Cancer Detectives Finding the Cures Season 1 Episode 2

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Transcript

00:01I'm creative.

00:03I don't see creativity being limited to artistic endeavours.

00:08Actually, it's there to be applied to everything.

00:13And applying it to a tricky scientific question is brilliant.

00:22You've got to think big.

00:25You've got to dream the dream.

00:30Cancer is a huge adversary that's trying to hoodwink you.

00:37Well done, Gary. Nice deep breaths for us.

00:41One, two, three.

00:44But now we're at the dawn of a new series of cancer treatments.

00:49We have the opportunity to change medicine forever.

00:53For generations, a cancer diagnosis left almost no hope.

00:59It's a terrifying disease that has stalked us for millennia.

01:04I didn't expect I had cancer because all the tests were coming back negative.

01:08I don't think my body can take any more.

01:11Science has fought hard against it.

01:13And now the tide is finally turning.

01:16One of our key goals is to transform this idea of cancer as a death sentence.

01:22A group of trailblazing scientists are making new breakthroughs.

01:29We now need to take those discoveries and make them work for patients.

01:33This is the world's first lung cancer prevention vaccine.

01:38Discovering cures and finding ways to stop cancer before it even starts.

01:44The tumor seems to be shrinking.

01:46Your scan shows no active disease.

01:49Creating a future where cancer doesn't win.

01:53We're getting very close to defeating cancer once and for all.

01:58What's not curable today could be curable tomorrow.

02:02What's not curable today?

02:03The human cancer is a very common disease.

02:05What's not curable today?

02:06We're getting very close to it.

02:07What is not curable today?

02:08What's not curable today?

02:09Cancer has been evolving with us throughout the history of humanity.

02:25humanity it's a notorious killer and very good at growing but very bad at dying

02:41cell division is vital to life most of your cells in your body will divide at some point

02:48a mutation is an error in the code that every cell has within its nucleus its DNA mutations are

02:58happening in your body right now but your immune system is very good removing them your body has

03:04lots of mechanisms to deal with interlopers and and problem cells what cancer is very good at is

03:12evading those natural mechanisms mutations cause cells to grow when they should have stopped and

03:22that can cause major problems for your body sure I not to move your head Gary in the battle against

03:37cancer neurosurgeon and scientist Richard Mayer specializes in fighting one of the disease's

03:43deadliest forms glyoblastoma a type of brain cancer while there have been advances in treating many

03:52cancers no one has made real progress against brain cancer for decades Richard is determined to change

03:58that I think there is something brilliant about everyone saying you can't do it and saying well

04:08sod you can so there's a little bit of the defiant spirit you have to think outside the box making

04:17good progress brain cancer is a very difficult disease to treat the treatment at the moment revolves around

04:25three distinct steps first is surgery second is radiotherapy and then chemotherapy which works

04:36reasonably well in about a third of patients and in two-thirds of patients less well and that's been

04:43the standard of care now for 30 years and we haven't seen any changes in standard of care over that time

04:50and so from our perspective that seems like a long time especially when average survival is a little

04:57over a year you've done really well Richard plans to revolutionize brain cancer treatment but he's up

05:06against a formidable enemy brain cancer is often fast growing and symptoms can appear out of the blue

05:15blue what did you have for lunch my head jacket but they've got the good cheese again yeah

05:25come on then give us a hug yeah my name's david go sit down have a drink take him in i live with my wife laura

05:41and my daughter lucy

05:46we were on a walk and i suddenly had a dizzy spell followed by at that stage it was just like a phantom smell

06:00and i continued to have them sporadically so we started pursuing the doctors and i got diagnosed with

06:08everything from inner ear infections upper respiratory infection and then they settled

06:15on sinusitis and had all sorts of medications and then a month ago i had a seizure where i actually

06:23passed out and collapsed at first i thought maybe he was having a stroke or a heart attack he clutched his

06:29chest his face dropped but then his whole body you know he just collapsed he was shaking all over

06:34struggling for breath um you know everything was clenched up and then i realized it was a full seizure

06:42david underwent a scan it showed a large tumor on his brain

06:47within a week he's sent to richard at addenbrookes hospital in cambridge

07:02so david not uncommonly for one of my patients has had a seizure which means he's had a fit and that's

