AMMF’s Manchester Visit

Report on AMMF’s Visit to the Paterson Institute for Cancer Research and the Christie Hospital, Manchester,  21 May 2012

 by Helen Morement

AMMF was invited to tour the laboratories of the Paterson Institute for Cancer Research, and the facilities of the Christie Hospital and to meet with Dr Juan Valle for an update on the research work into treatments for cholangiocarcinoma that is being carried out there.

I was delighted that Liz Heywood, a stalwart supporter of the charity who lives in the Manchester area, was able to join me and so AMMF was well represented.  Liz and I were greeted on arrival by Clare Dickinson, Senior Nurse and Lead Clinical Research Nurse, Catherine Palmer of CRUK, and members of Dr Valle’s research team, who took us on an extensive tour of the research laboratories, and of the impressive clinical trial patient facilities.

Following this (and a very welcome tea and biscuit break!), we met Dr Juan Valle and he presented an update on the various current chemotherapy trials for cholangiocarcinoma, and also explained what is planned for the future.

Dr Valle outlined the current situation with the ABC trials (these are looking at chemotherapies for advanced, inoperable cc):

The ABC-02 Phase III trial completed in 2010 and results from this have provided a defined “standard” treatment for inoperable cholangiocarcinoma for the first time.

The ABC-03 first line trial followed on from ABC-02 (using the proven Gemcitabine/Cisplatin combination with the randomised addition of the anti-angiogenic Cedirinib). ABC-03 is on target to complete recruitment by September, and Dr Valle is hopeful that there will be enough data by April of next year to enable a presentation at ASCO 2013.

The ABC-04 first line trial is now also running – this again uses the Gemcitabine/Cisplatin combination but with the addition of AZD6244 (Selumetinib – which is thought to enhance anti-tumour efficacy when combined with conventional chemotherapeutic agents). This trial is taking place at the Hammersmith and Christie hospitals.

Once there is enough data gathered from the ABC-03 and ABC-04 trials, a decision will be made to move forward to a further Phase III trial – ABC-XX – with whichever combination proves to be the “winner”.

Dr Valle then outlined the new BBC-01 trial – which is a small trial to study the use of chemotherapy before surgery (Cis/Gem and Cetuximab). The hope here is that for certain inoperable patients, undergoing chemotherapy would bring about sufficient improvement for them to then move forward to surgery.

At this point we talked about international collaboration and asked about the sharing of research results with other teams around the world. Dr Valle mentioned that, in fact, IBTCC (The International Biliary Tract Cancer Collaborators) was a new group that had been set up to do just this, meeting at ASCO each year to share information – and with the intention to have a common dataset, to agree eligibility criteria for studies, and to set up multi-centre and multi-national studies.

The discussion then moved on to second line treatments – what was available for patients once they had received the Gemcitabine/Cisplatin chemotherapy? Apparently there is a research abstract being presented at ESMO (the European Society for Medical Oncology) regarding 63 patients across the UK who received a second line treatment (we understand this was FOLFOX – Oxaliplatin and 5FU), and who gained an average of 19 months survival. Dr Valle felt that if these second line treatment studies show success, then it could be possible to consider third line treatments, too.

We raised the subject of the SORAMIC trial* which is being held in Europe but not the UK, and which follows on from SIRT (Selective Internal Radiotherapy Treatment) which uses radioactive beads for inoperable advanced primary and metastatic liver cancer, and has proven to be effective, yet it is not routinely offered here in the UK. Dr Valle agreed that this should be looked at for cholangiocarcinoma, and said he is considering setting up a trial here in the UK.

A further very interesting point was raised by Dr Valle – he mentioned that he had a patient whose jaundice could not be relieved by stenting, the bilirubin levels remained high despite stenting. He found that giving, or in Dr Valle’s words, “trickling in”, chemotherapy (Gem/Cis combination) actually helped, and increased survival to 14 months, instead of just the expected weeks. And this, the use of chemotherapy in uncontrolled jaundice, is yet another area Dr Valle feels needs to be followed up.

The questions of statins and cholangiocarcinoma was raised – and although statins can cause problems with liver enzymes in some people, research into statins/cholangiocarcinoma would seem to point towards statins inducing apoptosis (cell death) in cc cells.

For information:  To read a report re statins/cholangiocarcinoma that appeared in GUT (International Journal of Gastroenterology and Hapatology), click here  and for a report that appeared in the International Journal of Oncology, click here

In conclusion, the visit and meeting left us in no doubt that there is still so much to be done, but very hopeful that progress is beginning to be made. To see the work being done by Dr Valle and his research team, and by Clare Dickinson’s teams running the clinical trials facility was certainly impressive.

Dr Valle was very generous with his time, and showed great patience in answering fully the many and varied questions both Liz and I put to him!  I will be in touch with Dr Valle again from time to time, so will definitely be following up topics discussed. We both gained much valuable information from this visit, and I am very grateful to everyone involved in organising it for us.

* Explanation of the Soramic trial from http://www.soramic.de : ”SORAMIC combines the most promising novel diagnostic and therapeutic approaches in HCC treatment available to date: diagnosis with hepatocyte specific contrast agent Primovist®; microtherapy with SIRT (Y90 radioembolisation) or radiofrequency ablation; and systemic treatment with thyrosinekinase inhibitor Sorafenib.”

31 May 2012