Leeds Cancer Centre, UK

June 2013

Leeds Cancer Centre

• Provides comprehensive cancer services for• 750,000 population of Leeds• 2.7 million population of Yorkshire• Supra-regional services for 5.4 million population of Yorkshire-

Humber

Leeds Cancer Centre

• Cancer services co-located at St James’s University Hospital• St James’s Institute of Oncology – clinical care / trials

• Opened in 2008, £220 million development• 3rd largest cancer centre in the UK (66,000m2, 350 beds)

• Leeds Institute of Molecular Medicine – laboratory research• £21M development, opened 2005• >7,000m2 building linked to existing research laboratories

St James’s Institute of Oncology

• 11 floors, 12 wards, patient hotel• Excellent transport links (airport 20 minutes)

• Unites• Non-surgical oncology (including TYA cancer)• State of the art imaging and radiotherapy• Specialist Cancer Surgery• Haematology• Clinical pathology• Cancer registry• Protected research beds

UK cancer incidence, 2009

Breast

Lung

Colo-rectal / Anal

Prostate

Non-Hodgkin Lymphoma

Malignant Melanoma

Bladder

Kidney

Pancreas

Leukaemia

Oesophagus

Uterus

Stomach

Ovary

Oral

Brain and CNS

Myeloma

Liver

Cervix

Mesothelioma

Other sites

0 10,000 20,000 30,000 40,000 50,000 60,000

Leeds Cancer Centre

• Comprehensive cancer services• Surgery, chemotherapy, radiotherapy• Radiology and pathology• Clinical research• Academic research

• 24 site specific multi-disciplinary teams• Common cancers - breast, colorectal, lung• Intermediate cancers – gynaecology, urology, upper GI, H&N• Others – liver, CNS, melanoma, skin, thyroid• Haematological malignancies

Multi-disciplinary teams

• Site-specific teams basis of cancer care• Weekly meeting to review all new and relapsed cases

• Leeds and Yorkshire• Central, specialist review of all radiology, pathology

• Electronic transfer of radiology• Working towards digital pathology

• Patients managed according to clinical guidelines• Guidelines agreed across Yorkshire Cancer Network

• Site specific teams subject to annual peer review• Measures defined by National Cancer Action Team

Our workload

• 12,500 new cancer diagnoses in Yorkshire each year

• 6,500 radiotherapy patients

• 90,000 fractions of radiotherapy

• 5,000 cycles of chemotherapy

• 120 bone marrow transplants

• 11,700 elective NSO admissions

• 3,500 acute NSO admissions

• Significant specialist surgery workload

Leeds Cancer Centre• 430 consultants• Including:

• 31 clinical oncologists• 24 medical oncologists• 22 haematologists• 33 histopathologists• 42 radiologists• 70+ surgeons

• 35 general surgeons• 4 thoracic surgeons• 5 gynaecology surgeons• 12 urology surgeons• 4 head and neck surgeons• 8 plastic surgeons• 6 neurosurgeons

• 1240 nurses• 100 radiographers• 60 medical physicists• 20 allied health professionals • Includes

• dieticians• occupational therapists• physiotherapists• speech and Language therapists• social workers

Cancer surgery

• First class Service Delivery incorporating state of the art technologies

LaparoscopicSurgery

RoboticSurgery

Chemotherapy

• Comprehensive range of chemotherapy services• Intravenous / Oral• Intra-peritoneal / Intra-vesical / Intra-arterial

• Rapid access to modern drugs• Modern cytoxic chemotherapy drugs• Targeted therapies

New agents targeting the VEGF Pathway

VEGF

VEGFR2 KDR

Cation channel

Permeability

Antibodies inhibiting VEGF(e.g. bevacizumab)

Antibodies inhibiting VEGF receptors Soluble VEGF receptors

(VEGF-TRAP)

Small-molecules inhibiting VEGF receptors (TKIs)(e.g. PTK-787)

Ribozymes(Angiozyme)

– P– PP–

P–

– P– P

P– P–

– P– P

P– P–

Migration, permeability, DNA synthesis, survival

Lymphangiogenesis

Angiogenesis

VEGFR1 FLT1

Radiotherapy• Linear accelerators

• 10 NHS, 2 research• 4 Planning CTs

• Brachytherapy unit• State of the art technology

• Image guided radiotherapy• Intensity-modulated radiotherapy• Volumetric Modulated Arc Therapy• Stereotactic radiosurgery unit

