Cancer is a one of the most complex diseases. Today our growing understanding of the biology of cancer is pushing the boundaries of how we detect, prevent, diagnose and treat the disease. These advances mean that a person diagnosed with cancer in today has a better chance of surviving than ever before, with half of people diagnosed surviving for ten years or more.

What once seemed impossible in cancer treatment and care is now a reality thanks to a huge number of technologies and innovations like, artificial intelligence, magnetic resonance imaging (MRI) and robotic surgery. These technologies are at the forefront of enhancing patients’ experiences and treatment outcomes, from detection to diagnosis.

The field of radiation therapy in particular is an exciting treatment area that has witnessed remarkable progress in recent years. This progress can be attributed to technological leaps, from state-of-the-art imaging modalities, immensely powerful computing capabilities, and novel delivery systems like advanced linear accelerators. These advancements enable healthcare professionals to more effectively target cancerous cells, minimising damage to healthy tissue and enhancing overall treatment outcomes.

Today radiation therapy continues to play an important role in cancer treatment with approximately 50 per cent of all cancer patients receiving radiation therapy as part of their treatment regime. The primary objective of radiotherapy is to administer the highest possible dose to the tumour while sparing healthy surrounding tissues.

Advances in cancer diagnosis and treatment

Thanks to its focus on research, the Department of Radiotherapy at The Royal Marsden NHS Foundation Trust is at the forefront of advancing radiotherapy techniques to improve cancer outcomes. The department treats approximately 5,000 patients per year, offering access to state-of-the-art radiotherapy machines and clinical trials for new treatments.

Based in London, The Royal Marsden was the first hospital in the world dedicated to the study and treatment of cancer. Today it’s renowned as a world-leading innovation centre – one of the largest in Europe, treating more than 60,000 patients every year.

From clinical trials that assess the safety and effectiveness of novel treatments, to  its unique partnership with The Institute of Cancer Research, London, which allows for ‘bench-to-bedside’ research, the hospital’s commitment to research and collaboration contributes significantly to advancements in cancer diagnosis and treatment.

Groundbreaking treatments

With innovation at its core, The Royal Marsden is pioneering the way many cancer types are treated, using the latest state-of-the-art equipment for radiotherapy. The Royal Marsden’s radiotherapy department covers all main tumour sites and has specialised services for sarcomas and paediatrics. For example, the hospital offers some patients stereotactic ablative body radiotherapy (SABR), a highly targeted type of radiotherapy, as an alternative to conventional radiotherapy.

The pioneering approach can, for example, target metastatic cancers with an intense and targeted dose of radiotherapy, and offers the potential to shift the treatment paradigm for some patients with advanced diseases. It can open up new possibilities for those previously facing a palliative outlook, offering a potentially curative approach.

The Royal Marsden is also at the forefront of groundbreaking research in heart-sparing radiotherapy for breast cancer patients. – Previously centres used expensive machines to help patients with the disease hold their breaths during radiotherapy to minimise radiation damage to the heart. However, the HeartSpare study, which was led by researchers from The Royal Marsden and The Institute of Cancer Research (ICR), led to a simple solution which replaced the need for costly equipment. The study found a a surgical pen and a light field can be used to accurately monitor a patient’s breath hold, replacing the need for expensive machines. This intervention halves the dose of radiation to the heart associated with breast treatment.

Dr. Alison Ranger, Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, is dedicated to advancing complex radiotherapy techniques. She is interested in optimising the delivery of radiation to the breast and lymph nodes for high-risk breast cancer patients, while minimising exposure to the heart and lungs. She says:

“I built on research from the HeartSpare study, which focused on early-stage breast cancer patients, to ensure patients with locally advanced disease could also benefit from our innovative and easily accessible new approach, which can reduce serious long-term side effects from radiotherapy to the heart.

Research is a huge undertaking which takes a lot of time and effort. Fortunately, The Royal Marsden is partnered with The Institute of Cancer Research, who together, using a ‘bench-to-bedside’ approach, work closely to launch and run trials. They also provide invaluable statistical support, so the quality of the data produced by our research is world-class.”

