Advances in Cancer Treatment

DOI: https://doi.org/10.58248/PN598 

Summary

The pace of innovation in cancer treatment is rapid, with promising outcomes for patients both in terms of survival and quality of life. Advances in scientific research and clinical practice in the fields of immunotherapy and radiotherapy has shown positive results in some cancers that are difficult to treat with standard first-line approaches. 

The current standard of care for cancer treatment might involve surgery to remove tumours, a combination of several chemotherapy drugs and/or conventional X-ray radiotherapy to kill cancer cells. There has been continuous gradual improvement in these treatment technologies due to advances in our understanding of how cancers work and how the immune system responds to cancer. Advances in genome editing have led to more “personalised” treatment approaches where cancer cells may be more accurately targeted, and treatments can be adapted for the individual patient. Despite this, these standard treatments are often ineffective in advanced or difficult-to-treat cancers and may have side effects that have a detrimental impact on the patient’s quality of life. 

There have been recent notable developments in radiotherapy and immunotherapy. These treatments, which are covered in this POSTnote, have shown promising results and clinical efficacy in particular types of cancer and patient subgroups. The downside is that these are expensive treatments, many will still result in severe side effects, and they require highly skilled clinical staff and specialist resources to deliver them.  

CAR T-cell therapy is an immunotherapy that involves collecting, modifying and using a patient’s own T-cells to treat their cancer. So far, CAR T-cells have been highly effective in clinical trials in treating some blood cancers in specific patient groups. In January 2019 the first NHS patient received a treatment infusion at Great Ormond Street Hospital, London. There are numerous ongoing clinical trials to determine its relevance for other cancers and into how to limit side effects. Another form of immunotherapy, immune checkpoint inhibitors, target proteins on T-cells to help them kill cancer cells. These are also available on the NHS for particular cancers and patient groups, and are the subject of further clinical trials. 

In radiotherapy there have been significant advances in imaging, machine manoeuvrability and patient immobilisation techniques, which allow for more precise treatment delivery. The UK has two new Proton Beam Therapy Centres which have recently begun treating specific patient groups for whom proton therapy is clinically advantageous. Developments in molecular radiotherapy mean that radioactive isotopes can be infused or injected into patients with certain cancers that spread, resulting in the effective treatment for some patients with metastatic cancers. 

The National Institute for Health and Care Excellence and the Cancer Drugs Fund (and the relevant bodies in the devolved administrations) have changed their funding and evaluation processes so that innovative cancer treatments can be accessed by NHS patients as soon as possible. Overall, patients have good access to information about available treatments. Many play an increasingly active role in decision–making about their care and about the development of cancer treatments. Clinicians can support patients in this process by using evidence–based guidelines about new treatment technologies.  

Key Points

• New cancer treatment technologies have shown promising results in clinical trials, particularly for difficult-to-treat cancers. 
• Significant progress has been made in cancer immunotherapies for specific cancers and patient populations. Research into the use of these therapies for other cancers and patients is ongoing.
• Advances in radiotherapy include improved imaging and precision, proton beam therapy and molecular radiotherapy, all of which have also shown positive clinical results.
• Combination therapies, which combine different types of immunotherapy, or drug and radiotherapies, are a priority for current and future research. 
• New therapies require specialised knowledge and resources; stakeholders agree that they should be delivered as part of a comprehensive multidisciplinary care package.

Acknowledgements

POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

• Professor Frances Balkwill*, Board Member of the Parliamentary Office of Science and Technology and Queen Mary University
• Julian Braybrook*, National Measurement Laboratory 
• Professor Neil Burnet*, The Christie NHS Foundation Trust 
• Bloodwise
• Dr Yen Ch’ing Chang*, University College London Hospitals 
• Professor Peter Clark, Cancer Drugs Fund 
• Henry Edwards*, National Institute for Health and Care Excellence 
• Rose Gray*, Cancer Research UK
• Dr Sara Ghorashian*, Great Ormond Street Hospital
• Brad Groves*, Cancer Drugs Fund
• Dr Pasquale Innominato, University of Warwick
• Professor Karen Kirkby*, University of Manchester
• Rob Lester*, patient representative  
• Professor Ran MacKay, The Christie NHS Foundation Trust 
• Dr John Maher*, King’s College London  
• Paul Martynenko*, Board Member of the Parliamentary Office of Science and Technology* 
• Professor Alan Melcher, Institute of Cancer Research, London 
• Dr Rebecca Nutbrown*, National Physical Laboratory ‏ 
• Professor Glenn Flux*, The Royal Marsden Hospital
• Dr Sheuli Porkess, Association of the British Pharmaceutical Industry 
• Dr Alasdair Rankin, Bloodwise  
• Phil Reynolds*, Bloodwise 
• Dr Olivia Rossanese, Institute of Cancer Research, London  
• Professor Ricky Sharma*, University College London 
• Sir Bernard Silverman FRS, Board Member of the Parliamentary Office of Science and Technology* 
• Professor Henning Walczak, University College London 
• Christopher Walden, Bloodwise 
• Professor Catharine West*, University of Manchester  
• Dr Steve Williamson, Cancer Drugs Fund 
• Craig Whittall, Policy@Manchester

*Denotes those who acted as external reviewers of the briefing.

Image Copyright Darryl Leja, National Human Genome Research Institute, National Institutes of Health