"One in two of us will get cancer - it's a disease that touches every family in Britain." "I've just had really fantastic news that a year on, there's still no evidence of tumour in my lung." "It shrank, and it hasn't grown back." "Panorama has spent the last 18 months on the front line in the fight against the disease." "This is an unprecedented time of progress in the history of cancer medicine and cancer research." "At the Royal Marsden Hospital in London, patients given just months to live are keeping cancer at bay for years." "Five years ago, before the Marsden, I thought that was it." "And, you know, they've given me a good four years, so far." "I do all the things I want to do," "I have my friends and..." "I go to other people's funerals." "Advances in genetics are delivering a new generation of smarter cancer drugs." "I'm taking a drug that doesn't have a name, but it's letters and numbers " "I think it's LDK378." "We told her in the clinic - really, she is a miracle child." "Leading scientists at the Institute of Cancer Research see this as a game-changing moment." "Cure is something that I think we're going to be, increasingly, able to talk about." "I think for some small numbers of patients, that will truly become a possibility." "Patients who've run out of options under conventional treatment are helping to revolutionise our understanding of cancer." "Even though it is terminal, you have to think," ""Well, no." "That's just a word."" "If you don't succeed, it's not for the want of trying." "Tonight we meet the patients at the heart of clinical trials that promise a new armoury of weapons in the battle against cancer." "So you've got to write a complaint letter?" "About how not to be rude, but get your point across?" "More than 7,000 women a year in the UK are told they have ovarian cancer." "Tami from Bath is one of them." "Mum to Edie, she was diagnosed in 2004, when she was just 30." "They removed the ovary, because they thought there was a cyst in it - obviously, when they took it out they found the disease." "I was then given three sessions of chemotherapy, to do some shrinkage, and then I had a debulking surgery where they removed bits of my bowel, my other ovary..." "I mean, they did say after that surgery that I was clear." "Surgery and radiotherapy are the main weapons used to successfully treat localised cancers - helping thousands of patients a year to overcome the disease." "Once a cancer has spread, chemotherapy drug treatment becomes vital in trying to keep the disease in check." "Yet, despite 18 sessions of chemotherapy," "Tami's cancer kept returning and spreading." "Ten when it came back again, they tried a different kind of chemo, which it continued to grow through." "And it was at that point, my local hospital said," ""There's not a lot else we can do for you."" "Erm, which is when we got in contact with the Marsden." "Now, thanks to pioneering drug treatments, her disease is being kept in check." "Pills she simply takes at home morning and night have replaced - and outperformed - conventional chemotherapy." "It's also personalised medicine." "The experimental drugs" " MEK162 and BYL719 - are designed for patients with specific genetic mutations in their cancer." "She's monitored at one of the hospitals two sites." "I'm just doing what we call the drug accountability, where we count the drugs and check that the right amount of drugs are missing, for the amount of days that the patient is dosed for." "Because they need to check when the empties are sent back down to pharmacy that our numbers all add up." "Do your numbers usually add up?" " They do, don't they?" "!" " They do." "You're very good!" "Apart from that one I dropped under the fridge!" "Oh, yeah." "THEY LAUGH" " You found it, didn't you?" " I think I did, yeah." "Tami has come to meet Professor Johann de Bono." "He's in charge of nearly 40 early drug trials run through a unique partnership between the Institute of Cancer Research and the Royal Marsden." "The doctors are both research scientists and clinicians, dividing their time between the ICR laboratories and the hospital." "How are you?" "You OK?" " Yeah, not too bad, thank you." " Well, the results from today are back" " and your blood tests are looking fantastic." " Really?" "They're looking really pretty good." "The last scan was clearly stable so the key thing is this next scan in two weeks' time." "I mean, there is still some disease there, but it seems to be controlled." "So this current trial, of these two pills..." "Has that been much different, regarding side effects, to the previous trial of the other two pills that we gave you?" "Um, yeah." "I mean, the skin rash is, definitely." " And the tiredness on this one is..." " Is worse." " ..is worse." " OK." "But compared to chemo and all the side effects from that, this is...easy." "I think that's really it for today." "The scans are in two weeks - that scan, obviously, is key." "We keep going as long as the scans are stable." "If he says it's stable, and he's happy with the scan, then I am." "You always worry they're going to say something you don't... think they're going to say, but, no, I'm over the moon." "I think fingers crossed for the scan, carry on and..." "Yeah, it's great!" "This is an unprecedented time of progress in the history of cancer medicine and cancer research." "The most wonderful thing is that these drugs have much less side effects than chemotherapy." "Unlike chemotherapy, these drugs are largely oral tablets, you can go home and take them every day." "The key to this new generation of cancer drugs is our greater understanding of human genetics." "A revolution in DNA sequencing has meant that we can map the disease faster, cheaper and in greater detail than ever." "Cancer is caused when genes in healthy cells mutate, leading to uncontrolled cell growth." "Conventional drug chemotherapy is a blunt instrument - it