1
00:00:04.080 –> 00:00:10.740
You’re listening to the Cornwall Cancer Cafe podcast with me, Matthew and me, Emma. Thanks to
2
00:00:10.740 –> 00:00:17.520
the National Lottery Community Fund for supporting this podcast. So we’re back with Dr. Dave Tucker
3
00:00:18.080 –> 00:00:25.380
in his office in Hematology in the Royal Cornwall Hospital, otherwise known as Trilisk,
4
00:00:25.700 –> 00:00:31.720
you know, so what do you call it? RCH or do you call it Trilisk? Trilisk. Trilisk,
5
00:00:31.720 –> 00:00:36.580
okay, yes. Okay, so they’ve just got to clear these things up from an early start, you know,
6
00:00:36.700 –> 00:00:42.320
but I think as a quick name Trilisk flows off the tongue, doesn’t it? What do you call it?
7
00:00:42.980 –> 00:00:49.280
Yeah, Royal Cornwall or RCHT or Trilisk. Are you given guidance for what you’re meant to say?
8
00:00:49.640 –> 00:00:55.580
Well, we are given guidance, actually. A year or two ago, we were asked all to
9
00:00:57.880 –> 00:01:03.180
make our email sign-offs uniform, and I think it says something like Royal Cornwall on there,
10
00:01:03.200 –> 00:01:07.480
but yeah, no, they do like for us to use the proper nomenclature.
11
00:01:08.260 –> 00:01:13.000
Oh, that’s a long word. And I’m sure we might have some other long words.
12
00:01:13.020 –> 00:01:13.640
Four syllables.
13
00:01:13.860 –> 00:01:16.660
Four syllables. Well, I’m sure we’re going to have lots of other long words.
14
00:01:16.660 –> 00:01:25.980
Yes, and because this week we are discussing new developments because, I mean, this is something
15
00:01:25.980 –> 00:01:30.700
which really catches your attention. Why does this catch your attention so much?
16
00:01:31.100 –> 00:01:35.140
Yeah, it’s probably the reason, one of the reasons I went into hematology, to be honest,
17
00:01:35.280 –> 00:01:41.360
Matty. I’m really fascinated and enthused by technology and the new developments that
18
00:01:41.360 –> 00:01:46.380
are coming through medicine and hematology is really at the forefront of lots of drugs that
19
00:01:46.380 –> 00:01:53.460
coming through. So we’re very interested in research here. We do a lot of big projects
20
00:01:53.460 –> 00:01:57.980
with sponsors to develop new drugs. That’s something that I’m really interested in.
21
00:01:58.620 –> 00:02:01.760
So yeah, it’s a big thing. It’s a big part of our work.
22
00:02:03.120 –> 00:02:08.080
So if we’re talking about medications for cancer and hematology in particular,
23
00:02:08.820 –> 00:02:17.000
if you go back over the decades, we started using cancer, anti-cancer chemotherapy,
24
00:02:17.120 –> 00:02:23.920
which we normally call chemotherapy nowadays. Well, back in the 40s, 50s and 60s,
25
00:02:24.540 –> 00:02:29.980
with fairly conventional chemotherapy drugs, and they’ve been in use ever since and still
26
00:02:29.980 –> 00:02:35.740
remain in use. They’re good drugs for killing cancer cells, but the problem with them is
27
00:02:35.740 –> 00:02:42.260
they tend to be non-specific. So they tend to try to kill any cell that’s dividing sometimes.
28
00:02:42.260 –> 00:02:46.060
And some of them can be a bit nasty. I think I had the Red Devil,
29
00:02:46.600 –> 00:02:51.140
but I can’t remember the name. Yeah, Dornarubicin or Doxorubicin.
30
00:02:51.160 –> 00:02:59.990
That’s the one. Yeah, that’s a red solution and it’s a drug which basically just
31
00:03:01.290 –> 00:03:07.990
stops cells from dividing and creates new damage to cells. So it doesn’t only damage
32
00:03:07.990 –> 00:03:12.210
the cancer cells. That kind of combination of drugs don’t only damage cancer cells.
33
00:03:12.310 –> 00:03:17.610
Often they’ll damage non-cancer cells, which are also dividing. And so as a result,
34
00:03:17.650 –> 00:03:22.390
you get lots of the side effects that we all know about things like hair loss and skin
35
00:03:22.390 –> 00:03:29.610
thinning and inflammation of the gut, because all of those cells are also dividing.
