A POSTnote that gives an overview of recent advances in cancer treatment, the potential benefits and risks, and considers the opportunities and challenges to using new technologies in the NHS.Jump to full report >>
The pace of innovation in cancer treatment is rapid, with promising outcomes for patients both in terms of survival and quality of life. Advances in scientific research and clinical practice in the fields of immunotherapy and radiotherapy has shown positive results in some cancers that are difficult to treat with standard first-line approaches.
The current standard of care for cancer treatment might involve surgery to remove tumours, a combination of several chemotherapy drugs and/or conventional X-ray radiotherapy to kill cancer cells. There has been continuous gradual improvement in these treatment technologies due to advances in our understanding of how cancers work and how the immune system responds to cancer. Advances in genome editing have led to more “personalised” treatment approaches where cancer cells may be more accurately targeted, and treatments can be adapted for the individual patient. Despite this, these standard treatments are often ineffective in advanced or difficult-to-treat cancers and may have side effects that have a detrimental impact on the patient’s quality of life.
There have been recent notable developments in radiotherapy and immunotherapy. These treatments, which are covered in this POSTnote, have shown promising results and clinical efficacy in particular types of cancer and patient subgroups. The downside is that these are expensive treatments, many will still result in severe side effects, and they require highly skilled clinical staff and specialist resources to deliver them.
CAR T-cell therapy is an immunotherapy that involves collecting, modifying and using a patient’s own T-cells to treat their cancer. So far, CAR T-cells have been highly effective in clinical trials in treating some blood cancers in specific patient groups. In January 2019 the first NHS patient received a treatment infusion at Great Ormond Street Hospital, London. There are numerous ongoing clinical trials to determine its relevance for other cancers and into how to limit side effects. Another form of immunotherapy, immune checkpoint inhibitors, target proteins on T-cells to help them kill cancer cells. These are also available on the NHS for particular cancers and patient groups, and are the subject of further clinical trials.
In radiotherapy there have been significant advances in imaging, machine manoeuvrability and patient immobilisation techniques, which allow for more precise treatment delivery. The UK has two new Proton Beam Therapy Centres which have recently begun treating specific patient groups for whom proton therapy is clinically advantageous. Developments in molecular radiotherapy mean that radioactive isotopes can be infused or injected into patients with certain cancers that spread, resulting in the effective treatment for some patients with metastatic cancers.
The National Institute for Health and Care Excellence and the Cancer Drugs Fund (and the relevant bodies in the devolved administrations) have changed their funding and evaluation processes so that innovative cancer treatments can be accessed by NHS patients as soon as possible. Overall, patients have good access to information about available treatments. Many play an increasingly active role in decision-making about their care and about the development of cancer treatments. Clinicians can support patients in this process by using evidence-based guidelines about new treatment technologies.
Authors: Sarah Bunn; Lucy Irvine
The Parliamentary Office of Science and Technology produces independent, balanced and accessible briefings on public policy issues related to science and technology.