is personalised to the individual.
Working out the right treatment for a patient is dependent on a number of factors, including how much cancer they have, the particular molecular fingerprint of their cancer, their general health and fitness, and how strong their lungs are. The treatment strategy is decided in conjunction with other colleagues in the multidisciplinary team (MDT), and we're very fortunate to work here at The Royal Marsden with global leaders in their field.
I am very proud that our team at The Royal Marsden won the International Association for the Study of Lung Cancer’s Cancer Care Team Award for the Europe region in 2021, which was especially pleasing because this is a patient-nominated award.
We have a research-led diagnostic and treatment private care facility based at Cavendish Square in London’s Harley Street district, as well as our private care facilities at our hospitals in Sutton and Chelsea. I am based at both Chelsea and Cavendish Square.
Patients would see me and, also, a Clinical Nurse Specialist (CNS), who would be their key worker through their cancer journey. We would undertake a comprehensive evaluation of their cancer and review any previous scans or tests that have been provided. We would also review any specimens they may have brought to be confident of the patient’s original diagnosis. If not, we will assess the status of the cancer and, if required, carry out additional tests, such as a biopsy – removing a small tissue sample for further examination under the microscope.
We are very fortunate to work with some of the world's leading pathologists. In fact, one of our pathologists has recently co-authored with the World Health Organization (WHO) the current textbook of how we should be classifying our tumours – we really are working with experts at the top of their field.
More often than not, we would want a specimen to undergo comprehensive molecular analysis in our genomics laboratory at The Royal Marsden, which is one of the UK’s leading genomics laboratories. The important thing here is how that molecular analysis is interpreted in order to decide the optimal treatment for patients. We have a history of expert genomics here at The Royal Marsden and I am a professor of thoracic oncology at The Institute of Cancer Research, London, focusing on the genomics of lung cancer to best determine and decode the genetic signatures that we see in our patients.
For our international patients, we establish and enact a treatment plan and monitor each individual to ensure they are tolerating the treatment and that no side effects are occurring – whether this involves chemotherapy, immunotherapy, or a tablet of molecular targeted therapy – and that their cancer is on the right trajectory before they are in a position to return home. Treatment may then be continued in conjunction with their local oncologist.
Some patients may require a brief period of drug treatment before being considered suitable for surgery, in which case we would recommend they have their surgery with us. If a patient needs surgery, we would be able to arrange that in the right timeframe, after confirming the diagnosis and that surgery was the best way forward. In terms of thoracic malignancies, we work with our partners at Royal Brompton Hospital – a world-leading thoracic surgical centre, where we have a shared practice for surgery.
Research is critical to improve our knowledge and expertise in determining the right treatment for each individual. Such research takes place at a global level and I am leading several clinical trials in which we are evaluating new drugs to be used in patients with a variety of lung cancers. It's important that we have these trials in our portfolio because our patients may be eligible. But, more importantly, we will also have advance understanding of how such drugs work when they are approved, which can be approximately two years later.
My colleague Dr Fiona McDonald, Consultant Clinical Oncologist, is also leading the way in advanced radiotherapy with several studies using advanced radiation technologies in patients with very specific types of lung cancer to improve their outcomes, looking specifically at the role of stereotactic radiotherapy, which is delivered from various angles around the body. These research projects are important for The Royal Marsden because, when such treatments become the standard of care, we are already experts in their delivery.
I am really interested in the molecular profiling of cancer, which continues to transform the face of lung cancer treatment. As little as 15 years ago, lung cancer was considered a death sentence, with the average survival time of less than a year for patients with metastatic or widespread lung cancer, which form the majority of cases. Through genomic screening and molecular profiling of patients and the implementation of immunotherapy and molecular targeted therapy, some patients are now living for years. We are seeing a much improved survival rate for patients due to these breakthrough treatments.
What really excites me for the future is how we will implement the new drugs that are coming through and how new genomic technologies will enable us to do this at the right time for each patient. In diagnostics, one of the novel technologies coming through is something called liquid biopsies, in which we are taking a blood sample and are able to detect at extremely low levels parts of the tumour’s genes or the tumour’s DNA, which are shed into the blood. Understanding that blood test is a key skill and art, and this is an area in which The Royal Marsden team has great expertise. It is an evolving field that, I think, will revolutionise how we manage cancer over the next five years.
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