36
00:03:29.610 –> 00:03:35.650
If you lose those, then you get those sorts of problems. And over the last few years,
37
00:03:36.850 –> 00:03:44.670
really since the 1990s and beyond, we’ve become much smarter in the drugs that we use in cancer.
38
00:03:45.010 –> 00:03:50.890
And we are more and more using drugs that harness the immune system. And we’re much
39
00:03:50.890 –> 00:03:55.510
cleverer about how we target our cancer cells because we know so much more about them.
40
00:03:55.510 –> 00:04:02.370
So that’s really an exciting area for me. But I think it’s worth just spending a moment
41
00:04:03.330 –> 00:04:08.050
thinking about how those drugs are developed because they don’t just come to us.
42
00:04:08.430 –> 00:04:12.770
They’re not just out of thin air. And this goes on all around the world,
43
00:04:12.810 –> 00:04:19.290
doesn’t it? So there’s a lot of labs and a lot of countries and it all comes together,
44
00:04:19.310 –> 00:04:23.910
doesn’t it? That’s right. Yeah. So what happens in the, because we do a lot of these
45
00:04:23.910 –> 00:04:31.730
trials, what happens initially is a lab will develop a drug which they can see is effective
46
00:04:31.730 –> 00:04:38.110
in a cellular level in the laboratory in cell culture. They use cell, what are called cell
47
00:04:38.110 –> 00:04:42.990
lines, which are cancer cells that they can grow and keep alive. And then they can use
48
00:04:42.990 –> 00:04:47.710
new drugs. Once they’ve got a compound that they’re happy with or a technique that they’re
49
00:04:48.330 –> 00:04:55.010
then start to develop those into very early phase trials. And clinical trials start
50
00:04:55.010 –> 00:05:00.530
really with a phase one, which is sort of what we call often first in human.
51
00:05:01.150 –> 00:05:06.770
And those trials are very small trials. And really they’re looking at, is this drug safe
52
00:05:07.290 –> 00:05:12.790
to use in human beings? First of all, is it safe? And that’s the most important thing.
53
00:05:13.370 –> 00:05:19.210
And then once we’ve gone through phase one and established safety and side effects and the dose,
54
00:05:19.790 –> 00:05:24.270
the trial then moves into a second phase. And that’s a wider phase where they roll the
55
00:05:24.270 –> 00:05:30.510
drug out into more patients. And those are called phase two trials. We take part in lots
56
00:05:30.510 –> 00:05:35.310
of phase two trials and indeed some phase one trials, even here at Royal Cornwall Hospital.
57
00:05:36.330 –> 00:05:40.810
So phase two trials are for a wider patient base and they’re just look at effectiveness.
58
00:05:40.810 –> 00:05:48.170
So we know it’s safe, how effective it is. And so we do large phase two trials and those are
59
00:05:48.170 –> 00:05:55.370
usually conducted in multiple sites. So across the globe, often the studies are
60
00:05:55.370 –> 00:05:59.530
conducted in lots of different countries to show that they’re safe and effective
61
00:05:59.530 –> 00:06:05.310
and can be used in lots of different healthcare settings. Once you’ve got through phase two,
62
00:06:05.310 –> 00:06:09.790
the trial then goes to phase three, which is a much bigger,
63
00:06:10.010 –> 00:06:14.790
wider trial where they try them out on much larger numbers. And it’s only when you get
64
00:06:14.790 –> 00:06:19.630
to those really large numbers that you can be sure that you’re not missing any major side
65
00:06:19.630 –> 00:06:24.610
effects because you might not see something that happens very occasionally in a small group of
66
00:06:24.610 –> 00:06:29.430
patients, but you will see it if it happens in a thousand or a few hundred patients,
67
00:06:29.430 –> 00:06:33.330
for example. So that’s called a phase three trial. And then at that stage,
68
00:06:33.890 –> 00:06:40.070
the company will then usually go to the licensing organization of the country
69
00:06:40.770 –> 00:06:45.210
and say, we’ve got this drug. We’ve proven that it’s safe. We’ve proven that it’s effective.