Other innovations at The Royal Marsden

Another innovation in radiotherapy that has been pioneered at The Royal Marsden, in partnership with the ICR, is the MR Linac. Five years ago, the hospital became the first in the UK to treat a patient using this machine, which delivers radiotherapy with the guidance of an MRI scanner. This allows clinicians, radiographers and physicists to work together to tailor the treatment precisely to patients in real time, with detailed imagery.

After an initial trial for prostate cancer patients, many other tumour types – including gynaecological and head and neck cancers – have since been treated on the MR Linac. Studies investigating variations in treatment delivery – such as changes to dose, margins and frequency – are also ongoing at The Royal Marsden, with the aim of improving patient outcomes and reducing time spent in hospital. This technology may one day become a useful tool to treat patients with breast cancer using radiotherapy.

The hospital, building on laboratory research at the ICR, is also at the forefront of groundbreaking clinical trials aimed at harnessing liquid biopsies – which identify fragments of circulating tumour DNA (ctDNA) in the blood – to predict the recurrence of cancer. One notable example is the TRAK-ER trial – which is funded by Pfizer, Invitae and The Royal Marsden Cancer Charity – aims to detect the signs of relapse earlier in oestrogen receptor-positive (ER+) breast cancer patients by looking for ctDNA in the bloodstream. What sets this trial apart as a potential game-changer for patients is that, rather than relying on invasive biopsies, the centre is using a simple blood test that can identify very low levels of ctDNA in the blood, potentially diagnosing recurrence at the very earliest stage. This technology can be combined with novel ablative therapies such as SBRT which is able to significantly improve patient outcomes.

Streamlining the patient journey

Another crucial area of innovation at The Royal Marsden revolves around the patient journey. For example, the hospital offers a streamlined experience through a one-stop diagnostic clinic for breast cancer patients, where tests are completed on the same day, and patients receive results very quickly. This approach seamlessly integrates with various departments, including imaging, surgery, radiotherapy, and chemotherapy. The objective is to create an environment where patients feel well supported and can smoothly navigate their path from diagnosis to treatment as quickly as possible.

“Multidisciplinary team working is absolutely essential in cancer care,” Alison adds. “There are so many different faculties involved in one patient’s treatment, and having a team of experts who you can rely on to give an absolute top-notch opinion is so important. Teams at The Royal Marsden work very closely together from the beginning of the patient pathway to make each step of treatment and care is planned out as much as possible.”

In this short video, Dr. Alison George discusses The Royal Marsden’s pioneering approach to research and innovation in cancer care, spanning the entire spectrum from detection to diagnosis and treatment.

The growing numbers of people expected to be diagnosed with cancer in the UK in the years ahead presents a pressing challenge. The NHS Cancer Plan 2000 set targets for wait times, and while the COVID-19 pandemic created setbacks, NHS trusts across England have been working diligently to tackle waiting lists and improve patient care. Innovative partnerships between NHS trusts, academia and industry have emerged as a powerful tool to support these efforts. The Royal Marsden, the first hospital in the world dedicated to the study and treatment of cancer – and a world-class innovation centre – has a long history of working collaboratively with industry and academia to pioneer new treatments for cancer.

The complexity of cancer

Cancer is not a single disease, but a group of diseases characterised by the uncontrolled growth and spread of abnormal cells. Each type of cancer is unique in its biology and behaviour, making it a highly complex area of study. This complexity makes collaboration a crucial part of cancer research. Partnerships allows researchers from various disciplines to pool their expertise and resources. This helps to accelerate the transition of lab-based discovery science to the clinic, driving forward the best possible results for those affected by cancer. Collaborations between hospitals and industry also play a vital part in giving patients access to the latest cutting-edge technology.

Advancing cancer research involves conducting clinical trials to test new therapies and interventions. It also requires a wide range of skills and expertise: no single individual or research team can possess all these skills, so collaboration enables scientists with different backgrounds to work together share knowledge and expertise on how to address the multifaceted nature of cancer. The ultimate goal of cancer research is to allow researchers to better understand, prevent, diagnose, and treat cancer.

Collaborative efforts enable researchers to work more efficiently, share findings rapidly, and collectively push the boundaries of knowledge and treatment options. This is particularly important when it comes to cancer, which is a disease that can be deadly if it’s not treated early and effectively.