kills rapidly dividing cancer cells - but also damages healthy tissue." "A new generation of targeted cancer drugs work differently." "They're designed to home in and block changes within the cancer cells which drive tumour growth." "By targeting them, the cancer cell cannot function and dies." "The Holy Grail for us in cancer research and cancer medicine is to develop drugs that have the ability to spare the normal cell, causing minimal side effects, and killing, selectively, the tumour cell." "Sophie is just ten years old - and one of the hospital's youngest patients." "She's come with her mum from their home in Buckinghamshire to talk to the paediatric care team." "How has the last three weeks been?" "She was sick last week on Sunday, and we took her temperature and it was quite high, so we rang here to get some advice as to what to do, and they told us to go down to Stoke," "which we did, so she was taken in there." "And that was just for a few hours, is that right?" "If that, really." " So you're really back to normal now?" " Yes." "Yes, obviously, you've lost a bit of weight, you have, which is..." " Appetite has been quite suppressed." " Yeah, hm." "Just probably make sure that your diet is really as optimal as it can be." "You know, so get a dietician to see you." "Although cancer is rare at Sophie's age, the Royal Marsden treats 170 children a year." "Her cancer is especially unusual and aggressive." "Sophie has this tumour called IMFT or IMT which was growing in her chest." "A large amount of tumour tissue growing around her lungs and the breathing tubes in a very sensitive area in her chest." "The failure to treat that condition would have been incompatible with life." "Sophie's cancer was diagnosed nearly two years ago, after she became seriously ill with pneumonia." "Doctors initially thought the shadow on her lungs was a cyst, or even TB." "Finally, they said she would need major surgery." "A couple of days after they said," ""No, actually, it's this very rare type of tumour,"" "which is why they didn't get the diagnosis right, and that they would have to remove her lung." "What was going through your minds during all that?" " Just hell." " Indescribable." "It was..." "Yeah, it was hell." "It was..." "Yeah." "Just sort of lurching from one..." " One extreme..." " ..misery to another." "That one's the special one which only people on the trial get." "On each visit, the nurses are helping Sophie to create a necklace, a keepsake of her hospital treatment." "Everything that I go through, like blood tests and things, I get a bead for." "Sophie's tumour is due to a faulty gene called ALK, which creates a chemical signal that drives the growth of abnormal cells." "Her drug blocks those messages." "The treatment is showing great promise against some forms of adult lung cancer." "It was first tested on mice that were bred to carry the ALK mutation." "These ALK mice are studied at the Institute of Cancer Research." "What we really need to understand is the impact of a drug on tumour tissue itself." "For obvious reasons, in many children it's ethically very difficult." "It's also painful and dangerous to take tissue from children." "These mouse systems allow you to rapidly conduct pre-clinical trials in a so-called mouse hospital." "The mice are anaesthetised and scanned to see which of the drug compounds are working to kill the cancer and so might translate to humans." "What do you say to people who would say you really can't learn from animal trials and we'd be better off not doing them, at all?" "We think very carefully about what the results mean in these models." "We don't think this is the solution to all drug development for cancer." "There are other approaches that are useful and that data should all be considered equally." "So this is small part, then, of the whole research picture?" "Yes, it is." "A small part, but in its contribution, it does speed the delivery of cancer drugs to the clinic." "I'm taking a drug that doesn't have a name - but it's letters and numbers" " I think it's LDK378." "I thought we were going to have to beg to get on the trial but, as it was, I think they were really pleased to have us on the trial." "And, at that stage, were you optimistic or did you just think, "We'll just have a go?"" " We didn't have any hope!" " It was our last chance, so it was..." "It was all or nothing." "Scared, is the best word." "It was just..." "That first six weeks was terrifying." "Sophie's future depended on the performance of the drug LDK378." "And everything was riding on what the first scan would reveal." "We went in, went into the room, and..." "It had shrunk by about 60%." "Results were incredible." "It was..." "They were gob-smacked." "They said afterwards that there was a big departmental cheer, because they just don't see results like that." " It was just..." "It was brilliant." " Yeah, quite a miracle, really." "Unbelievable." "I mean it had started off about plum-size, and it was down to... ..not much bigger than a hazelnut, I would guess." "What was it like when you saw Sophie's scans, and what the drug had done to the tumour?" "It's..." "It is life-affirming." "It's the goal of every paediatric oncologist to see that kind of response." "It's truly astonishing and miraculous to see." "And I think we told her in the clinic that she's unique, and that she's very lucky, and that that, really, she is a miracle child." "You've mentioned that it's like a miracle and they've used that term." "But, of course, it's not a miracle, it's science." " Mm." " Yes." "Well, yeah, except it's..." "It's miraculous science, isn't it?" "!" "And we'll be meeting Sophie again, later." "Hi, John." " Hello, Fergus." " How are you?" " Good to see you." " This is beautiful." " Nice, isn't it?" " Yeah." "In both young and old cancer patients, some targeted treatments are producing spectacular results." "Oh, what a good