70
00:06:45.490 –> 00:06:51.930
We would like you to give us a license for us to use that drug. And in the UK, we have
71
00:06:52.530 –> 00:06:57.150
the licensing organization, the regulatory authorities called the MHRA. It’s different
72
00:06:57.150 –> 00:07:01.750
in Europe. It’s the EMA. And in America, people might have heard of the FDA, which is
73
00:07:01.750 –> 00:07:08.890
the Federation of Drugs over there. So each one of those will issue a license if they’re happy
74
00:07:08.890 –> 00:07:13.970
that the company has provided enough safety data and enough effectiveness data. And then once
75
00:07:13.970 –> 00:07:21.890
they’ve got the license, they can then start to approach health providers like the National
76
00:07:21.890 –> 00:07:26.690
Health Service and say, we’ve got this drug. It’s licensed. We would like you to be
77
00:07:27.270 –> 00:07:34.230
funding it basically. Emma, have you been on a trial? I haven’t, but I do have a question.
78
00:07:34.950 –> 00:07:39.890
I think that’s one of your jobs here, isn’t it? To ask questions.
79
00:07:40.210 –> 00:07:46.790
Thank you. So you’ve mentioned two continents. You’ve mentioned America and Europe. Obviously,
80
00:07:46.870 –> 00:07:52.110
there are other continents. My question is more about the coordination of it. How does it get
81
00:07:52.110 –> 00:07:56.810
coordinated around the continents and around the globe, and especially with America being
82
00:07:56.810 –> 00:08:03.530
as it is at the moment? I know Trump’s reduced the funding that’s going into health care.
83
00:08:03.930 –> 00:08:09.550
So I know that the coordinators over in America, there’s fewer of them. So I was just
84
00:08:09.550 –> 00:08:14.170
wondering how it gets coordinated, not just in Europe and America, but all the way around
85
00:08:14.170 –> 00:08:20.050
the world. And who does all the negotiating? And also, how do you feed back the data
86
00:08:20.050 –> 00:08:25.370
that you get during your trial? Yeah. So those are two massive questions.
87
00:08:25.670 –> 00:08:30.910
And they may be a bit above my pay grade, certainly, on the coordination around the
88
00:08:30.910 –> 00:08:38.610
globe. The honest truth is that there are differences in what’s licensed in Europe and
89
00:08:38.610 –> 00:08:43.490
what’s licensed in the US, for example. Usually, there’s harmony over the two,
90
00:08:43.490 –> 00:08:51.690
but there is a bit of difference. Some drugs will come to the US or Europe first and take
91
00:08:51.690 –> 00:08:58.170
a bit of a time to get adopted. So I’m not an expert on the coordination around the globe,
92
00:08:58.190 –> 00:09:03.650
but there are some discrepancies because what you have to remember is that sometimes the
93
00:09:03.650 –> 00:09:11.270
evidence is a little bit ambiguous or not quite as good as it might certainly look to
94
00:09:11.270 –> 00:09:16.850
the company. And the companies obviously are very enthusiastic about their drugs and say,
95
00:09:16.890 –> 00:09:21.810
you know, this really works, but then that has to be looked at in the cold light of day by
96
00:09:21.810 –> 00:09:28.730
a sort of a non-biased assessor. So there are some ambiguities sometimes and some discrepancy
97
00:09:28.730 –> 00:09:33.290
between what’s licensed. But the bigger question really for me is that once the drug is
98
00:09:34.050 –> 00:09:40.710
licensed, it’s whether or not that healthcare provider will pay for it. And that is a
99
00:09:40.710 –> 00:09:45.930
question that often gets the press into the press because patients will sometimes be aware
100
00:09:45.930 –> 00:09:51.510
of drugs that, well, this is licensed. Why can’t I get it on the NHS, for example?
101
00:09:51.870 –> 00:09:58.310
And that occasionally happens. I would start by saying that the NHS is really proactive
102
00:09:58.310 –> 00:10:05.030
in terms of funding new cancer medications. And there are drugs that we use here in the
103
00:10:05.030 –> 00:10:12.270
NHS, which are not available in other developed and wealthy companies because they don’t
104
00:10:13.030 –> 00:10:19.450
necessarily fund them through their healthcare settings. So there are differences there,
105
00:10:19.450 –> 00:10:25.270
but generally the NHS is generally as generous as it can be in terms of what it can provide
106
00:10:25.270 –> 00:10:29.930
based on the evidence. But sometimes it does say no. And the organisation that does that
107
00:10:29.930 –> 00:10:36.050
is called NICE. So NICE will look at the clinical effectiveness and say, well,
108
00:10:36.710 –> 00:10:43.370
how much is this drug costing? Do we think it’s going to be value for our taxpayers?
109
00:10:43.670 –> 00:10:45.190
So they’re talking about bang for the buck.