Our experience from COVID-19 has clearly shown that collaborative working can drive forward lifesaving research. By pooling collective expertise, with like-minded organisations from around the world, we can accelerate lifesaving innovations for cancer patients, much faster.

Advancing cancer research

The Royal Marsden is a world-renowned cancer centre based in London and is actively involved in cancer research. In fact, it was the first hospital in the world dedicated to the study and treatment of cancer. But contrary to popular belief, the Royal Marsden is not just a cancer hospital. It’s a world-leading innovation centre – specialising in cancer care – the largest in the whole of Europe. It brings together a multidisciplinary team of clinicians, nurses, physicists, computing physicists, and molecular pathologists, who work together to transform the way we understand and treat cancers. From clinical trials that assess the safety and effectiveness of novel treatments, to collaborating with other research institutions, both within the UK and internationally, the hospital’s commitment to research and collaboration contributes significantly to advancements in cancer diagnosis and treatment.

The field of cancer research is fast evolving, and today immunotherapies, for instance, are emerging as a promising new approach to tackling cancer. And the Royal Marsden has been at the forefront of advancing research in this field. In 1991 the hospital became the first NHS hospital to be awarded the Queen’s Award for Technology for their work on drug development. Together with its principal academic partner, the Institute of Cancer Research (ICR), the hospital has led trials in the UK for the ground-breaking immunotherapy drugs Vemurafenib and Ipilimumab – the biggest breakthrough in the treatment of metastatic melanoma for more than 30 years.

Fast forward to today, cellular therapies are emerging as promising forms of immunotherapy. These innovative approaches bolster the immune system’s capacity to target both blood cancers and solid tumours, with CAR T-cell therapy presenting a very complex and specialist modality. Cellular therapies are showing great promise – and The Royal Marsden is at the forefront of pioneering research in this complex and exciting field. The hospital is also engaged in exploring additional approaches against solid cancers, including therapies such as TIL (Tumor-Infiltrating Lymphocyte) and TCR (T-Cell Receptor) therapy. There have already been promising results with these innovative treatments in clinical trials for patients with advanced melanoma for whom standard immunotherapy has been unsuccessful. Importantly, this research involves collaboration among various stakeholders.

Dr Andrew Furness, a Consultant Medical Oncologist who is leading on cellular therapies in solid tumours for the Royal Marsden Hospital, says: “The great thing here is that there are lots of support for innovation. One of the areas that I lead in is cellular therapy, which is using immune cells to tackle cancer. It’s complex research – it’s a living product, it’s not a drug like chemotherapy, it’s an actual living cell or cells that get to work. There are multiple stakeholders involved in the process, from scientists, surgeons, people who work in theatres, laboratories, all the way through to critical care. We all really believe in team science, working together collaboratively to get the best results.”

Partnership drives progress

As a centre of excellence, partnerships with industry and academia form an essential part of The Royal Marsden’s strategy for cancer research and treatment advancement. These collaborations foster innovation, provide access to resources and expertise, facilitate clinical trials, and accelerate the translation of research findings into new and improved cancer treatments for patients.

Today it operates as a specialist cancer hospital and National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Cancer, working closely with the Institute of Cancer Research (ICR). Together, The Royal Marsden and the ICR are ranked in the top five cancer centres in the world for the impact of their research, treating over 59,000 NHS and private patients every year.

The hospital also collaborates with pharmaceutical companies, biotechnology firms, medical device manufacturers, and other industry partners to bring novel solutions to patients that improve our ability to detect, diagnose and treat cancer. The hospital recently partnered with Automata, a leading automation company, to increase cancer genomic testing capacity through robotic automation. Together, The Royal Marsden and Automata will establish the UK’s first fully automated system for clinical cancer genomic testing, increasing the hospital’s next-generation sequencing (NGS) capacity and expanding the range of tests the specialist cancer centre can perform.

Dr Furness adds: “That’s the benefit of having a public healthcare system, that we’re all linked up. If you’re a patient, it’s nice to know that we do all work together. So, if there’s a complex case, particular in cancer care, if there’s something really challenging, we are all linked up together and can ask questions to make sure we’re trying to do the right things for patients everywhere.”

In this short video, Dr Furness shares his first-hand experiences and insights into the Hospital’s approach to collaborating and the incredible role it has in pioneering new cancer treatments that benefit patients everywhere.