shot...!" "John, from Surrey, has advanced prostate cancer which has spread to his spine." "He's been part of an international blinded drug trial led by the Royal Marsden, involving more than 1,000 men." "It'll be a 50% chance as to whether what you're given is the real thing or the placebo." "You take these four rather large tablets a day." "I've so far consumed nearly 4,000 of them." "And, um..." "I suppose after about six to nine months it began to be evident, because of my well-being, that I was getting the real thing." "Did you think you'd be here, so many years after your initial diagnosis?" "No." "I really didn't." "I really didn't." "I mean, let's face it," "I thought if I see 80," "I probably ought to be lucky." "I'm now 83 and I feel no different." "John's drug is a targeted therapy which blocks signals from hormones that drive prostate cancer growth." "It works so well on him that he's what's known as a super-responder." "Right, sir, my name's Adam." "I'm going to give you this injection today." "He's having a bone scan to monitor his progress." "So what we're doing today, Mr Timberlake, is giving you an injection of a radioactive compound." "Now, this yellow band lets all our staff know that you're radioactive - the idea being, that if they're pregnant they can run away and avoid you." "HE LAUGHS" "Hello, Fergus." "How nice to see you." " How are you?" " Good." "If you're pregnant, you mustn't be sitting near me, I warn you." "I don't think I am." "Do you get anxious before you talk to the doctor?" "I did at the beginning, but I've got possibly a little bit complacent." "I don't know." "Because this is my 26th month on this programme." "Wow." "I'm beginning to think, well," "I guess it's going to be all right, isn't it?" "I mean, one day they'll say," ""I'm afraid, John, I've got a bit of bad news,"" "but, so far, there's absolutely nothing." "And, of course, it's great, my life goes on," "I do all the things I want to do." "I have my friends and, um..." "I go to other people's funerals." "Yes." "But, uh, you know, what I'm listening for is," ""No change, John - all is good."" "Fingers crossed." "Yeah." "Absolutely." "John's trial drug, Enzalutamide is now licensed." "It costs £35,000 a year, though the NHS has negotiated a confidential discounted price." "Dr Alan Smith - please come in." "John's just had some more tests." "So I didn't find anything on exam that I'm worried about." "We've done some blood tests, and we did the scans." "So the bone scan didn't show anything new or different." " Today?" " Correct." "We're really happy to see there's nothing new worrisome." "Good." "The CT scan didn't show anything new, as well." " There are no new spots, anywhere." " Yeah." "I'm very confident that with some of these drugs we will be giving patients many, many years of life." "In prostate cancer, I'm seeing patients living 5, 10 years, regularly." "So you're really now coming to making cancer a chronic illness, that you can live with like blood pressure or diabetes, for many years." "Scientists are understandably reluctant to talk about conquering cancer." "But some believe we're at the dawn of a new age of cancer therapy, as these medicines move into the mainstream and become first-line treatments." "I do think, increasingly, we will cure a larger number of cancers, particularly if we can catch them early." "Because, actually, if you can catch these cancers when there's less cells, statistically, numerically, the chances of that cell evolving and changing, if there's less cells, are much less." "These sort of pleasures that you have, everyday pleasures, in a way it's down to the tablets, isn't it?" "The treatment?" "It's the tablets, it's the treatment, it's the fact that I'm so happy to be alive." "And may many more years of it come," "I don't know how many, but..." "You've still got your touch on the croquet lawn, that's for sure." "It's not too bad." "I've..." "I've played better." "I've been quite a low handicap in my best days, but, um..." "You know, I have played twice for England." "This year, 2.5 million people in the UK will be living under the shadow of a cancer diagnosis - the biggest number in the history of the NHS." "Thank you." "Tami's decade-long struggle against ovarian cancer continues." "Every eight weeks" "I have this full-on day." "Most of the time we just come up and it's to see the doctor and have the bloods done, and that's pretty much in and out." "But because this is the first day of the third cycle, it's, um, yeah..." "Quite a full-on one, this one." " Hi, Tamarin." " Hi." " How are you doing?" " I'm good, thank you." "You?" "Hi, nice to see you." "So how are things?" "Yeah, not too bad, apart from this bug that I've had." " Does it feel like it's getting any better?" " Yeah." "I think it's just slowly it's getting better." "And the other thing which we routinely doing the scan for, is to look at your disease - and things look great, actually." "Yeah." "When I spoke with the radiologist, she was really happy." "And I'm really happy, too." "And I'm really happy." "That's good." "Thank you." "I'm really pleased, actually." "There's been a bit of concern that maybe there was a bit of growth, and it wasn't doing what we were hoping, but it seems to be fine." "How far into the future do you think?" "It's hard because Edie starts senior school next year, but... you know, that voice in the back of your mind, is..." ""Will I be there to take her?"" "But I do feel confident that I will be here to take her." "So you kind of..." "You have that little dark voice, but then there is my rational side that, you know..." "Five years ago, before the Marsden, I thought that was it." "And, you know, they've given me a good four years, so far." "Cancer survival in the UK has doubled in the past 40 years." "Half of those diagnosed can now expect to live at least 10 years." "But some cancers are still very hard to treat." "We