110
00:10:45.370 –> 00:10:49.030
Bang for the buck, exactly. And sometimes they have to make really difficult decisions
111
00:10:49.030 –> 00:10:53.190
and they have to say, well, actually on balance, we don’t think that this adds a
112
00:10:53.190 –> 00:10:59.290
huge amount or more often they do say, yes, I think that this would be a good drug to
113
00:10:59.290 –> 00:11:06.510
commission. I have noticed that that is the case in some situations where someone has a
114
00:11:06.510 –> 00:11:14.930
limited life expectancy and they want to use a drug which will give them say another
115
00:11:14.930 –> 00:11:20.210
two months and it’s going to cost millions. Exactly. And that’s a really difficult
116
00:11:20.210 –> 00:11:25.450
decision to make because he’s sort of balancing economics with life expectancy.
117
00:11:25.450 –> 00:11:30.690
And those are two really difficult things to balance. I feel actually that most of the time
118
00:11:31.270 –> 00:11:37.690
NICE does get things right. And we’re very lucky to be able to prescribe
119
00:11:38.630 –> 00:11:44.930
lots of medications on the NHS, but they are expensive. They do come with a cost and those
120
00:11:44.930 –> 00:11:49.710
costs are understandable. The companies need to regain the money that they put into the
121
00:11:49.710 –> 00:11:55.430
development of the drugs and running clinical trials is really expensive. I mean, that’s the
122
00:11:55.430 –> 00:12:02.510
so it’s a real difficult balance, but NICE makes that decision for us. In the US, it’s different.
123
00:12:02.930 –> 00:12:09.390
If a drug is licensed on the FDA in the US, you can buy it and you can ask your physician
124
00:12:10.050 –> 00:12:13.830
to prescribe it for you. It doesn’t need to go through. They don’t have the same
125
00:12:13.830 –> 00:12:21.090
healthcare setting over there. But I have noticed that they have for say non-Hodgkin’s lymphoma,
126
00:12:21.090 –> 00:12:26.050
very different chemotherapy regimes, because I’ve been looking at people commenting on them
127
00:12:26.050 –> 00:12:32.070
and they don’t seem to use our chop as much. No, I mean, in the US, I don’t I’m not an expert
128
00:12:32.070 –> 00:12:38.190
on the US healthcare system, but it does lead to inequality, I think, because it depends a
129
00:12:38.190 –> 00:12:43.470
little bit on what your insurance can provide and what you can pay for. Whereas we’re
130
00:12:43.470 –> 00:12:50.310
fortunate to have this paid for by the NHS. So and to be fair, I mean, we were talking
131
00:12:50.310 –> 00:12:56.350
earlier about how do you coordinate between the different countries? Well, we in all specialties,
132
00:12:56.350 –> 00:13:03.830
we tend to go to big international conferences where we discuss which treatments we give.
133
00:13:03.930 –> 00:13:08.970
And so we try to harmonize what we get. So there isn’t the discrepancy and that tends
134
00:13:08.970 –> 00:13:15.270
to be based on what’s the evidence? Why is this a good regime? And why does it work? And
135
00:13:15.270 –> 00:13:20.490
should we be adding something different to it? So we do talk and we do discuss these things.
136
00:13:21.130 –> 00:13:27.030
But there’s always going to be situations where people feel I wasn’t able to get the drug that
137
00:13:27.030 –> 00:13:32.370
somebody else got, for example. And that’s difficult. But most of the time, I think we
138
00:13:32.370 –> 00:13:39.810
get it right, I would say, in this country. I suppose the question about technology and the
139
00:13:39.810 –> 00:13:43.950
development of new drugs, Emma, we’ve heard so much about AI recently in the news, haven’t
140
00:13:43.950 –> 00:13:51.670
we? Yes, yes, AI is. There’s something very recently about AI actually sort of gatekeeping
141
00:13:51.670 –> 00:13:57.230
itself as well, isn’t there? So obviously, AI is playing a big part in in medicine because
142
00:13:57.970 –> 00:14:04.970
it’s faster and quicker and and hopefully will and brings to we talk about developments
143
00:14:04.970 –> 00:14:10.510
going on around the world. And I suppose AI can dip into everything and then come up with
144
00:14:10.510 –> 00:14:15.710
a solution. Yeah, and hopefully that will be the case. At the moment, we’re still,
145
00:14:16.190 –> 00:14:22.310
I guess, that’s still on the horizon. And we’re not sort of seeing that in the clinic. But
146
00:14:22.310 –> 00:14:25.910
hopefully in the future, that will be the case. And that leads to another interesting point is
147
00:14:25.910 –> 00:14:32.050
that some of these, thankfully, some of our cancer types that we have now have much better
148
00:14:32.050 –> 00:14:37.370
outcomes than they used to, which means that the old measurements that we use for these
149
00:14:37.370 –> 00:14:44.690
like how long the patients survive and on a certain drug, they almost become very difficult
150
00:14:44.690 –> 00:14:49.690
to run trials on because patients may survive for a very long time. And so the trial,
151
00:14:49.970 –> 00:14:55.170
the companies will say, well, we can’t afford to run a trial for 15 years. And so they have
152
00:14:55.170 –> 00:15:00.630
to use what are called surrogate outcomes, which is where they say, well, we can’t measure
153
00:15:00.630 –> 00:15:04.310
overall survival anymore because it’s just too long into the future. So we measure
154
00:15:05.810 –> 00:15:11.150
molecular targets and to see when the drugs, when the molecular targets start to change,
155
00:15:11.150 –> 00:15:15.950
and we use those to project how effective our drugs are. So that’s really important.