07:08likely related to this tumor that we found so obviously that can generate a lot of anxiety

07:13and we need to treat those seizures that he's got but obviously we also need to treat the underlying

07:19tumor and that's what we're going to talk about today

07:27come through nice to meet you i'm richard come through

07:31my name is richard mayor one of the consultant neurosurgeons so what we can quite clearly see is

07:42asymmetry with an area of abnormality here okay my concern is that this represents some form of tumor

07:52okay and that may be a malignant form of tumor so a type of cancer so there are three options in

07:57neurosurgery one we do nothing we watch it but i think if we were to do that with serial mri scans

08:04say every couple of months my worry would be that this would increase in size quite quickly second

08:11option would be to do a biopsy which would tell us what this is but it wouldn't remove any of it

08:17the third option would be to try and do what's called a debulking operation we take out as much of

08:23the bulk of the tumor as we can and we send some of that off for analysis so we make a diagnosis but

08:29we also try and remove as much as we can safely all right so i think of those three options you

08:35discussed with my colleague the plan was for debulking yes is that right yes okay any questions about

08:42that at all we're happy to follow your recommendations fair enough even though there seems to be a sort of

08:51well demarcated region on the brain on the scan for where this tumor exists we will not be able to

08:58get out absolutely everything and it is just debulking it's taking out the bulk of it okay so the

09:04results are normally a week and then after that we can make plans for anything we need to do subsequently

09:09okay good all right nice to meet you both thank you yeah and i'll see you tomorrow yes thank you take

09:16care see you soon bye now my concern is that this is some form of malignant brain tumor most common

09:23being a glioblastoma but until we've actually done the operation and got the results back we try not to

09:30predict too much

09:35glioblastoma is richard's greatest nemesis as it's almost always fatal

09:40when you see these patients week in week out telling them i'm very sorry but there's nothing

09:48we can do by absolutely nothing i think if that doesn't motivate you to try and turn the train

09:55around and i don't know what will richard's frustration has inspired him and a colleague

10:02to pioneer a revolutionary new approach to treating brain cancer

10:06a clinical trial using personalized treatment i think this could absolutely change medicine for

10:15good because what we're trying to do is understand really the molecular level of what's going on in

10:21these tumors richard's plan is to pinpoint the specific genetic mutation causing each patient's

10:28cancer from hundreds of possibilities then as quickly as possible to match the patient with a drug

10:35thought to work against that precise mutation the whole process used to take months months that

10:44patients didn't have richard found a way to do it in weeks so this is a world first because we're

10:52putting together precision therapies and targets that we've identified in real time using whole genome

10:59sequencing and we think by bringing all of that together it gives us a much better chance of finding

11:05a genuine treatment that's going to work for these patients just a day after his appointment david

11:12is going under the knife obviously it's very very real now um but basically i just want to get it over

11:21and done with just get this part out of the way get the first step out of the way just wake up

11:29basically we go from there good morning david hiya how are you getting on yeah all right did you get

11:39any sleep on and off on and off okay someone will come and collect you take you upstairs and then we'll

11:47get on with it yeah all right keen to get it out of the way yeah indeed absolutely all right well i'll see

11:52you upstairs yes okay thank you what's your favorite place in the world

12:07with my family with your family yeah yeah

12:12for david family life came late

12:14wait for us play time i was very nervous about becoming a father at 50

12:27but i was there at the birth and when she came out that that's when it changed

12:34you know there was instant love there and it's just been an enjoyable experience from then to now

12:48she's always coming up with something new and yeah it's just a pleasure to be around

12:56he makes a laugh all the time and they're little jokes i'm doing this for gcs i did an engineering

13:04he's a big softy lets her get away with a lot

13:08when you get ill well it makes life more precious but not just your own

13:17you start thinking about others especially the ones close to you

13:26you know if the worst happens i want them secure i want to know they're not going to struggle

13:36don't know what i'd do without it

13:49this is just some oxygen nothing else all right nice big breaths david all right that's it

14:07oh lovely sun's shining having the best round

14:19in my childhood my parents had a really big bookshelf that was full of loads of books that

14:27were off limits and there was a book that looked like it had been well thumbed through

14:36and it was called gray's anatomy an anatomical textbook

14:42the book showed that there were other worlds that could be explored

14:46that might be interesting probably that's what does drive me is that there's something under the