identified an area of what we would consider to be very high unmet need, with a group of tumours that arise in the salivary glands of patients." "Specifically, they are almost entirely insensitive to all of the standard chemotherapy drugs." "And there is a subset of these tumours which spread very readily to tissues around the body, particularly to the lungs, the liver and the bone, and there are no treatments available for patients who suffer that disease." "Hello, hi." "Anne has just such a form of hard-to-treat cancer - which started in her windpipe, but has now spread." "She's come with her husband Jamie to enrol on a unique research project designed to create drugs tailor-made to the patient." "So, next week, we're going to take a biopsy from one of the tumour masses in your chest." "In the coming weeks and months, we're going to conduct detailed genetic analysis of that tumour and, hopefully, discover what are the mutations that exist in that tumour that are driving its process, and allowing it to cause the disease that you have." "Anne's biopsy tissue will come here to the ICR's Tumour Profiling Unit." "Until recently it would have been too complex and expensive to map an individual patient's cancer." "Gene sequencing is now so much faster and cheaper it's enabling cancer to be examined and understood in greater detail than ever." "It's a very, very exciting time." "Sequencing is the technique that can be used not only identify the genes that can drive, but also to monitor, as the disease progresses." "It can tell us about evolution." "About how the tumours evolve, and how they evolve with treatment, how they change..." "So it's a very good way to monitor the way the tumours act - behave - in different conditions." "But the scientists will not only sequence Anne's biopsy, they will attempt something unusual." "What we are also going to do, is take the tumour tissue that we obtain next week and we're going to put some of that into conditions where we would allow it to grow, we hope." "And we'll do that by implanting it under the skin in mice that don't have an immune system, so that they'd be able to grow human tumour within their bodies." "The aim is for the mice to become cancer avatars, replicating Anne's tumour and its DNA profile." "A range of drugs can then be tested on them." "It holds out the possibility of treatments capable of targeting both primary and secondary cancers." "Do you test the drugs on the mice before you test them on me, or...?" "That happens or...?" "Yeah, so, the idea around this approach is to try to avoid using people, patients, as the field of battle in which we test these drugs." "When we try treatments, we want to be as certain as we possibly can be that there is a very good chance that it's a good selection of therapy and that there's a good chance that you're going to respond to this treatment." "Clearly, we hope that for every patient from whom we take a tumour, we will get a successful result, that we'll be able to grow the disease, and we'll be able to then use that" "to test the therapies that we want to try." " Hands are a bit cold." " That's OK." "How are you feeling about the whole process?" "Um..." "Quite excited." "You know, it's good." "It's obviously... ..a hard situation to be in, but something's happening, so that's good." "He sounds really positive about it, so..." "Anne and her husband have three young children." "Now the family, from Hertfordshire, are planning a special holiday." "So who remembers where we are going?" " Taiwondo." " Taiwondo?" " Thailand." " Thailand." "And how many aeroplanes do we have to get?" " Three!" " Four." " Two!" " Four!" "Three on the way there and three on the way back." "I kind of had a year of just getting better and getting back to normal life, and then a scan showed that it had spread to my lungs, and I think I've got about" "20 tumours across both lungs." "Then, in January, this year, they found that the tumour's back in my trachea so that's probably been the worst." "And I've never really been given a prognosis before, but they did say this time, they think months rather than years, so that, that was probably the worst." "That's why were going to Thailand." "They've always known, since I've had cancer." "I've always told them." "The advice is always to tell them." "We told them that" "I probably won't be around as long as I want to be, or as long as they would like me to be." "And it was the most heart-breaking thing we've ever done." "It was absolutely hideous, but, hopefully, in the long run, it will have been the right thing to do." "Anne is back for the biopsy." "The team scan her to find the most accessible tumour in her lung to extract some of the tissue containing its corrupted DNA." "Some of the biopsy is sent for sequencing at the Tumour Profiling Unit." "In the near future - rather than an invasive biopsy like this - it may be possible to track the changes in the cancerous DNA wherever it has spread - or metastasised - simply by analysing a blood sample." " OK, Anne." "I'll see you later." " OK." "See you later." "Blood DNA is also quite interesting for metastatic disease once there is spread." "Different areas of the body when you've got metastatic disease, can have tumours, and you only biopsy one, but when you're looking at blood, it might have representation of all the different tumours." "The rest of Anne's tissue is implanted in mice in the hope that they will grow her tumour - allowing doctors to test drugs that will attack her individual cancer." "Isn't it just a practice, Olive?" "Practise the notes." "THEY PLAY HALTINGLY" "Anne is one of 12 patients who are part of this avatar trial." "Four of the patients tumour biopsies subsequently grew in mice and this research is ongoing." "They've called me in, so this..." "I think it's either going to be the tumour is growing on the mice, or the tumour is not growing, can we take