156
00:15:15.950 –> 00:15:20.710
And I think that that is quite relevant to the last drug that I was on, glofitamab,
157
00:15:20.870 –> 00:15:28.210
in that I was on it just months after it was licensed. And I believe you’ve been doing
158
00:15:28.210 –> 00:15:35.950
trials on it as well. But the thing is, is that going through appointments whilst on
159
00:15:35.950 –> 00:15:42.150
glofitamab, it seems the results are coming through that it’s actually more effective and
160
00:15:42.150 –> 00:15:48.770
more durable than we thought. And so it’s still developing that information even once it’s
161
00:15:48.770 –> 00:15:55.090
licensed. Absolutely. So you’ll get initial interim data sets that say this is really good
162
00:15:56.450 –> 00:16:01.330
and that’s enough for the commissioners to say, yes, we’ll pay for it. But the overall
163
00:16:01.330 –> 00:16:09.030
long-term data is still to come. So we often see outcomes for that. And that really, yeah,
164
00:16:09.490 –> 00:16:14.610
I was going to go on and talk about those sorts of new drugs, which are really exciting.
165
00:16:14.830 –> 00:16:17.410
I see a question coming from my left hand side here.
166
00:16:17.530 –> 00:16:23.330
Yeah, I was going to ask if you could talk about if a patient comes to you and you say,
167
00:16:23.330 –> 00:16:27.930
we’ve got this new trial, what can they expect? So it sort of fits in, I think,
168
00:16:27.990 –> 00:16:31.870
probably with what you’re about to say. So there’s a new drug coming out,
169
00:16:31.890 –> 00:16:34.910
a new trial coming out, a patient comes to you, you’re like this patient,
170
00:16:35.010 –> 00:16:38.370
this trial is going to fit. What happens next?
171
00:16:38.730 –> 00:16:46.070
Well, that’s great. So if we have a new clinical trial, what we have to do is make
172
00:16:46.070 –> 00:16:51.050
sure patients give us informed consent to go into that trial. So they’ll usually
173
00:16:51.050 –> 00:16:58.610
expect a very weighty patient information sheet or sheets of paper with all of the
174
00:16:58.610 –> 00:17:03.370
tests and things that they would be expected to have if they go into the clinical trial.
175
00:17:03.830 –> 00:17:10.109
It will tell them what might happen, the sort of probabilities of things that might happen
176
00:17:10.109 –> 00:17:14.650
in some of those things. But it will also tell them the uncertainties. So we have to
177
00:17:14.650 –> 00:17:17.829
be honest with patients. If we’re putting them into clinical trials, we don’t know
178
00:17:18.390 –> 00:17:23.849
whether it’s going to be more effective than the current standard. And we have to be honest
179
00:17:23.849 –> 00:17:30.990
about that so that they know that there’s an element of uncertainty there.
180
00:17:31.930 –> 00:17:35.870
But if you go into a clinical trial, it depends a little bit on the type of trial,
181
00:17:36.170 –> 00:17:38.390
obviously the phase one or phase two or phase three.
182
00:17:38.470 –> 00:17:42.790
And I suppose there’s also whether you’re being given an active
183
00:17:43.430 –> 00:17:46.110
or a passive or a placebo type.
