Overview of The Royal Marsden/ICR NIHR BRC contribution to the national effort to respond to COVID19

20 July 2020

During the COVID-19 pandemic, The Royal Marsden took a leading role in delivering urgent cancer treatment, particularly surgery. 

The Trust, together with their local cancer alliance, RM Partners, University College London Hospitals and Guy’s and St Thomas’ Hospitals led the ‘cancer hub’. They are working with major teaching hospitals including the Royal Free, Barts Health and Imperial, as well as local hospital partners.

The Hub ensures NHS hospitals continue to deliver as much cancer treatment as possible across the capital, with an initial focus on surgery, which requires critical care beds.

It has also supported hospitals across the NHS and independent sector to work together to maximise capacity and ensure that people receive the treatment that they need.

The Royal Marsden also continued its focus on research and, together with The Institute of Cancer Research, London (ICR), launched several critical studies at an unprecedented pace, to investigate the impact of the COVID-19 pandemic on cancer treatment and care.

Research will be funded by The Royal Marsden Cancer Charity, with the Charity needing to raise over £500,000 over the coming weeks to support the studies, and supported by the NIHR Biomedical Research Centre at The Royal Marsden and the ICR

Studies range across cancer types and services, tapping into key clinical and research strengths at the world-leading cancer centre and working with commercial and academic partners and NHS Trusts from across the country.

More information can be found here

Our cancer research activities during the pandemic

  1. Our researchers analysed existing Public Health England data on delays to cancer surgery on patients’ five-year survival rates to estimate the effect of three-month or six-month delays, respectively. The modelling, which factored in the risk of hospital-acquired COVID-19-infection, showed dramatic differences in the impact of delay on cancer survival depending on patients’ age, their cancer type and whether it was earlier- or later-stage cancer. The findings should help policymakers and clinicians make evidence-based decisions as we continue to deal with the effects of the pandemic on other areas of medicine. 
  2. A new approach to better select breast cancer patients in need of urgent surgery or chemotherapy during the COVID 19 pandemic has been developed by our researchers in collaboration with colleagues in the UK, Germany and US. The innovative algorithm, using data from multiple international trials, can identify postmenopausal patients with primary ER+HER2- breast cancer (c.70% of cases) who have less endocrine-sensitive tumours and who should be prioritised for early surgery or neoadjuvant chemotherapy. 
  3. Fast track publication in April of the outcomes of the FAST Forward trial conducted in the ICR-CTSU has revolutionised breast radiotherapy delivery during this pandemic. A one-week course of radiotherapy in fewer but larger daily doses was found to be as safe and effective as standard three-week therapy for women following surgery for early stage breast cancer. This allowed us to move from 15 daily fractions to 5 daily fractions for almost all breast adjuvant treatment thereby significantly freeing up capacity, reducing patient footfall in hospital and enabling timely delivery of radiotherapy for those patients needing it as part of curative treatment. In addition, our researchers were involved in drafting the national and international COVID guidelines on breast radiotherapy. Five fractions have been adopted not only across UK but also in Europe and more widely internationally. 
  4. Patient safety is the prime objective of early phase clinical trials. To help the extraordinary reshaping of delivery of patient care on experimental Phase I cancer trials, our researchers created a risk-based approach to experimental early phase clinical trials during the COVID-19, which has just been accepted for publication in Lancet Oncology.

Adapting cancer research tools/expertise to COVID19 research 

  1. Our researchers have created a dynamic database driven by artificial intelligence which is collecting together the world’s research on coronavirus in a single online space. The new ‘knowledgebase’, called Coronavirus canSAR, draws in data published across the world on viral proteins, interactions of viral proteins with human proteins, drugs and drug mechanisms, and clinical trials. It is believed to be the world’s first one-stop shop for research on COVID-19 and related diseases such as SARS and MERS and will make freely available vast amounts of data on the biology and treatment of COVID-19.
  2. Professor Terry Rabbitts, Professor of Molecular Immunology at the ICR has started a project that could lead to a new method of testing people for the coronavirus using an antibody ‘tetramerisation’ technology, already developed by his team. The research may also lead to a new way of treating patients with symptoms, by giving them artificial antibodies that could boost their own immune response to the virus.

Supporting the national effort against the new coronavirus

  1. Researchers are implementing a simple, structured algorithm for cancer management to personalise and prioritise treatment to reduce cancer deaths. The PREVAIL pathway uses the existing structure of NHS Tumour Specific Cancer Multidisciplinary Teams to enable combined assessments by Radiologists, Oncologists, Surgeons, Pathologists and the Clinical Nurse Specialists to ensure that the correct patients are diagnosed, prioritised for surgery or identified for safe non-surgical options. Surgery can be delayed if the cancer is closely monitored for example in non-aggressive tumours, after holding therapies such as radiotherapy, drug therapy, or non-surgical thermal heat destruction of cancer cells. The PREVAIL pathway has been constructed in collaboration with surgical ‘Cancer Hub’ representatives as a tool to harmonise tumour assessment and prioritisation across the cancer alliances to ensure a needs-based fairness of access to surgery for all patients with cancer for the duration of the COVID period and until cancer surgical services have been restored. It also provides a strategy to manage the recovery period and potential further waves of pandemic.
  2. Dr Mike Hubank, Head of Clinical Genomics at The Royal Marsden and Reader in Translational Genomics at the ICR, is leading the co-ordination of cancer diagnostic sequencing services across London from the joint Royal Marsden/ICR NIHR Centre of Molecular Pathology. Dr Hubank has also played an instrumental role in setting up NHS staff testing for coronavirus at the Francis Crick Institute. 
  3. Dr Richard Lee, Consultant Physician in Respiratory Medicine and Champion for Early Cancer Diagnosis at The Royal Marsden, was seconded to the Nightingale Hospital London alongside our chief nurse, who acted as Nursing Director for the coronavirus field hospital. 
  4. With support from The Royal Marsden Cancer Charity, our researchers have created a patient video involving breast consultants, radiographers and junior doctors about ‘Having breast radiotherapy’. The link has been made available to all new patients prior to their appointments so that they are able to watch it at their convenience. This has greatly helped with offering telephone appointments to new patients, decreasing footfall in hospitals and has received great patient feedback. We hope to be able to use this video even after COVID in order to help with the new patient consenting process.