RCR Clinical Oncology: Inspiring Future Academics

in Clinical Oncology

The National Radiotherapy Research Strategy

David Sebag-Montefiore Professor of Clinical Oncology and Health Research

Honorary Consultant Clinical Oncologist

Deputy Chair CTRad

d.sebag-montefiore@leeds.ac.uk

@MontefioreD

And an excellent partner for a career in Clinical Oncology

https://quotefancy.com/quote/1399506/Frederick-Sanger-Scientific-research -is-one-of-the-most-exciting-and-rewarding-of https://quotefancy.com/quote/1399506/Frederick-Sanger-Scientific-research-is-one-of-the-most-exciting-and-rewarding-of

Radiotherapy is a crucial, effective and cost–effective cancer treatment

• >50% of cancer patients require RT • 60% treated with curative intent

• >100,000 UK patients receive RT with curative intent every year • Across all tumour sites and different technology platforms

Curative treatment by modality

2003 – NCRI Review

2006 Oxford Institute

2008 – NCRI Rapid Review

2009 – CTRad

2016 CTRad: ‘NCRI flagship’

2017 CRUK Radiotherapy Review

2015 Centres of Excellence

CTRad Mission Statement

To maximise the quantity and quality of life for

patients receiving radiotherapy by optimising

tumour control and minimising toxicity

CTRad Executive Group Chair

Deputy Chair Workstream co-chairs

Consumer representative Ex-officio members

NCRI Executive

Workstream 1 Science base

• Preclinical studies • Radiation-drug interactions

• Radiobiology • Biomarkers & imaging

•Physics & imaging

Workstream 2 Phase I/II trials

• Phase I/II studies • Experimental Cancer Medicine

• Biomarkers & imaging

• Systemic therapies and RT

Workstream 3 Phase III trials and

methodology

• Phase III trials • Linking with CSGs • Trials methodology development for evaluating novel RT approaches

Workstream 4 New Technology,

Physics, QA

• New technologies (e.g. proton therapy, SABR, functional imaging)

• Quality assurance • Radiotherapy Physics • Databases

General Membership

Membership Refresh and Launch New Strategy July 18

• WS1 (Basic Science) • 2 Co-chairs • 9 members + 1 PPI

• WS2 (Phase I/II) • 2 Co-chairs • 8 members + 1 PPI

• WS3 (Phase III and methodology) • 2 Co-chairs • 11 members + 2 PPI

• WS4 (New technology, physics and QA) • 2 co-chairs • 9 members + 1 PPI

• New General Membership Category n=80

Trainees very welcome Email - Carolyn.Chan@ncri.org.uk

TOTAL = >130!

RADCAS

SABR

RaDCom

Biomarker Support Network

Preclinical RTQA

RTTQA

Protons

Molecular RT

Database development

Academic work force development

Trials proposals meetings

CTRad Executive Group

WS1 (science base)

WS2 (phase I/II)

WS3 (phase III/

methodology)

WS4 (new technology,

physics, QA) Consumers

Proton Beam Clinical Trial Strategy Group

CTRad General Membership

Consumers (Patient and Public Involvement –PPI)

CTRad Strategic Vision 2018-21 http://ctrad.ncri.org.uk

Any sufficiently advanced technology is indistinguishable from magic.

Arthur C Clarke

https://www.telegraph.co.uk/news/obituaries/1582125/Sir-Arthur-C-Clarke.html

Current CT scan

MR Sim CT Scan

New Radiotherapy Technology – MR Linac

Elekta View Ray

New Radiotherapy Technology – Protons

Slides courtesy of Dr David Thompson Manchester

Stereotactic ABlative Radiotherapy

• Highly targeted • High ablative doses • 5-8 treatments • 90% local local control

Early stage Lung Cancer Leeds 2009-May 18 n=1531 pts

New Indications – CtE

NHS England >1200 patients treated (Feb 18)

CTRad Strategic Vision 2018-21 http://ctrad.ncri.org.uk

Practice Changing Radiation Therapy Trials for the Treatment of Cancer : where are we 150 years after the birth of Marie Curie? In Press BJC 2018

• Born 4th July 1867

• First woman to win a Nobel Prize

• First woman to win two Nobel Prizes and in two different scientific domains

• First female professor University of Paris

• Discovered Radium

• Founded Institute Curie

Authors • Marieke Thompson • Philip Poortmans • Anthony Chalmers • Corrine Faivre-Finn • Emma Hall • Robert Huddart • Yolande Lievens • David Sebag-Montefiore • Charlotte Coles