• UK lead in stereotactic body radiation• World first clinical use of Agility (beam shaping device) and use

with SABR technique – October 2012

Haematology

• Supra-regional service (3.8 million)• Treats both adults and TYA• 43 beds, +ve pressure hepa-filtered

• Bone marrow transplantation• 50 allografts, 55 autografts• On-site stem cell harvest

• National lead for PNH• Prof Peter Hillmen

• Strong research record• Myeloid – Dr David Bowen• Lymphoid – Prof Pete Hillmen• Myeloma – Prof Gordon Cook

Paediatric and adolescent cancer

• Designated treatment centre for 3.8 million population• Paediatric oncology• Paediatric haematology• Teenage and Young Adult• Bone marrow and stem cell transplantation

• Services located at Leeds General Infirmary• 3 in-patient wards, 25 beds• Dedicated day care unit and out-patient clinic

• One of the most active research centres in UK• National leadership roles throughout• International leadership in TYA and cancer survivorship

Clinical Informatics

• PPM• All cancer diagnoses since 1990• ChemoRx and RadioRx since 1995• All clinic letters, MDT reviews since 2002

• Clinical outcomes• Early morbidity/mortality• Overall survival

• Open-source EHR in development• Trust-wide clinical portal• Links to primary care

• SystmOne and EMIS

Pathology

• Standard light microscopy plus antibodies

• Molecular phenotyping• HER2 over-expression in breast cancer• EGFR mutations in lung cancer• K-Ras mutations in colorectal cancer

• Part of CR-UK Stratified Medicine Programme• Aiming to deliver Next Generation Sequencing• Cancer Genome in 4 hrs for $1000

Clinical trials - Recruitment

• Strong clinical trial recruitment across LTHT• 33% of all patients recruited to trials

• 10% of patients recruited to randomised controlled trials

• Large, dedicated trial support team • Nurses, co-ordinators, data clerks, administrative/finance

• Leadership profile• Colorectal cancer; ovarian cancer; breast cancer

Clinical trials - Leadership

• Chief Investigator on large international phase III trials• ICON3 – Dr Tim Perren, NEJM, 2011• FOCUS2 – Prof Matt Seymour, Lancet, 2011• EMBRACE – Prof Chris Twelves, Lancet 2011• CR07 – Prof Sebag-Montefiore, Lancet 2009

• Leeds Clinical Trials Unit• Prof Julia Brown• Co-ordinating centre for phase 1 Myeloma UK Network

• NCRN – national co-ordinating centre for cancer research• Prof Matt Seymour

Cancer Research UK Clinical Centre

• Director – Prof Tim Bishop• Formal partnership between

• University of Leeds, LTHT, Cancer Research UK

• 4 core programmes• Genetics and epigenetics of cancer• Targeted therapies• Early phase and randomised prospective clinical trials• Biomarkers and pathology

• Aims to harness the scientific power of Leeds-based cancer researchers in order to deliver improvements in cancer therapy at local, national and international level. 

• Director Prof Peter Selby

Leeds Institute of Molecular Medicine

• Level 9 - Genetics; Molecular Gastroenterology

• Level 8 - Neurosciences

• Level 7 - Experimental Cancer Therapeutics

• Level 6 - Experimental Haematology

• Level 5 - Targeted Cancer Therapies

• Level 4 - Cancer Pathology, Tumour Biology

• Level 3 - Support services

Radiation research

• Prof David Sebag-Montefiore

• Dedicated research facility• Collaboration with Elekta

• UK consortium with Elekta• Christie, Manchester

• Marsden, Sutton

• International consortium• Netherlands Cancer Institute

• Princess Margaret (Toronto)

• Algemeines Krankenhaus (Vienna)

Imaging Research

• Leadership in both PET and MRI• Dr Andrew Scarsbrook

Prof David Buckley

• Involvement with CR-UK

• Large portfolio of oncology projects (>150)

• Dedicated research PET/CT machine

Surgical research

Surgical Technologies

Stratified Surgery

TISSUE-DEVICE INTERACTIONSINTRA-ABDOMINAL PLATFORMS

BIOSENSORS FLUORESCENCE-GUIDED SURGERY

INTRACORPOREAL ROBOTICS

• Led by Prof David Jayne

MRC/EME/NIHR ROLARR Trial• Robotic vs Laparoscopic Rectal Cancer• £1.2m over 5 years• Pan-World randomised control trial

MRC/EME/NINR GLiSten Trial• £1m over 3 years• Multicentre UK randomised controlled trial• Fluorescence guided surgery

Surgical research

Intraoperative fluorescence for Stratified colon cancer surgery

Any questions ?