184
00:17:46.270 –> 00:17:53.050
So that’s another how the trial is designed. So some trials, the most sort of kind of
185
00:17:53.050 –> 00:17:58.310
robust, scientifically robust trials are ones where you’re compared in a randomized
186
00:17:58.310 –> 00:18:03.030
controlled trial, which is where you’re taken into the trial, but we don’t know
187
00:18:03.030 –> 00:18:09.650
and you don’t know whether you’re going to get the experimental treatment or the standard
188
00:18:09.650 –> 00:18:16.710
treatment. And that reduces the risk of bias coming into the trial. So if neither of us know,
189
00:18:16.710 –> 00:18:23.010
then we can’t be biased about the results. And it also increases the integrity of the trial
190
00:18:23.010 –> 00:18:29.150
because you’re actually comparing it like for like with patients who are going through the
191
00:18:29.150 –> 00:18:34.470
same clinical trial. Some trials are run like that. Some trials these days are what
192
00:18:35.130 –> 00:18:42.310
is where you’ll only get the new treatment. So there’s a variety of different models for
193
00:18:42.310 –> 00:18:49.450
delivering clinical trials in cancer. Sometimes it’s unethical to have a placebo if we know
194
00:18:49.450 –> 00:18:56.370
that the placebo wouldn’t be effective. But most trials are not controlled in cancer with
195
00:18:56.370 –> 00:19:00.870
just a placebo. They’re controlled with a standard therapy that we’ve used for years
196
00:19:00.870 –> 00:19:05.530
versus the new therapy. And we have to be honest, we don’t know whether that new therapy will be
197
00:19:05.530 –> 00:19:10.670
effective until we’ve seen the results. And I think that’s the case when I was on my R-Trop.
198
00:19:10.930 –> 00:19:17.790
There was a trial drug on top. So I had got the normal R-Trop with extra drugs to see what
199
00:19:17.790 –> 00:19:30.850
happened. And then once that information is known, we then decide whether we’re going to
200
00:19:30.850 –> 00:19:36.590
add a drug to an already established regime is not the right thing to do because it might add
201
00:19:36.590 –> 00:19:43.030
side effects. So sometimes taking away a drug or running things and that regime needs to be
202
00:19:43.030 –> 00:19:48.550
sort of adjusted. So there are all sorts of considerations when you’re starting a trial.
203
00:19:48.930 –> 00:19:55.990
I suppose this actually leads me to think on the patient side of it.
204
00:19:55.990 –> 00:20:03.610
One of the reasons why I went on a trial was because I knew that I’d have extra monitoring
205
00:20:03.610 –> 00:20:08.290
and for my anxiety. You know what my anxiety is like. That was great.
206
00:20:08.590 –> 00:20:13.590
Yeah. Yeah. I know talking to a lot of cancer patients, there’s a lot of anxiety out there.
207
00:20:13.790 –> 00:20:20.310
There’s more anxiety than there is calmness generally in people that I’ve spoken to
208
00:20:20.310 –> 00:20:23.970
generally across all of the different bits and pieces that I’ve been involved with.
209
00:20:23.970 –> 00:20:29.350
So anxiety is definitely a thing. And I know that having the research team monitoring me.
210
00:20:30.370 –> 00:20:33.910
Being on a trial could also make you more anxious because you don’t know what the
211
00:20:33.910 –> 00:20:38.270
outcome is going to be. So there’s all of that to be considered as well, isn’t there?
212
00:20:38.370 –> 00:20:43.210
And what are your thoughts on that? Well, yeah. I mean, I’m a real advocate
213
00:20:43.210 –> 00:20:49.650
for going into clinical trials because it makes us better. It makes our practice better.
214
00:20:49.650 –> 00:20:55.550
It makes our outcomes better. So I would always encourage patients to think about
215
00:20:55.550 –> 00:21:00.810
going into clinical trials and they’re not always about experimental new therapies.
216
00:21:00.850 –> 00:21:04.430
Sometimes they’re asking questions about, well, how do we sequence these things?
217
00:21:04.530 –> 00:21:10.490
Do we need to do more scans at certain points? Do we change how we do monitoring
218
00:21:10.490 –> 00:21:14.870
afterwards? So they’re not all about new experimental therapies and sometimes they’re
219
00:21:14.870 –> 00:21:21.450
about changing what we do do. The anxiety is a real issue and I can fully appreciate that.
220
00:21:21.970 –> 00:21:28.490
But patients hopefully will get good attention and care whether or not they decide to go into
221
00:21:28.490 –> 00:21:33.870
a clinical trial because we wouldn’t want patients to feel they’re getting second
222
00:21:33.870 –> 00:21:39.050
best with either of those two things. So hopefully that will be something that we can
223
00:21:39.050 –> 00:21:42.410
allay. But yeah, it is an issue.