14:51hood i don't understand and can we get down to the bare bones of what's going on

15:00okay to pin

15:05right roll on three one two three and back

15:09with david anesthetized the operation to remove his tumor can start

15:17if the tumor does turn out to be glioblastoma david's best hope would be if richard could match

15:22him to a drug on the pioneering trial

15:26all good okay can we make sure he has a strap please

15:31it's very privileged you know to be able to look at someone's brain

15:35without wanting to sound strange is is a great privilege and it's one that no one takes lightly

15:44knife back please

15:48brain surgery

15:49has the risk

15:51of a terrible disastrous outcome not that far away

15:56jorill please

15:57you can inadvertently damage something that leads to the patient's death or significant disability

16:11relatively easily and so you have to be concentrating throughout the operation to a very high level

16:23bone flat

16:24a lot of cancers when you come to operate on them they look like well demarcated lumps and

16:45you can be relatively confident that you've got all the tumor out

16:51with a primary brain cancer that's not the case

16:55glioblastomas are a group of tumors that are related to certain genetic mutations

17:02what this leads to is an uncontrolled cell growth and the way these cells grow

17:08and move is like tendrils leeching out from where they've started meaning that there are these long

17:16trails that go into the normal brain the cells will infiltrate deep into the brain and you can't cut

17:23them out you can't even see the edges because you have cells that are proliferating and cells that can

17:27migrate and invade into tissues and that's why it's called cancer because it's the claws of the crab

17:32what that means is it's essentially like trying to unpick two tins of paint that have mixed together

17:38you you just can't do it because we all would love to be able to take every last cell of the tumor

17:45but we know that's impossible so this is definitely tumor thank you a bit more tumor coming out

17:53the hope is there is a drug on the trial which can treat any tumor left behind

18:04to pinpoint the right drug samples of david's tumor are collected for genome sequencing

18:10to map its genetic code

18:16wonderful thanks david thanks everyone send to the next

18:23david we're just taking you around to recovery ward okay

18:31hi there it's richard uh the surgeon here calling from adam brooks

18:34hiya everything went really well um he's woken up in recovery and i was very pleased with how the

18:40surgery went i managed to get out everything that i wanted to i can't get out everything obviously but

18:47i was really pleased with the amount that we managed to remove

18:49oh that's fantastic thank you for calling me okay no problem at all

18:54thank you very much all right you take care now see ya bye bye

19:04with brain cancer time is of the essence so david's tumor is rushed to the lab

19:10if it is cancer they then need to find out which specific mutation is the cause

19:14so they can match it with an existing drug

19:19that's done through genome sequencing which once took a very long time

19:25whole genome sequencing used to be something that was you know otherworldly that was you know brand

19:32new um took forever was so expensive you had to batch the samples together which means you could

19:37only run them once every month or two and that's not the case anymore the costs have come down our

19:43pathways have got better so actually people can be put in for hold you know sequencing as they get

19:49on and have their treatment so really getting those results back more quickly is much more possible

19:56this would have been impossible five years ago just getting the infrastructure the sequencing

20:02um the analysis the drugs this is you know on point for something that is is groundbreaking

20:16it's been a week since david's operation

20:20today is results day for david so we're going to get him into the clinic and we'll talk him through what

20:25his tumor has come back as what pathological diagnosis this is and also how much we managed to

20:32remove that surgery it's a big day for him yeah it's a big day

20:41one of my first neurosurgical mentors told me that it's important to give people hope

20:48and similarly it's important to be realistic and we used to always skirt around cancer in terms of

20:57mentioning the word and talking about prognosis so i think it's important to get a balance of both

21:04and that's what i try and do

21:12david if you want to sit there all right oh god

21:19so you're obviously here for results

21:22so we have been able to make a diagnosis and it has come back as some form of tumor okay

21:28and it's a malignant type of tumor so a type of cancer and it's called glioblastoma it's a cancer

21:36that's treatable but it's not curable okay any questions about that diagnosis at all no i think

21:44we were pretty much expecting that yeah because we've we've always trusted your confidence and

21:50your sure and you know your your ability we have read up on these sort of things what's not

21:58clear it's just what happens next really okay well let's let's start with the scan so this is the

