What did you think of the time when I asked you to go into a clinical trial?
And what do you think it's meant for you and
done? Given me life. Because what would I have got. Six months,
somebody did say initially. Yeah. And five years later I'm still here.
My name's Gary Middleton I'm Professor of Medical Oncology at
the University of Birmingham. I also consult at the University Hospitals
Birmingham. In fact we're in the middle of clinic today.
We've already seen about 25 patients they've all got lung cancer
and we've finished clinic probably about 4:30 - 5 o'clock today and we see
normally about 40 patients a day. I've been treating lung cancer now since
about 1995 and at that time we still didn't even know
if chemotherapy was any good. It actually took us another five years
to understand that chemotherapy did provide a little bit of benefit for
patients with advanced lung cancer but those benefits were very, very small.
What we were looking at there was median survivals. That's the point at which 50%
are alive and 50% are dead of just nine months.
So really pretty poor outcome, nine months, and that was with chemotherapy.
But since that time the management and the treatment of lung cancer has been
completely transformed in particular by two really important advances. One of
those is called targeted therapy or precision
medicine or stratified medicine and the other one is immunotherapy. Paul
is a patient who's on targeted therapy is in a clinical trial that I run called
the National Lung Matrix Trial and he started that treatment nearly
four years ago. What we did was we took his tumour and we sequenced it. We
understood the DNA structure of that particular tumour and what we found was a
particular abnormality that we knew was driving his tumour that made it
divide and avoid cell death and we could give him a treatment
that was specifically targeted at that particular aberration
which could switch it off completely and what happened was it basically switched
off the cancer okay. So this is targeted therapy
understanding what genomic abnormality makes that cancer tick and then
switching that off with a targeted therapy.
What did it feel like to be put into a clinical research program and, and what
difference has it made to you really. Well
given the starting position in 2016 um I think you can see the obvious
improvement and that's reflected in the way I felt as
well. Now Norma she was actually on immunotherapy this
is a much more recent treatment we've been using since about 2012, 2013
and this is where we enable a patient's own immune system
to fight their own cancer. In fact it was the first real time that we realised
that there was true immunity against cancer so these
treatments basically stopped the cancer stopping the immune response. And in this
lady, she had a large cancer and her own
immune cells enabled by our treatment has actually
completely eradicated those amazing. Now that doesn't happen with
everybody. Patients have really good responses in about 25 to 30 percent of
cases but when they have a good response it's amazing and it's often very
prolonged so even when they stop the treatment
it can be very durable and this really has completely transformed the
management of lung cancer. So from going from a disease where we
either gave nothing at all or a bit of chemotherapy we're now treating with
targeted therapy and with immunotherapy. And as I said
both of these patients are in clinical trials
and really clinical trials should be at the heart of what we do for our patients
because it's only by trialling these treatments so we can come up with really
good new advances to really make their outcomes so much better.
And I can tell you that if you go back to 1995
the amount of patients that would be alive at five years
with advanced lung cancer would basically have been nil
and now we've got the situation probably we've got about 20 to 25 percent of
patients that can make it to that five-year mark but more importantly
those patients that respond to immunotherapy if they have a good
response out of four years something like 60%
of those are still in a good remission and doing well and it's an amazing
statistic really. And whereas I knew exactly where we were going with the
treatment because we just didn't have many advances. Now
the field is moving so quickly that I can't even predict what it's going to
look like in 18 months time it's really great time
for our patients. I can't thank you enough and as far as
I'm concerned the programme has effectively saved my life. Lovely to see
you, you too thanks Prof you've still got cold hands. I know, God bless and you.