224
00:21:55.520 –> 00:22:02.200
You’re listening to Dr. Dave Tucker talking to Emma and myself on the Cornwall Cancer Cafe
225
00:22:02.200 –> 00:22:07.320
podcast. And Emma, what’s caught your attention so far?
226
00:22:08.200 –> 00:22:16.840
Oh, just the amount of progress that’s going on is incredible, isn’t it? And the speed.
227
00:22:17.140 –> 00:22:22.020
Well, what’s the most exciting thing that you’re currently looking at which
228
00:22:22.020 –> 00:22:29.940
gives you real hope for big changes? So I think over the last two or three years
229
00:22:29.940 –> 00:22:34.880
there’s been a real explosion in what we call immune therapy, as people know it.
230
00:22:34.880 –> 00:22:40.380
But where we harness the immune system. And there’s a couple of things in hematology where
231
00:22:40.380 –> 00:22:45.340
this has made a real step change in how we do things. One is what we call cellular therapies
232
00:22:45.340 –> 00:22:53.220
where you take a patient’s own immune cells, own T cells out of their system. You reprogram
233
00:22:53.220 –> 00:23:00.460
them to fight a cancer cell and then you put those cells back into the patient. And that’s
234
00:23:00.460 –> 00:23:04.320
something that’s now commissioned and licensed and it’s been around for two or three years
235
00:23:04.320 –> 00:23:12.100
now on the NHS. But we’re still working out new ways of using that therapy and that technology
236
00:23:12.100 –> 00:23:17.740
in new diseases. So that’s a really exciting development. That’s sometimes people call that
237
00:23:17.740 –> 00:23:23.590
CAR T cell therapy or cellular therapy. And it doesn’t work for all diseases and it doesn’t.
238
00:23:24.380 –> 00:23:29.040
We haven’t developed it, refined it for everything, but it’s a really interesting
239
00:23:29.040 –> 00:23:36.800
way of fighting cancer. So there’s no chemotherapy as such. It’s just using your own immune system
240
00:23:36.800 –> 00:23:41.680
against the cancer cells by reprogramming those cells. It’s not without its side effects,
241
00:23:41.700 –> 00:23:47.620
it must be said. There are some really serious side effects that can happen, but it’s really
242
00:23:47.620 –> 00:23:53.900
revolutionized how we treat, for example, lymphoma. And then on top of that, more
243
00:23:53.900 –> 00:24:01.980
recently we’ve developed, companies have developed antibodies which will bring together
244
00:24:02.860 –> 00:24:09.540
cancer cells in direct contact with immune cells. So it doesn’t require the cells to be
245
00:24:09.540 –> 00:24:15.320
reprogrammed. They sort of pull them together, almost like a marriage counselor, if you like,
246
00:24:15.340 –> 00:24:20.720
and then cause the immune cells to kill the cancer cells. So not really a very good marriage
247
00:24:20.720 –> 00:24:31.800
counselor, but they work by dragging those two cells into direct contact, binding them
248
00:24:31.800 –> 00:24:36.800
together and then the immune cells kill the cancer cells. And the great thing about that
249
00:24:36.800 –> 00:24:42.120
therapy is it doesn’t require cells to be manufactured or changed out of the body,
250
00:24:42.160 –> 00:24:46.740
they can be done off the shelf. That’s what they’re called,
251
00:24:46.740 –> 00:24:52.440
so they’re specific, they’re antibodies which are specific for two cells, your immune cell and
252
00:24:52.440 –> 00:24:59.060
the cancer cell, they pull them together and cause a direct sort of cell-related killing.
253
00:25:00.660 –> 00:25:06.300
Those are being developed all the time for new cancer types and they’re talking about
254
00:25:06.300 –> 00:25:12.940
bispecifics and trispecifics and new ways of delivering those. So those cellular and
255
00:25:12.940 –> 00:25:18.380
immune therapies have really revolutionized hematology and they’re looking at using them in
256
00:25:18.380 –> 00:25:24.060
other cancer types as well. So that’s a really exciting development.
257
00:25:24.500 –> 00:25:29.200
Is there any hard tech you can drop on your foot which is interesting coming through?