22:04post-operative scan on the left this is pre-operative on the right and so what we can see is there's a

22:09good amount of the lump that's been removed but as i mentioned prior to surgery not all the cancer

22:16will have gone because unfortunately we can never remove all of the the cancer so given that there will

22:23still be cancer cells there the next stage of your treatment is to go for radio and chemotherapy

22:30all right we also sent your tumor off for dna sequencing as we mentioned the results from that

22:36may or may not direct what we do next how long will chemo and radiotherapy keep this at bay

22:43okay so you're talking about prognosis is that something you want to talk about

22:47today oh yeah we we have discussed this yeah so prognosis is an average so it's not a specific

22:54figure for you personally but on average survival is in the region of about 14 and a half months

23:05so traditionally students don't like coming to our clinic because it's full of bad news

23:10and it is a very difficult environment to to work sometimes but i do think if you can do something

23:19that's difficult and not very nice in a compassionate and empathetic way then you can gain some sort of

23:28satisfaction from that but it is tough it's horrible you're telling people the worst news they've ever

23:33heard in their whole life you know we've got a young daughter sure we want to spend any you know

23:45what time is left is precious sure absolutely extremely precious and where we want to make the

23:51most of it it's all i want now it's been time with you and lucy so can it be a bit longer okay

23:56how many people have like gone on past you know 12 14 months yeah i mean we have a kind of five to

24:04seven percent five-year survival okay it's an average okay so let's hope you're on the other side

24:10let's face it law i've never been average have i or lucky oh of course i've been lucky you better

24:16win on that scratch of course i've been lucky

24:19don't you know he doesn't know at the end of the day you know you've been loved you know you will be

24:32loved right up to the end but they're gonna they're gonna be happy times what i've got okay

24:38okay take care okay all right i'll see you i'm gonna do without him

24:51it's trying to get up a bit please for me i don't like seeing the license that's even more

24:58it's um it's really tough for them really tough david's got a lot of positives despite this overwhelming

25:06negative he's had a good operation where we've managed to get a large chunk of this tumor out

25:12he's well and when we get his whole genome data back we can look and see whether there are mutations

25:20or alterations in his dna and regions that we can target with drugs that we've got on our clinical trial

25:27what we want to do is transform this idea of cancer as a death sentence into something that can

25:33not only be treated but that can be treated to give people a normal quality of life

25:42richard's revolutionary trial aims to rewrite the script

25:51one of the first patients to join the trial was amanda a former finance director

25:57you put half a pack of um butter on this did you yeah not that i'm complaining no

26:04almost two years ago amanda had surgery and post-operative treatment for a glioblastoma

26:10you got dirty face you've been digging again but a few months ago amanda's tumor returned

26:18patients with brain cancer will unfortunately recur very quickly if it takes months to get the results

26:32of the dna analysis you're going to use to plan their treatment they may have already died by the time we

26:39get those data amanda pre-cancer she worked 15 hours a day 16 hours a day she was up london looking after

26:51the grandchildren she had come back and hit work

26:54i've looked at these for years these wedding photographs long time ago amanda yeah and it seems like

27:07yesterday sit down baby i'm with her 24 7. i love it push pushing but break your leg no you won't go

27:20push like i'm gonna get a breakfast i'll take it get a tablets first thing in the morning give it to

27:26her and it's just that because she'll forget and i go you you ain't took your tablets manda just take

27:32your tablets i look at it it's my job ready yeah oh thank you come on then come on gary's

27:43very very kind he worries about me and he gives me lots of support especially now brain cancer robs

27:58the person of themselves as it grows it takes away that individual's personality their ability to

28:05function in this world and i really hope that our current approach will get some of that back for the

28:12patient to try and enable a normal life to improve amanda's future richard sought to get her onto

28:23his trial so he analyzed her tumors dna to see if it had a mutation that matched one of the trial drugs

28:32it's vitally important that we have the results back quickly so that we can plan

28:37what treatment and get them in a clinical trial as soon as possible and that's in a period of weeks

28:44not months and certainly not longer than that

28:50when amanda's cancer dna was examined a mutation was found that matched a drug on the clinical trial

28:56i was really surprised to find out that there was still some hope for me and when my oncologist informed

