Interview with James Veal, head of the Newcastle Cancer Centre Pharmacology Group

15 Apr 2019

So Gareth, tell us a bit about your group and what they do.

I head the Newcastle Cancer Centre Pharmacology Group (NCCPG) at Newcastle University. We are heavily involved in the development of novel assays for the quantification of new drugs ahead of early phase trials, which leads on to the analysis of clinical samples following patient recruitment.

We are very active in running clinical pharmacology studies in a paediatric oncology setting, with a view to optimising the use of anticancer drugs in childhood cancer patients. This can be either in real-time, through the utility of therapeutic drug monitoring approaches and adaptive dosing, or through the generation of data to support the implementation of new dosing regimens. The work of the group has predominantly been funded by Cancer Research UK and the ECMC over many years.

What can you tell us about the therapeutic drug monitoring service and the problems it overcomes?

For a number of years, our research group has worked on the development of a national Therapeutic Drug Monitoring (TDM) programme. This would assist in the treatment of particularly ‘hard-to-treat’ childhood cancer patients, including pre-term infants and neonates, anephric patients, children with obesity and patients receiving high dose chemotherapy.

This involves the real-time measurement of drug levels in the blood to determine individual patient exposure. Recent studies in particular have focused on learning about the pharmacokinetics of anticancer drugs in these challenging patient groups.

We recently obtained a grant from NIHR to carry out TDM approaches in defined childhood cancer patient groups. This 3 year programme of work is allowing us to roll out a national study utilising the measurement of real-time drug levels to maximize the chances that patients achieve drug concentrations that are most likely to lead to clinical benefit.

What does the initiative mean to the ECMC Network and how can they utilise it?

We now have all the necessary regulatory approvals in place to formally open the trial and hope to officially open our first centre later this month. We will be looking to recruit patients in the vast majority of the 21 defined paediatric oncology principal treatment centres across the UK and Ireland. This will include ECMC Paediatric Network centres from Southampton all the way up to Glasgow, with a recruitment target of approximately 50 patients per annum across all participating centres.

What's the future of the service? How will it change clinical practice?

The patient groups being targeted in the TDM study currently involve the administration of non-standard chemotherapy regimens, and their treatment could potentially benefit from the generation of real-time information on the drug exposures being achieved in individual patients. This information can then be used alongside clinical response and toxicity data to make the most appropriate treatment decisions moving forwards.

In addition to providing potential benefit to patients, we anticipate that the programme of work will lead to the adoption of scientifically-supported dosing regimens and the provision of national guidelines for multiple drugs in these challenging patient populations. We believe that the TDM programme is the most appropriate approach to establishing more informed and scientifically-based dosing regimens for future use in the clinic.