A Women in Science event held in Newcastle upon Tyne earlier this year demonstrated that women are certainly coming into their own in the fields of science, technology, engineering and maths.
In this, the second in a three-part series, HELEN COMPSON talks to one of those present, Prof. Ruth Plummer, Professor of Experimental Cancer Medicine at Newcastle University, consultant medical oncologist at Newcastle Hospitals NHS Foundation Trust and director of the Sir Bobby Robson Cancer Trials Research Centre.
By the time a cancer patient meets Professor Ruth Plummer’s team, he or she has few options left.
The 300 or so people referred to the Sir Bobby Robson Cancer Trials Research Centre each year are living on borrowed time and, indeed, it is a race against time to try to find a solution that, while it might not necessarily cure them, will at least give them a bit more time.
“We focus on early phase and precision medicine trials in relation to solid tumours here at the Sir Bobby Robson Centre, with another team doing similar trials in haematological malignancies such as leukaemia,” said Prof. Plummer.
“We frequently profile the patient’s tumour, to find out what’s gone wrong and then aim to find a medicine that will target that tumour specifically.
“We’re very honest with patients. They know where they stand when they go on a trial – to ensure they understand what the unknowns are both in terms of chance of response and possible side effects.
“We’re always very clear with patients, this is early phase research work, but our aim is to help them.”
Cancer research caught her attention right at the very beginning of her professional journey, when she was studying pre-clinical medicine at Cambridge University. “I did a lab research project in my final year and absolutely loved it!” she said.
So much so, her supervisor suggested she put her medical training on hold for three years to do a PhD, which she did. The Medical Research Council funded the programme. Afterwards, she completed her medical degree, but at Oxford.
By then, very interested in oncology, not least because it is an ever changing discipline, and having found the six months she’d spent in palliative care very rewarding, she accepted a job offer from Prof. Hilary Calvert, then the senior oncologist at Newcastle Hospitals NHS Foundation Trust.
“Hilary led cancer drug development in early phase trials and I guess I ended up following in his footsteps,” she said.
The Sir Bobby Robson Cancer Trial Research Centre, based in the Northern Centre for Cancer Care at Newcastle’s Freeman Hospital, opened in 2009.
Part and parcel of the world-class Newcastle Experimental Cancer Medicine Centre and funded by the Sir Bobby Robson Foundation, Cancer Research UK and the Department for Health, its raison d’être is the discovery of new anti-cancer drug therapies.
It is a designated unit for the administration of first in human experimental cancer drugs, meaning her team takes innovative new drugs from lab to clinic.
Indeed, Prof. Plummer was the first clinician in the world to write a prescription for the PARP – or Poly (ADP-ribose) polymerase – inhibitor Rucaparib, in 2003. The drug was given accelerated approval in the USA in 2016 and sanctioned for use across the EU in 2018.
She also led another new type of drug, an ATR (Ataxia telangiectasia and Rad3) inhibitor, through early-stage clinical trials. Some cancer cells rely on ATR to survive.
Prof. Plummer said: “Cancer cells are human cells that are dividing out of control. Modern cancer drugs are designed to target whatever has gone wrong and use that vulnerability to kill the cancer cells, without harming the patient too much.
“Basically, we are trying to kill human cells inside a human, so in doing trials, we are working out the correct dose and the side effects.
“You usually do that in the patients themselves, because you can’t test a cancer drug on a cancer-free person, so we really rely on the commitment of our patients to help us deliver trials and better treatments.
We explain our research to them and ask if they are prepared to go down the cancer trial route. The people I see and treat have run out of the standard options but they take the risk of toxicity with a new drug which may not help them.
“For many patients we then look at their tumour cells, trying to work out what’s going wrong and would this potential treatment work or perhaps that one?”
It has always been the puzzle-solving aspect of cancer research that has appealed to Prof. Plummer, the chance to get to the bottom of each individual mystery.
“I do also like the human side of it too!” she said. “My excellent research team see more of the patients on a day to day basis, but I do enjoy being in the clinic.”
Asked if the sadness she must see ever got her down, she answered: “There are success stories, but yes, there are checks and balances.
“One of the things I say when I’m teaching medical students, when I’m talking about my job, is that in some ways it would be a bad thing if from time to time a patient didn’t strike that particular chord, if I didn’t get upset.
“Then I would be thinking ‘I’ve been doing this too long’. You do still need to have the empathy there.”
Huge advances had been made in the treatment of cancer, particularly over the past two decades, and that in itself was a source of comfort and satisfaction. “People are living longer and better with cancer,” she said. “We’re able to keep them feeling well and alive for longer.”
There were still tremendous challenges in the field, of course. While some cancers were becoming ever more treatable, pancreatic cancer, for example, remains a difficult one that has so far defied any real solution.
Hepatocellular carcinoma, or liver cancer, too is on the rise against an increasing background of obesity, diabetes and non-alcoholic fatty liver disease.
She said: “In childhood cancers there is a 70% survival rate generally, but we haven’t been able to achieve that in adult cancers, so yes, there is still a lot to do.
“An interesting field of research is how our own bodies deal with cancer. The benefits of immuno-therapy, which harnesses the body’s own ability to tackle cancer, is an emerging discipline.”
Prof. Plummer also leads Cancer Research UK’s Newcastle Cancer Centre, is a member of its national Clinical Research Committee and Research Careers Committee as well as the MRC Experimental Medicine Panel and NIHR Efficacy and Mechanism Evaluation board.
Of the 18 experimental medicine centres for adults Cancer Research UK has nationwide (there is also a paediatric network), Newcastle’s is one of the top five most active units in terms of early phase drug trials.
The close-knit group includes the Royal Marsden in London, The Christie in Manchester and the Beatson West of Scotland Cancer Care Centre in Glasgow.
Staff from one can nominate patients for a trial at another, if appropriate. “We have an internal website where we share all the trials going on,” she said, “so if we have a patient with a rare tumour type or rare changes in the tumour, we can look up what opportunities are available right across the UK.”