29:10me that richard would be phoning me to ask me to see if i was interested in joining this trial

29:18i was really pleased at that i was thrilled actually

29:21we both were how much hope does do you think we get from it that's all you had to do man

29:32that's all hope hope yeah that's all you've got is hope yeah and if that i want more well it's going

29:43the right way at the moment yeah time is everything but a new treatment might just give me a little bit

29:52more time my cups always are full so they always give you hope that they do something else

30:01and it's hope and that's all you can ask for is hope and therefore if there's a chance of a hope

30:08i'm with amanda you'll be all right what we're doing at the moment is trying to help the patients of

30:21today but that will also help the patients of tomorrow

30:38amanda's now been on richard's clinical trial for three months

30:52i feel so much better than i did when i was on the chemo

30:55so i'm hoping that's these are all good signs

30:58as part of her routine amanda has regular mris that take detailed images of her brain

31:11i have to have them frequently in order to spot any changes to my tumor

31:17and if there are no changes yay they're not a problem for me at all and in fact it's a reassuring

31:29confirmation clarification of your current situation so precision therapies are

31:38an interesting way of addressing cancer we know that in a majority of patients they have specific

31:46mutations that we can target with drugs a precision drug has to have a target what we need to work

31:54out is which of those targets and which of those drugs work in which patient

32:05a few weeks later amanda is back in cambridge for an appointment with richard

32:10and to collect the drug she's taking on his trial thank you so we got that door

32:20so the part of the clinical trial that amanda is on involves taking drugs that work on the kind

32:25of mutations we found in her cancer's dna

32:28once these drugs were absorbed into amanda's body they travel to the tumor in her brain

32:39and into the cancer cells

32:43the mutations in the cancer cells dna are causing too many out of control signals to be produced

32:49telling the cancer cells to keep growing when they shouldn't

32:52the drugs work by blocking these overactive signals to prevent cancer cells from multiplying

33:01and to prevent cancer cells invading amanda's brain

33:05in theory that means the tumor should stop growing or even shrink

33:10it's great to you know see how she's getting on

33:30it's great to you know see how she's getting on like most people here you all you do is you just hope that it works

33:44and that's what you want to do in it yeah we've got we just need to be positive all the time don't we

33:50hi there come and have a seat thank you how are you doing great good to see you both

34:01so i guess we're here to look at your scan so we probably should start with that this is you

34:08at the beginning of february and this is the scan from june and i hope you can sort of appreciate that

34:14that sort of distance there is a little bit smaller oh yes i can see that yeah i think that's very

34:22very encouraging really there's definitely no increase in size in the lump which is good and

34:29perhaps it's actually shrunk a little bit which is really really encouraging given the fact that you're

34:35on this trial and that's something that we are looking for okay yeah i'm amazed and how are you

34:43feeling how are things i feel absolutely fine yeah okay any symptoms at all no she's getting stronger

34:51okay good she's getting more and more back to normal okay although she's got a long way to go

34:58from where she was yeah she's doing absolutely fantastic well that's fantastic news and as i say

35:04from from our perspective you know we knew that you had these targets within the tumor these changes in

35:11certain genes yes that made this new type of treatment which sort of specifically targets

35:17those changes rather than the generic chemotherapy right as an appropriate thing for you yeah um so

35:25that's a really you know good thing that we were able to find that and to match that change to a drug

35:31you know through the clinical trial obviously hopefully and certainly at the moment is going to have some

35:36sort of benefit but it's in herself yeah indeed yeah the fact that she's feeling better as well yeah yeah

35:43yeah he just wants me to start cooking again yeah i don't know about that

35:50my wife is a nurse and when we discuss our day at work it often relates to bad news

36:13and i think it does give you a frame of reference okay it's dad's home have you had a good day

36:25most of the patients i see had planned for the future and boom it's gone

36:33and i think the thing i take home from that is make sure you enjoy what you're doing you live your life

36:38to the full and enjoy it okay have you been playing on the trampoline oh well done mate that was excellent

36:55family helps people get through difficult times

36:58things i think it's really important and i can see how families strengthen each other hello

37:11you have a good day at school yeah

37:13it's been two months since my operation then i had my chemo and radiotherapy

