Therapeutic Drug Monitoring Approaches to the Optimisation of Chemotherapy in Challenging Paediatric Patient Populations
by Northern Institute for Cancer Research, Newcastle University/Newcastle Hospitals NHS Foundation Trust
Chemotherapy treatment of childhood cancers is associated with significant toxicities. A major challenge in this area is that drugs are handled differently by individual patients, resulting in variable drug exposures following standard doses.
The Newcastle group carried out clinical trials over a number of years, generating data which has impacted on dosing regimens now used for important drugs across a wide range of tumour types. They have led to dosing tables for optimal carboplatin treatment in patients with varying renal function for several tumour types, and the definition of new dosing regimens for 13-cis-retinoic acid in high-risk neuroblastoma.
This approach has been used to maximise efficacy and minimise toxicity in challenging patient subgroups for a number of commonly used therapeutics, providing clinicians with a vital tool.
"An extremely innovative initiative with clear evidence of partnership working across the UK to improve patient care"
The Guildford Prostate Brachytherapy Team 2013 – from 4D-Brachytherapy to Focal Brachytherapy
by Royal Surrey County Hospital NHS Foundation Trust
The 4D-Brachytherapy initiative to deliver prostate brachytherapy was designed to shorten the treatment approach without adversely affecting the patient. The team developed a new technique to take place in a short single hospital attendance, taking no longer than the treatment slots for the 2-stage technique, while achieving better outcomes.
Transrectal ultrasound measurement of the prostate at the clinic (in preference to general anaesthetic in a theatre) enables the correct strands of radioactive iodine seeds to be ordered for the patient to treat the prostate while sparing nearby tissues as much as possible. The implant procedure is speeded up, and the dosimetry can be recalculated in real time.
Results show significant improvement in key radiation dosimetry factors, allowing more of the prostate to be treated to a higher dose throughout. Urinary morbidity, urethral stricture and use of phosphodiesterase-5 inhibitor medication are reduced, while potency rates are improved.
Implementation of BRAF mutation testing in advanced melanoma following Zelboraf licensing in the UK “A success story”
by Queen Elizabeth Hospital, Birmingham
There is increasing excitement about the opportunities presented by genetic testing as a prognostic tool and a way to target treatments.
The drug Zelboraf (vemurafenib) is a new, targeted treatment for BRAF V600 mutation-positive stage IIIC/IV metastatic melanoma and has been shown to dramatically improve survival of patients with advanced disease.
Three diagnostic laboratories worked together to offer reliable BRAF testing with a quick turnaround time (three to five working days) and testing was available to all NHS patients. Over 4,000 tumours have been successfully tested and 84 per cent of patients with stage IIIC/IV melanomas received a BRAF mutation test. The test success rate in all three laboratories is above 97 per cent.
Furthermore, 93 per cent of patients tested and who have been shown to be suitable for the drug could be prescribed Zelboraf; which indicates that testing was relevant for their clinical management.
The GI and Nutrition support team: Managing consequences of cancer treatment, focusing on gastrointestinal problems within a wider context
by The Royal Marsden NHS Foundation Trust
The Royal Marsden’s Gastrointestinal (GI) and Nutrition Team helps manage chronic changes in bowel function as a result of cancer treatment. It provides comprehensive care for patients experiencing ongoing GI symptoms and/or nutritional issues, and improves long-term management.
The team applies a systematic approach to assess symptoms and uses a tested algorithm to request appropriate investigations. Guidelines to manage the conditions identified have been published and research is ongoing within the team to optimise treatment plans.
The focus of the clinic is on GI symptoms and their impact on quality of life. The team is engaged in several clinical research projects and is active in disseminating the results.
A “VIP” approach to the development of a patient centred 14-day radical radiotherapy pathway delivering optimum treatments to head and neck referrals at Velindre Cancer Centre
by Velindre Cancer Centre
Treatment planning and delivery for head and neck (H&N) radiotherapy is complex and resource intensive. The team felt that delivering the best clinical outcomes required a quicker pathway and better access to techniques such as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT).
The Velindre Improvement Programme (VIP) was launched in 2012 and focuses on the whole pathway. Training was centred on a three-day programme for all staff involved. Central to VIP is a belief that – with the right support – the multi-disciplinary team will be the driver that improves the service.
The programme has delivered several improvements, such as reducing waiting time from referral to treatment and scan, and increasing the percentage of patients receiving IMRT and able to start treatment on a Monday. The centre now has a 14-day radical radiotherapy pathway that delivers optimum treatments to H&N referrals.