We aim to deliver a step change in the effectiveness of radiotherapy through the evaluation of novel scientific approaches derived from the Institute's scientists in hypothesis driven clinical trials.
The Institute’s vision is to improve the chances of cure for patients with cancer through scientifically valid and novel ways of improving the effectiveness of radiotherapy. We are concentrating on some of the hardest to treat cancers, particularly those arising in the lung, gastro-intestinal tract and bladder where radiotherapy makes an important contribution to treatment.
We are pursuing three main ways to improve outcome from radiotherapy:
- The major advances in radiotherapy in the past 30 years have been through improved technical accuracy leading to reduced side effects. We are testing higher dose treatment using intensity modulated and stereotactic radiotherapy treatment and proton beam therapy. We have completed a clinical trial (‘Foxfire’) of targeted radiotherapy to the liver using 90-yttrium labelled micro-beads.
- Low levels of oxygen (hypoxia) in the cancer make it resistant to radiotherapy and more likely to spread. We have shown in lung and pancreas cancer that use of novel targeted drugs which inhibit the PI3kinase-AKT pathway can improve oxygen delivery and reduce hypoxia.
- Radiotherapy causes DNA damage in the cancer and normal tissues. Cancer cells are often less effective at repairing damage. As novel drugs that target DNA damage repair show a marked improved response to radiotherapy in laboratory tests, we are planning to test these in patients with oesophageal cancer.
Precision Cancer Medicine:
We are working on selecting approaches which can predict a person’s response to treatment based on functional imaging and biomarkers to help provide the right treatment for the right person at the right time.
- Imaging hypoxia using PET scans has enabled us to prove that hypoxia is altered through both drug and radiotherapy treatment. The degree of hypoxia and how it changes early in a treatment will help us select patients for hypoxia modifying therapy.
- Biomarkers, which can be measured from tumour tissue or the circulation, may guide selection of the appropriate patients for specific therapies.
Tim leads two national research studies in colorectal cancer. The MRC FOCUS4 trial started to recruit patients in 2014. It uses a novel trial design to evaluate treatments suitable for patients with molecularly-defined subgroups of colorectal cancer. The MRC funded stratified medicine consortium will be investigating biomarkers to identify those patients likely to benefit from either chemotherapy (oxaliplatin), radiotherapy, minimal surgery or novel drugs in the treatment of colorectal cancer.
Tim Maughan was appointed Professor of Clinical Oncology and Clinical Director of the CRUK/MRC Oxford Institute for Radiation Oncology in the Department of Oncology in 2011. Previously, Tim worked as an NHS consultant Clinical Oncologist in Cardiff, becoming Professor of Cancer Studies in 2007. During that time, he established the first clinical research network, the Wales Cancer Trials Network, and subsequently the development of the clinical research networks across the UK. He was the founding chair of the NCRI Clinical and Translational Radiotherapy Research Working Group (CTRad), which has a broad remit to enhance radiotherapy research in the UK.
Richard Kaplan*, Tim Maughan*, Angela Crook, David Fisher, Richard Wilson, Louise Brown & Mahesh Parmar Evaluating many treatments and biomarkers in oncology: a new design. Journal of Clinical Oncology 2013. doi 10.1200/JCO.2013.50.7905
Thomas Crosby+, Chris Hurt+*, Stephen Falk, Simon Gollins, Somnath Mukherjee, John Staffurth, Ruby Ray, Nadim Bashir, John A. Bridgewater, J Ian Geh, David Cunningham, Jane Blazeby, Rajarshi Roy, Tim Maughan++, Gareth Griffiths++. A multi-centre, phase II/III randomized trial of chemoradiotherapy in oesophageal cancer plus or minus Cetuximab – the SCOPE 1 trial. The Lancet Oncology volume 14, issue 7, year 2013, pp. 627 - 637.
Somnath Mukherjee+*, Christopher N Hurt+, John Bridgewater, Stephen Falk, Sebastian Cummins, Harpreet Wasan, Tom Crosby, Catherine Jephcott, Raj Roy, Ganesh Radhakrishna, Alec McDonald, Ruby Ray, George Joseph, John Staffurth, Ross A Abrams, Gareth Griffiths++, Tim Maughan++. Gemcitabine or capecitabine based chemoradiation for locally advanced pancreatic cancer: the results from SCALOP – a multi-centre, randomized, phase II trial. Lancet Oncology Published Online March 6, 2013.