258
00:25:30.740 –> 00:25:40.800
Well we’re looking at using smart technology in monitoring. So nowadays people wear smart
259
00:25:40.800 –> 00:25:48.380
watchers and wristbands that will monitor various vital signs and there’s work going on
260
00:25:48.380 –> 00:25:57.580
looking at can we use those to monitor disease types and how well people are and for example
261
00:25:57.580 –> 00:26:04.480
in some forms of chronic lymphomas people are wearing these wristbands and it measures how
262
00:26:04.480 –> 00:26:12.920
the patient is moving around and you can map that out and say well that patient’s not quite
263
00:26:12.920 –> 00:26:20.520
as active as they were a few months ago, maybe that means that they’re not as well
264
00:26:20.520 –> 00:26:26.380
for example. So that’s work that’s ongoing and I’m hopeful that that smart technology might
265
00:26:26.380 –> 00:26:33.240
really come and improve things and maybe we can actually monitor biomarkers through the skin
266
00:26:33.240 –> 00:26:40.100
for example. It’s not here yet, it is for some diseases like insulin-independent diabetes,
267
00:26:40.540 –> 00:26:45.280
people wear things and things but in cancer it’s still at a developmental stage but
268
00:26:47.400 –> 00:26:52.700
the hardware as you talk about it, the other area which is really revolutionized in terms
269
00:26:52.700 –> 00:26:58.720
of hardware is robotic surgery which has really made a big difference to outcomes in cancer
270
00:26:59.580 –> 00:27:05.760
that’s something that I’m not qualified to talk about but it’s an exciting area for development.
271
00:27:17.070 –> 00:27:24.130
So we’re coming to the end of the program and first of all Emma I’ve just got to
272
00:27:24.890 –> 00:27:31.330
remind myself of something which I haven’t said yet which is we have an expert in
273
00:27:31.330 –> 00:27:38.950
the room that’s Dr Dave Tucker, I’m not a doctor, I’m not a psychologist, I’m the counsellor, are you?
274
00:27:39.070 –> 00:27:44.570
No I’m none of those things not qualified to do anything like that. But you have been told by Dr
275
00:27:44.570 –> 00:27:51.210
Rebecca Hopkins that we are both expert patients. Yeah that was a really interesting
276
00:27:51.210 –> 00:27:57.450
reflection from her wasn’t it, it was lovely. And the other thing that we haven’t done is
277
00:27:57.450 –> 00:28:04.290
given everyone a hug virtually by means of whether it’s the radio or the interweb
278
00:28:04.290 –> 00:28:08.230
that they’re listening to so you’ve got your little thing to say here.
279
00:28:08.270 –> 00:28:14.630
Yeah I always say don’t I, we’re going to give you a really big hug now because when you
280
00:28:14.630 –> 00:28:21.330
give a hug you get a hug. I didn’t see Dr Dave Tucker join in. No he didn’t join in,
281
00:28:21.470 –> 00:28:26.310
I think we need to go again. Okay go for it again, go for it again. Right so big hugs
282
00:28:26.310 –> 00:28:34.770
everybody because when you give a hug you get a hug. There you go we’re just practicing
283
00:28:34.770 –> 00:28:40.770
everyone up on this look. Thank you so much for chatting with us once again we’ve learnt
284
00:28:40.770 –> 00:28:47.970
such a lot and it’s great to see the other side of what the patient sees and it’s
285
00:28:47.970 –> 00:28:52.270
interesting to me because so much of what you’ve been talking about has been relevant to my
286
00:28:52.270 –> 00:29:00.190
journey and I’ve benefited so much from a lot of this research work whether it’s been on a trial
287
00:29:00.970 –> 00:29:08.650
or a bi-specific which has come through all of that and is now in use in so many places I see
288
00:29:08.650 –> 00:29:15.770
around the world and I can see your excitement in that and I’m sure we’re going to get you
289
00:29:15.770 –> 00:29:22.630
in the studio once it’s not the studio it’s his office we’re in his office you will invite us
290
00:29:22.630 –> 00:29:28.850
in to chat again about more stuff thank you very much absolutely delighted thank you very
291
00:29:28.850 –> 00:29:34.670
much for having having me on yeah again next week are you going to participate in all this
292
00:29:34.670 –> 00:29:39.590
next week are you oh I think so yeah okay well I’ll come along and you can come along as
293
00:29:39.590 –> 00:29:45.090
I’ll do that as well okay so uh okay see you next week until next time bye
294
00:29:53.600 –> 00:29:57.990
thanks to the national lottery community fund for supporting this podcast