another biopsy." "Unfortunately, the tumours we've tried to establish in the avatars, we've now concluded that that's not actually going to be successful on this occasion." " OK." " We're very optimistic that the technique can work." "What we'd ideally like to do is to try again with another piece of tumour tissue." "I don't mind." "I'll do anything I have to do." "I don't mind, at all." "The last few years we've really made the most of things, you know we've done a lot, you know." "In a way, I don't want to have to be creating memories all the time, but that's what is happening." "So, erm, that's why we've booked this holiday to Thailand, to give something really memorable to the kids." "You just don't want them to forget you, I suppose." "Sadly, Anne died a few months after their holiday - three years after being diagnosed with cancer." "You know, it's one of the tough things about being an oncologist - you see people at a really bad time in their lives." "And often you are the bringer of very bad news - when things that they had hoped would happen, haven't happened." "When treatments that they hoped would materialise, do not materialise." "Now towards the end of Anne's life, we were still exploring other opportunities for her, and at that time we were still trying to think that there may be opportunities, clinical trials that she could take part in." "But, unfortunately, that was not something we could offer her." "But sometimes the targeted drug treatments are so effective patients can look forward to a future without cancer." "Sophie, who was treated for a rare tumour surrounding her airway, is still regularly monitored at the Royal Marsden." "Just close your eyes for me a minute, just while that laser light's on." "Keep your eyes closed." "You can open them again." "I need three blood tests..." "It's a special day for Sophie, and she adds to her personal record of all her hospital visits." " ..and one CT..." " And one CT scan." " ..and a birthday." " And birthday bead, cos it's your birthday!" " And how old are you going to be?" " Er, 11." "11, oh, how exciting!" " Happy birthday." " Thank you." "That makes up for coming to the hospital doesn't it?" " It does." " Yeah!" " Well done." " Very nice, thank you very much." " That's all right, that's OK." " Thank you." "So, you want to know about your scans, I expect?" " Yeah." " And they are good." "We're very pleased with how things are." "Things are stable to even smaller than they were before." "So your lump, when you came to see us, was this one over here..." "The scan results suggest that what is left of Sophie's tumour is completely inactive." "..and things have improved very quickly." "It makes me feel happy that there's not a massive mass in my lung any more!" "My very, very first scan was... the tumour was a very big... a big tumour, but now it's a much smaller tumour and it's not affecting me any more." "And were you expecting to hear today that it was a little bit smaller, or did you not think much about it?" "I didn't..." "Well, I thought that it was going to be something like that it hadn't shrunk, that you could see." "But it's good news to hear that it has shrunk." "She's never, kind of, felt sorry for herself, or..." " Which helps a lot, if..." " She's never asked, "Why me?"" " No." " Never." "And I think I would, if somebody told me I had cancer." "I'd want to know why me." "But it's never come out of her mouth." "Sophie!" "For Sophie, daily drug treatment doesn't need to interrupt holidays and a trip to the beach." "That was not too bad." "No." "That's her daily medicine, which she has to take with two spoons of low fat yoghurt, and that's it - that's her done for the day." "That's all she takes - that's her treatment?" "That's her treatment." "What is it like to be one of first people in the world to be on this treatment?" "Yeah, it's quite exciting." "And you are a medical pioneer aren't you?" " SHE GIGGLES" " Yeah." "So, has it spurred you on, then, to think about what you're going to do later in life?" "Well, I've always kind of wanted to be a doctor, but now that I've been through all this," "I want to be a doctor even more." "The Royal Marsden was the world's first hospital dedicated to cancer treatment." "Today is the Marsden March, and eight of my friends are doing a walk from the Chelsea Marsden up to the Sutton Marsden." "I think they're especially motivated this year, for me, cos obviously I've been being treated at the Marsden now for - oh, coming up for three years." "Sarah has ovarian cancer, and at one stage was given six months to live." " BELL RINGS" " Well done!" "THEY CHEER" "She's experienced some unusual side effects on her drug trial." "Unfortunately, I can't go out in the sunlight, though, because the drugs that I'm taking have made my skin photosensitive to the sunlight " "I'll either have my hood up or I'll be hiding in some shade somewhere." "I'll work it out, but I'll be there to see them come back." "Yay!" " You all right?" " Yeah!" " Tired?" "This is my little way of saying thank you." "You know, if it wasn't for the Marsden, my sister wouldn't be here today." "If she wasn't on the trial drugs - they've kept her alive, and we've had a few extra years out of her, so - may there be many more." "My goalposts, again, have extended." "My six months has now turned into three, three and a half years, and I'd like to think that that will be extended, you know, again, quite a bit longer." "Woo!" "Come and collect your medals." "But despite all the money raised by charity, the millions invested in this work by drug companies, research bodies and the NHS, there are no easy victories in the war on cancer." "Last one." "It is a hugely complex disease with a myriad of genetic variations, so tackling cancer can be like chasing a moving target." "Jacqueline, would you like to take a seat over here?" "Yes, thank you." "Jacqueline has had cancer