Practice Changing Trials – four disease “sites” n=47 trials; 47,890 patients

0 2 4 6 8 10 12

Breast

Lung

Prostate

Bladder

Rectal

Anal

UKNon UK

Last two decades

Development of clinical trial research proposals

• CTRad supports clinical trial research proposals development at all steps

• 184 trials reviewed at proposals guidance meetings up till June 16

Network of CTRad members within CSGs Consumers

CTRad provides reviews, feedback and guidance

Provision of expert reviewers for RT applications to CTAAC, NAC

184

Proposals submitted

Funded

58

CTRad Rated

48 87 22 27

Idea generation

Proposal development

Funding application

Funder peer review FUNDED

Lancet Oncology 2018 epub

Sharma et al Nature Reviews Clinical Oncology 2016

Alastair Greystoke, Gerry Hanna, Sarah Brown , on behalf of the CONCORDE study team

The proposed CONCORDE Study

Platform study of novel agents in COmbinatioN with COnventional RaDiothErapy in locally advanced disease

Leeds David Sebag-Montefiore

Sarah Brown Kevin Franks

Manchester Corrine Faivre Finn

James O’Connor Matthew Krebs

Oxford Ester Hammond Anderson Ryan

Glasgow Anthony Chalmers Stephen Harrow

Belfast Gerry Hanna

Richard Kennedy David G de Castro

Newcastle Alastair Greystoke

Chris Plummer

Cardiff Paul Shaw

Cambridge Susan Harden

11 ECMCs with RTTQA lung radiotherapy approval.

Primary endpoint: • DLTs within 3

months of RT

53.2Gy 28F

58.8Gy 28F

61.6Gy 28F

Ph II

Ph III

Pilot

T3/4 Nany,T2N1-3

Pilot/Ph II/PhIII

N=640

Leads – Hawkins and Sebag-Montefiore

ACT5

Primary end point :- 3yr locoregional failure

ACT3

Obsn

Margin ≤1mm

41.4Gy 23F

T1 N0/X Anal margin

Local excision

Phase II trial N=90

Lead – Renehan and Muirhead

50.4Gy 28F

41.4Gy 23F

ACT4

T1,T2<4cm N0/X

Randomised 2:1 Phase II trial

N=162

Leads – Adams and Harrison

PLATO - PersonaLising RadioTherapy dOse for Anal Cancer

CTRad Strategic Vision 2018-21 http://ctrad.ncri.org.uk

The Northern Oncology Trainees Collaborative for Healthcare Research NOTCH

@onctrainees

Dr Chris Jones @DrCMJones

Aims & objectives

THE NORTHERN ONCOLOGY TRAINEES COLLABORATIVE FOR HEALTHCARE RESEARCH

Aim: Promote high-impact collaborative trainee-led research Objectives: 1. Establish a network of research-interested trainees

2. Facilitate trainees to present & publish research

3. Enable learning & sharing of academic skills

4. Enhance networking opportunities

5. Promote leadership & teamwork

6. Undertake meaningful, practice-changing research

Sustainability: developing future academic leaders University of Leeds / Yorkshire Cancer Research University Academic Fellowships (UAF) – Examplar

• Consumable

Dr Louise Murray • Clinical Oncologist • CRUK PhD Leeds • Fellowship Toronto

Dr Ane Appelt • Physicist • CRUK PhD

Copenhagen • Post doc Denmark

• MRC Confidence in Concept –Reirradiation - STRIDER

• EPSRC – ePROMS SABR toxicity

• Co-lead YCR funded Aphrodite dose escalation trial in rectal cancer

• Big data distributed learning anal cancer

• Academic PA’s • 5 year tenure track to Associate Professor • 3 year probation review • Non Clinical PhD • Consumables budget

@cancerphysicist

Supporting academic training pathways Examplar - NIHR

Alex Gilbert

NIHR Academic Clinical Fellow

Royal College Radiologists Part 1 FRCR

Royal College Radiologists P art 2 FRCR

NIHR Lecturer 50% research

NIHR Clinician Scientist (pending)

NIHR PhD

@DeeGeeee

Current Clinical Oncology Trainees PhD and MD students - Leeds

Dr Chris Jones

Dr Katie Spencer

Dr Fin Slevin

Dr Fei Sun

Early mortality outcomes and cost-effectiveness of palliative radiotherapy for bone metastases in the English NHS

Optimising pelvic SABR (ART NET)

Cardiovascular outcomes in lung cancer

Unravelling non-genetic oncogenesis in oesophageal adeno-carcinoma: characterising the stress-inducible FGFR2-Grb2-

miRNA axis @DrCMJones

@Katiespencer72

The Twittersphere: A few suggestions

@gerryhanna @finn_corrine

@MontefioreD @ProfAJChalmers

@alison_tree

@achoud72

Conclusions

• Very exciting time to work in radiotherapy research!

• Crucial that we help development of our future academic workforce

• CTRad will drive the national strategy and we welcome trainees as members