37:39bumper crop this year

37:43you slowly come to terms with it i think you have to

37:49whereas he's just going to eat you up

37:52so now it's just i just relish my time with my family really so many people in cry now we can

38:00we have to put five rows of benches instead of four you're getting too good you need to be off

38:05key a bit more now drive people away

38:08see the biggest focus so spend a lot of time with her try and keep things normal

38:17right another day closer to end of time

38:20lucy's coping with it very well i mean she's just

38:23she just keeps reminding me i've got to get better at this time i am waiting to hear

38:32from the neuro oncologist about the the trial what are you up to goose what are you playing well i'm hopeful for

38:44myself and hopeful for my long-term prognosis you know that i will get on to a clinical trial

38:54yeah where you got to on your hospital game you've got a radiotherapy department on your hospital

39:01that's where daddy goes a lot

39:02i really hope it works and i hope it works for other people as well

39:10you know it's not just about me

39:13my hopes for david are that we have a target and that with that target we can put him on a trial

39:19and that he has a good outcome from that trial you know every patient i see now in the back of my mind

39:26i'm thinking do they have a mutation can we put them on the trial and will we see improvement

39:33which i think is amazing and that's something that i've never experienced before

39:42all right you comfortable i am very comfortable five months into the trial and amanda is still

39:50responding well to treatment ta-da look at gaz's face

40:04look at this beautiful evening yeah we're lucky now we can plan for our future it's lovely to look

40:11forward to something like that booking holidays and picking places to go to how much do i love you

40:20answer that do you love me enough to buy me a boat i don't know about that

40:28i think if it weren't for the clinical trial amanda may well have progressed and her quality of life

40:34would have been impaired obviously with the trial drug it's gone the other way it's actually shrunk

40:41and obviously this is brilliant because she can still you know live her life and that's exactly what we want

40:46what i want to achieve is a significant difference for patients with brain cancer

40:56you know when i started in cambridge in 2013 there were very few scientists who were doing work in this

41:03field and now i think there are more and that's what i want i want us to build a village to try and cure this

41:09that village includes consultant oncologist professor juanita lopez who worked with richard for three

41:19years to get the groundbreaking trial up and running

41:24they're now finally starting to see the first patients benefit from their work

41:28i saw amanda in clinic recently the tumor seems to be shrinking so from my perspective this looks

41:36really promising and i'm really excited the other thing to say is that if she wasn't on this drug

41:43not only would it not have shrunk it would have increased in size so actually you know seeing it

41:48shrink is really quite different to the natural history of what we'd expect this tumor to do in this

41:53scenario this is david scan so we've removed all the tumor in his right temporal lobe which is great

41:59i think we're still waiting for the sequencing on him but i've just checked and that should be back

42:03within the next week or so um so it'd be good to discuss to see whether he has any targets as well

42:11you must remember i said well this is too big this is too hard it's challenging it was too difficult

42:17it was too hard to do yeah but you know if someone was brave enough to do it here it is yeah and i

42:23think that you had great ambition i had ambition and i think by putting that together we were able to

42:31be greater than the sum of its parts there have been moments along the way where it's been exhausting

42:39it's been we're quite good floods of tears and um chaos and crisis management but if if you know

42:48we're not going to do it kind of who is and they don't have a voice and i think that's a really sad

42:53absolutely right sad um you know bit of this story that patients they can't speak for themselves so

42:59so it's really you know championing those who you know have no voice yeah

43:05where do we think this will take us i think we want to cure brain cancer

43:14it's all there we just need to link it together and have the ambition sky's the limit

43:25the trial structure means that we can add new drugs as they come on board and that gives us the

43:30opportunity to just keep adding to it keep adding to it until we find

43:34a solution for every patient who has this problem

43:40this clinical trial will last for as long as it needs to last

43:44and we hope it's going to last for as long until we cure this cancer

43:50the ultimate aim is to cure brain cancer i think we have to be that ambitious now we are a long way

43:54away from that okay i'm optimistic but i'm not stupid and we have a lot that we need to do

44:00but we are on a trajectory we are on the first step and the ladder but we have to be ambitious we have

44:05to be positive we don't just want to improve how the cancer looks we don't want to get people a few

44:12months we want to change how we manage this cancer for good but you have to start somewhere and we're

44:19very much at the start of that journey

44:31so

44:40so

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