twice." "More than a decade ago, it was breast, and now advanced lung cancer." "She's on another targeted therapy, and comes from Merthyr Tydfil with her family for her check-ups." " OK?" " Yeah." "Right..." "So, by the first cycle, only four weeks in, they noticed a significant difference in the fact that everything was shrinking." "Yeah." "So, we were really pleased, excited." "Really pleased." "She's only the second person in the world for it to have this effect, based on the type of cancer that she has." "And it was a bit of a gamble " "I think you persuaded them, didn't you?" " I did, I did!" " That you really wanted to have a go at this trial, and we're really pleased that they took her on." "Cos I was convincing them, I think, I was doing psychology on them!" "THEY LAUGH" "I will be all right, I'll be fine, I'll be fine." "Jacqueline gets the latest news from her consultant, Dr Udai Banerji." "Just very briefly, I've gone through your blood tests, and your white cell count seems to be holding - which is one of the things we look at in chemotherapy on these new drugs." "But if the white cell count drops below a certain point, there's a risk of infection." " Good." " So, I think we'll carry on." " I think we are very, very pleased the way it's going." " Yeah." "And you're looking amazing!" "SHE LAUGHS" "When I first saw you, I think you'd just come off radiotherapy..." " I know." " And you had a long journey from home, and you were feeling very tired, and we had this discussion, whether we should go on the study or not." "I convinced you." "It was the right decision, no doubt about that!" "The thing is, if nobody does these trials, nothing is going to get tested." "You know, you have to give everything a try." "Even though it's terminal, you have to think, "Well, no, that's just a word."" "And if you don't succeed, it's not for the want of trying." "The experimental drug Jacqueline's been taking is called BMN 673." "It jams a repair mechanism in cancer cells and inhibits their ability to grow." "On it, she's had a few extra months of good health." "But then the treatment fails." "The doctor that's seen me had said that they were going to stop the drug, because two more tumours have developed in the liver." "Bit of a shock." "Think that he was so upset as what I felt, because, you know, I'd been going so well with everything." "And, um..." "OK?" "So, why do the drugs sometimes stop working?" "Scientists at these ICR labs in London discovered that cancer survives through Darwinian evolution." "The DNA of cancer cells is inherently unstable." "Every time they copy themselves, more genetic errors occur, and the disease rapidly changes." "So when the drugs are sent to destroy them, this natural selection means some cancer cells develop resistance and survive." "Resistance is a major issue, because these are cancers that are genetically unstable, they can change and they evolve, we call this clonal evolution." "If you had to describe cancer, I would say it's an evil genius - it has...obviously it is destructive - it's learnt all the evolutionary tricks to survive." "So, for example, a lot of our targeted treatments, the cancer shrinks very quickly, and in about eight to nine months, or sometimes a year and a half, the cancer stop responding." "So, is resistance really the big hurdle that you're facing with these new targeted treatments?" "Resistance is inevitable, it's going to happen." "We have a huge effort trying to understand cancer evolution, and the more you understand it, you can predict the next step the cancer's going to take." "I get days when I'm a bit down, but I'm told that I'm not to be down on my own any more, that's what my daughter says." "So I try not to." "It is level 4 cancer - it's very aggressive." "They didn't even think it would shrink as much as it did." "But..." "So, I told them, like, "Keep me on your list," ""and make sure you don't forget me."" "Last year Jacqueline lost her battle against lung cancer." "We'd have many days where we would all be sat on her bed, because she didn't feel like getting out of bed, so we'd get in bed with her and sit and watch the Antiques Roadshow or something." "And your living room was her bedroom." " And the experience of being on the trial..." " Mm." "..when you saw that it was working, what was that like?" "A roller-coaster, wasn't it?" "But when it was working, every week there was just a sense of joy, and the hope back into our family again." "So it was...it was a tough time, but it was just amazing to have her for the time that we did because of it." "How important are these patients to you, and to the work of your colleagues?" "It's a privilege to actually be part of the cancer journey with them." "They are the true heroes of drug development - they go through all the treatments and then they volunteer, knowing, very often, that there is a very small chance of them benefitting from this, but they do it for their children their grandchildren - for humanity." "Is that how you think of your mum?" " Absolutely." " Yeah." " We're very, very proud of her." "It wasn't an easy trial," "In terms of the travelling" " I mean, this opportunity wasn't available where they were living, so she would make the effort, as poorly as she was, to travel up to London to stay overnight, and she effectively handed over her living body to research, to science." "Tami is on a targeted therapy for ovarian cancer." "But after a year her disease starts progressing, and she has to come off the trial." "The treatment stops working - drug resistance has kicked in." "I was shocked, because I didn't feel that I had any symptoms, but..." "Yeah, again, it's just an adjustment, it's kind of just that knock-back every time." "Yeah." "Just hope that they can find something else... to keep you going." "It's always there, it's hanging over you, so..." "I..." "I'm very good at denial, you kind of - you find a