We're funding Dr Alison Tree, an oncologist at the Royal Marsden, to trial a new kind of radiotherapy that keeps hormone therapy working for longer in men with advanced disease. She tells us about the cutting-edge technology behind the potential new treatment and the big hopes she has for it.

Dr Alison Tree, oncologist at the Royal Marsden
3 Dec 2018

Hormone therapies, like abiraterone and enzalutamide, have revolutionised the way we treat advanced prostate cancer. They have the potential to keep men’s cancer at bay for years, and give them more precious years of high-quality life.

But in the words of Dr Alison Tree, “cancer is crafty”. It can find a way around these valuable treatments. And once it does, men’s options start to run out. They’re left with a few chemotherapies, but the side effects can be significant and eventually the cancer will take over.

But with her new project – funded by one of our Research Innovation Awards – Dr Tree thinks she’s found a solution for some men. Men who fall into a specific group but who, up until now, have been treated with the same blanket approach as anyone with advanced prostate cancer.

“We’re increasingly recognising this phenomenon, called oligoprogression, where in some men, their cancer is only growing in a few sites,” explains Dr Tree. “These men are a group we haven’t paid much attention to. In the past, we’ve treated them just like every other patient with cancer that has spread.”

Picking off the resistant tumours

No one prostate cancer tumour that has spread in the body behaves exactly the same. While some may show signs of resistance, others will remain under the control of abiraterone and enzalutamide.

For men with oligoprogression, with just one or two tumours outside the prostate beginning to become treatment-resistant, Dr Tree thinks there’s a solution to keep these drugs working longer.

She plans to zap tumours with a powerful beam of radiotherapy, removing the problematic cancer sites, and leaving behind only the tumours that are responding to treatment. In this way, the clocks are reset for men, giving them more time on all-important hormone therapy.

“We hope this will control the cancer for longer, and put off the day when these men need to start chemotherapy,” says Dr Tree.


State of the art radiotherapy technology

The team are able to trial this exciting new treatment thanks to a new kind of radiotherapy, called SBRT.

“There’s been a revolution in radiotherapy in the last decade,” says Dr Tree. “We used to give radiotherapy less precisely, which could cause damage to any healthy tissues in its path. But SBRT uses lots of beams of radiotherapy, all from different directions, that focus in on the cancer.”

It’s a bit like using lots of spotlights from different directions, where each beam provides some light. But when they meet at a single point, in this case at the tumour site, the light from all the beams adds up to create one powerful spot.

In this way, radiotherapy can become more precise than ever before, giving a high dose to the resistant tumour while leaving surrounding tissues virtually untouched.

The advantages are clear. “With SBRT, we have a much better chance of clearing all the cancer in that region,” says Dr Tree. “And the chance of getting a significant side effect is extremely low in most of these patients – they may get one or two temporary side effects but these will go away very quickly.”

Funding the trial to bring SBRT to men within five years

Now we’re funding Dr Tree to put this innovative new treatment to the test, in a clinical trial as part of our Research Innovation Awards programme.

“We will use this new treatment on 84 men with oligoprogression, and at the end of the study we’ll review how they’ve all done,” she says. “What we hope is that the radiotherapy will have prolonged the time they can stay on their current drug without needing to switch to other treatments.”

And Dr Tree has big plans for what this project could mean for men with advanced prostate cancer.

“I hope that in five years we’re treating these kinds of patients very differently,” she says. “I hope we’ll be using radiotherapy as standard to pick off drug resistant parts of the cancer, and this will mean we can keep men on hormone therapy for longer. And that means less men will die of prostate cancer in the future.”

New treatments made possible thanks to you

It’s thanks to the generosity of our supporters that we can fund people, like Dr Alison Tree, to make these all-important improvements in treatment to the men that need them most.

“I’m very grateful for the support of Prostate Cancer UK and all the people who’ve donated to them,” says Dr Tree. “It’s only by doing more research that we can make things better for men in the future. And this kind of research, which is in a new group of patients, can really make a difference to how we treat cancer patients in the future.”

By donating today, you can help support more innovative research into better treatments for prostate cancer.

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