The first proton beam therapy clinical trial in the UK is now taking place at The Christie NHS Foundation Trust in Manchester. *
The trial, co-led by The Christie and The Institute of Cancer Research will determine whether the use of proton beam therapy reduces long-term side effects and improves quality of life for patients treated with radiotherapy for throat cancer. **
The study, funded by Cancer Research UK with support from The Taylor Family Foundation *** started last year and, despite the COVID-19 pandemic, is recruiting ahead of target, with 37 patients so far taking part. In total 183 people will take part in the study, about two thirds will receive proton beam therapy, and a third will receive standard radiotherapy.
Currently all patients allocated proton treatment within the trial receive this at the state of the art NHS proton beam therapy centre at The Christie in Manchester, which opened in 2018. Another centre is currently being built at University College London Hospitals.
A combination of chemotherapy and radiotherapy is usually effective in curing head and neck cancers, but radiotherapy can damage the healthy surrounding tissue. This can result in severe long-term side effects including dry mouth, loss of taste, difficulty chewing and swallowing and problems with hearing. Some patients might need to use a feeding tube for the rest of their lives.
Proton beam therapy uses charged particles instead of X-rays and can target tumours more precisely, causing less damage to surrounding tissues.
A year after treatment, patients will be asked about their quality of life and doctors will assess the impact of any side-effects, and whether they still need to use a feeding tube a year after treatment, or have lost a significant amount of weight.
David Thomson, consultant clinical oncologist at The Christie and chief investigator on the trial, said: “It’s very exciting and a privilege to conduct the first proton beam therapy trial in the UK here in Manchester. In what is a true team effort, the amount of support from colleagues across the country has been fantastic. There’s a real need to develop treatments which cause less side effects and improve long-term quality of life for patients with head and neck cancer. Proton beam therapy may do this, by reducing the damage to healthy surrounding tissues, so it was an obvious patient group to research first.
“Currently the proton beam therapy unit at The Christie is mainly used for children and young adults. We would like to make the facility available for other groups of adult patients who may benefit most from it too. The first step is to determine whether proton beam therapy improves side effects and quality of life for patients with throat cancer.”
Professor Emma Hall, Deputy Director of the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, who co-leads the study, said: “Radiotherapy is a highly effective treatment involved in around 40 per cent of cancer cures, but it can cause side effects where radiation affects nearby tissues, and this can be a particular problem for patients with throat cancers. Proton beam therapy has the potential to target tumours more precisely, with less spillover of radiation into the neighbouring healthy tissue.
“We think that for patients with throat cancer, proton beam therapy could be transformative – minimising side effects, improving recovery and sparing some people the long-term impacts of treatment, such as the need to use a feeding tube. This trial is an important first step in understanding if proton beam therapy can deliver on its promise, and if so who stands to benefit most.”
Beverley Ashworth, a 52 year old care worker from Middleton in Greater Manchester, who was diagnosed last summer, and treated recently, said: “I had treatment at The Christie for seven and a half weeks but it felt like no sooner had it started than it’d finished. I felt well for most of the time and I couldn’t have had nicer people looking after me. Initially I drank a lot of soup as I couldn’t swallow, but I’m eating toast again and lots of spaghetti and beans. I did have to have a feeding tube in for a couple of weeks but luckily that was taken out just before Christmas. I know the recovery will be slow but I’m getting there. I was very happy to participate in the trial and have already signed up for another one. If it wasn’t for clinical trials we wouldn’t find new treatments for patients in the future.”
Elizabeth Patch, a 58 year old hairdresser from Bristol, who discovered a tumour, which turned out to be tonsil cancer, during an emergency visit to the dentist, said: “The whole experience was first class with no stress. The Christie arranged for me to stay in a city centre apartment which had everything I needed, and I was picked up and dropped off by amazing drivers. The staff were unbelievable, and would always put a smile on our faces. It was well worth the 140 mile trip. I also can’t thank the doctors in Bristol enough for putting me put me forward for the trial. The NHS gave me my rainbow and the pot of gold treatment. I’ll be forever grateful for the care I’ve received which was painless in every way.”
The researchers will also study which patients benefit most from proton beam therapy to help them determine who to offer the treatment to in the future in terms of who is most likely to see long-term improvements.
Around 11,700 people are diagnosed with head and neck cancer every year in the UK, and more than 8 in 10 patients suffering from throat cancer – such as tonsil and base of tongue cancer – receive radiotherapy as part of their treatment.****
Michelle Mitchell, chief executive of Cancer Research UK, said: “It’s fantastic to hear that despite the challenges that this pandemic has thrown at us, patients with head and neck cancer have been able to access cutting-edge treatments like proton beam therapy. Many patients used to have to travel abroad to receive this type of treatment, so to be pioneering its use for adults in the UK is an incredible achievement.
“Cancer Research UK has a solid history of delivering practice-changing radiotherapy trials, which included making IMRT the gold standard for treating head and neck cancers. But there is always room for improvement, and we hope that proton beam therapy will be the next step in transforming the lives of people with neck and head cancer.”
Neville Shepherd from The Taylor Family Foundation, said “We are delighted to see the trial proceed against the headwinds of COVID-19. It’s wonderful to know a cohort of 24 patients are already receiving proton beam therapy treatment for their throat cancer. We thank all involved for dealing with the challenges of set up and delivery of the trial in these extraordinary times.”
* The TORPEdO trial is funded by Cancer Research UK and the NHS, with support from The Taylor Family Foundation. Proton beam therapy is administered at The Christie in Manchester.
** The trial focuses on throat cancers at the back of the mouth – including tonsil and base of the tongue cancer
*** The core costs for the trial are being funded by Cancer Research UK, but The Taylor Family Foundation’s £4.5m donation which will support head and neck proton research and innovation at The Christie as well as widening access to proton beam therapy trials by supporting patient travel costs for those who live further away. The Taylor Family Foundation was established by businessman and philanthropist Ian Taylor, who was chairman and former global CEO of the Vitol Group, the world’s largest independent energy trader, who sadly died in June 2020 after a long battle with cancer.
**** 84.6% of oropharynx cancer patients received radiotherapy as part of their primary treatment (England, 2013-2014)