place to put it, cos otherwise, you know, it consumes you." "And I guess, while you're on the trial and you're doing it, you forget about it." "It's something I don't dwell on, the fact that I'm ill, but when they take you off it, it comes crashing home again." "But new drugs are coming through." "For Tami, there is another treatment called olaparib which is helping patients like Tami whose cancer may be driven by inherited genetic faults." "How have you found this olaparib drug?" "How's it been?" "It's been good..." "Bit of nausea, keep getting that..." " bit of tiredness, but not as bad as the last trial." " OK." "So, no, overall feeling pretty good." "Looking at all your recent results, I'm really quite encouraged that we have what looks like stable disease on the scans." " OK, that's..." " There's been very little change overall." "So, you know, I'm reassured that, actually, things are relatively stable, although you've got a fairly slow-growing disease, so that's always been the case for us." "The blood tests have been very good, actually." "So, overall, the impression I get is that things are stable, the drug is having some impact, it would appear." "I mean, this drug has been spectacular in many ovarian cancer patients." "In fact, some patients have been on it for years, actually " "I think our record is over five years on an early trial." " So, you know, we have seen it work." " Uh-huh." " All right?" "Good." " Fantastic." " Thank you for coming in today." " Thank you." " Let's hope it keeps working!" " Fingers crossed." "Thanks very much." "The Royal Marsden ICR team know that by introducing new drugs, using them in combination and even rotating treatments, they may be able to stay ahead - or at least keep pace with cancer resistance." "It will be a key strategy in transforming the disease into a manageable long-term condition." "How's Tami doing?" "This trial has actually suited her quite well." "If she progresses, there are, I guess, other trial options." "She's got a low grade ovarian cancer, but she's got a K-ras mutation, so it is possible to personalise her care with the newer drugs." "So, by knowing that molecular data we can probably put her on the other trial if this drug stops working." "The advent of personalised treatments means that for tomorrow's cancer patients there will be far more options for fighting the disease than when Tami's mother developed breast cancer." "Mum was diagnosed with cancer when I was 13, 14, but ever since then - and she was a hairdresser - she fitted the wigs for the cancer patients at the hospital." "So, growing up, there was always women with no hair in my house." "I think if you come from a family where you haven't been affected by it," "I think it hits you harder." "And I think it was always around in our family, so..." "And had I not had Edie, possibly, it would have hit me a lot harder." "But having her made me strong." "What is it like getting the chance to try these new genetically advanced treatments?" "What does that feel like to be part of that?" "It feels incredible - because we lost mum to breast cancer last year, um, and obviously I've got a daughter, and a niece, and a sister..." "So, to be able to do something that could potentially stop my daughter going through it..." "Yeah, it's got to be done, hasn't it?" "Drug resistance remains one of the biggest hurdles in cancer." "But as well as extending life with new targeted treatments, scientists are also exploring how to harness the body's inbuilt defences by boosting the power of the immune system." " Have you had scans like this before?" " Yes." "Vicky is another cancer pioneer, and an astonishing example of how even advanced disease can be halted." "For Vicky has malignant melanoma - an aggressive form of skin cancer - and it was found only after it had spread to her breast and lungs" "They just said it was melanoma cells - not the breast cancer tumour that I had assumed it was." "It had gone to my lungs." "I'd never done any research into melanoma - very few people understand that it can progress into other parts of the body." "I came to meet Vicky's consultant, Dr James Larkin." "We looked at her initial scan, which shows the main melanoma tumour on her lung" "And there we have a 2 or 3cm lump, we'd call that a lung metastasis, so it's a melanoma that's spread into the lung, and that's probably 2-3cm in size - something like that." " It's big." " Yeah, absolutely." "The outlook seemed bleak, but Vicky was offered the chance of going on a trial at the Royal Marsden." "I understood that the life expectancy for someone with stage 4 melanoma was about six months." "So, I wanted to make the most of that six months, but I didn't want to spend it unwell." "So, although doing a trial is quite hard in lots of ways, and you don't know what to expect, it seemed to give me the best chance of a good quality of life, and it was quality I was looking for rather than quantity." "And originally you'd been going to go to the Black Sea?" "We spent a whole day cruising through the Bosporus..." "Vicky, from Cardiff, wanted to travel and see as much of the world as she could." "And I did something off my bucket list," "I went snorkelling in Skiathos." "What's different about the drugs Vicky was given is that they don't kill cancerous tissue themselves, but rather enable our immune system to do so." "Within our bodies is an army of cells designed to destroy any organism which poses a threat, but spare healthy tissue." "Cancer cells - which are corrupted copies of normal human tissue - can sometimes be difficult for our killer cells to identify." "And in some cases they inhibit the immune response through a chemical handshake on the cell's surface." "The new drugs block the handshake, so the killer cells see the cancer for what it is." "The immune system is reprogrammed to destroy the cancer." "Ordinarily, the immune system might recognise a cancer as foreign, if you like, and destroy it at an early stage." "And so, in a sense, the cancer is putting the brakes on the immune system." "And so we're coming in with drugs that act against these brakes - if you like, you're taking the brakes off the immune system, you're stimulating the immune system, and then the immune system, if you like," "recognises the cancer and is able to attack it." "And if the immune system can lock on, it holds out the hope of overcoming cancer even as it evolves." "With immunotherapy, you've reprogrammed the system, if you like, and so, inside the patient, you actually have an immune system that can recognise tumour cells, and if a bit of the tumour does become resistant," "the experience to date certainly seems to be that the immune system can still deal with that." "Vicky is part of a major international trial testing two immunotherapy drugs - ipilimumab and nivolumab." "The trial is blinded, so doctors don't know which of the drugs she's taking - but the effects were so rapid they suspect she's on a combination of both treatments." "I remember you saying - and this may only have been a couple of weeks after you started treatment, you'll need to remind me - that you'd already..." "Yes, I had quite a substantial lump here..." " ..felt the lumps beginning..." " ..and it had gone," " and you didn't believe me!" " THEY LAUGH" "You had your registrar come and check me out again, and she agreed with me that it had gone!" "It wasn't - it wasn't that I didn't believe you - it's more of the fact that when we see something like that, we're actually likely to re-measure things, so this was the scan, actually, before you started the treatment," "at the end of July last year, and then if we were to look at the scan that's been done from today, it looks like, on the scan, it's pretty much disappeared completely." " It's amazing, isn't it?" " It is." "However, she developed dangerous side effects - hepatitis and meningitis." "Vicky needed treatment for these, and she had to stop the cancer trial early." "But the immunotherapy had already worked." "So, you've just had two doses?" "And yet your cancer has shrunk, and seems to have disappeared?" "It has remained stable for virtually a year, now." "Yes." "What is it about immunotherapy that can have these unusual effects?" "We want the immune system to attack the cancer - that's how these drugs work - but at the same time, you can get the liver, for example, being attacked, and so you can get inflammation of the liver - hepatitis." "You can get the gut being attacked, and so those are side effects that we don't really see with any other type of drug used to treat cancer." "And so if the immune system has been, shall we say, overactivated, or it is attacking normal parts of the body, we need to dampen down that overactivation of the immune system." "And Vicky's case illustrated that very well." "Good morning!" " I've got Jenny with me today." " Hello!" " We haven't seen each other..." " Ages, isn't it?" " ..for a while." " You OK?" " Fine." " Good!" " So, scan was good again." "I'm really pleased to hear that." "The next visit is three months." "That's what I was hoping you were going say!" " Yes." " So, that's good news, as well." " That's brilliant." " It's been six weeks, hasn't it?" " Yes." " Every six weeks for the last year" " Yes, yes." "Are those your questions?" "Yes, yes" " I always come in with questions!" "I have managed to find somebody to give me travel insurance at a reasonable cost." "The only stipulation was that I was non-terminal." " So, I can say that now, can I?" " Yeah." " So, you're happy to say that?" " I'd be happy to say that, yes" " Fantastic!" " I don't think it was what we expected today, is it?" " No." "So it was fantastic to get that really good news from James today." "And it's lovely to have someone with you to have good news!" "Not just to support you at the bad times." "I can really get on with my life, and put this in the back of my mind and just drag it out once every three months, which will be fantastic." "I think everyone who treats melanoma, in particular, is excited about this." "We've had targeted therapies in melanoma, now we've got immunotherapy." "The prospect of controlling solid tumours for long periods of time has to be exciting and, if you like, a brand-new way of treating lots of different types of cancers." "But I think the critical thing is that now we have drugs that are effective in the clinic, it absolutely opens the whole field as a proof of principle that this is a new way to treat cancer." "Vicky and other melanoma patients are helping to change the landscape of cancer treatment." "She's no longer on any drugs, and living life to the full - here supporting her daughter, who's run a half marathon." "She's done really well, fantastic." "And she's raised so much money." "And how much have you raised altogether?" "It's about £1,000, I think, that we've raised, so, well worth the pain!" "When I first had the drug," "I think there were only about 50 other people in the world who'd had it." "And so, we are right at the edge." "Nobody can say what's going forward, because we've never been going forward." "So all the time it's a learning curve - and for me, luckily, it's been a good learning curve." "Just one of Vicky's new drugs costs £75,000 per patient before the NHS discount, and so these new treatments present hard choices for health spending." "But while the war against cancer is far from over, these new weapons offer the hope of keeping this deadly disease at bay for longer than ever - and, in some cases, permanently." "Cure is something that I think we are going to be increasingly able to talk about, particularly with these drug combinations, with immunotherapy as well." "So, yes, I think for some small numbers of patients that will truly become a possibility - but there is still a lot more work to do."