The Royal Marsden (RM)’s 31-bed Oak Centre for Children and Young People opened at the Sutton site in September 2011 following a substantial £20 million new build, and is one of the largest comprehensive cancer centres for children and teenagers in Europe. Almost 600 inpatients and more than 5,000 day patients are seen at the Oak Centre every year. There are approximately 220 new malignant registrations in children and adolescents per year, including of leukaemia, central nervous system and extracranial solid tumours.
Patients are referred to the Centre from south of the Thames, Kent and the south coast, although for early phase clinical studies patients are referred from all around the UK via clearly defined referral networks, with at least a third of patients recruited to paediatric early phase studies coming from out of region.
Our Centre runs the largest Paediatric and Adolescent Drug Development Programme in the UK and one of the largest in Europe and internationally. We have been formally designated by the Innovative Therapies for Children with Cancer (ITCC) European Early Phase Clinical Trials Consortium as a First-In–Child Study Centre. Investigators from our Paediatric and Adolescent Drug Development Unit are currently leading and involved in multi-centre national and international trials evaluating new therapeutic strategies, including trials of molecularly targeted agents and immunotherapies.
The Research activities of the RM Paediatric/Teenage and Young Adult (TYA) Clinical Unit (Head – Dr Julia Chisholm) and the Paediatric and Adolescent Drug Development Team are closely integrated with the Divisions of Cancer Therapeutics and Clinical Studies at The Institute of Cancer Research (ICR). Following the recent retirement of Prof Andy Pearson, the international recruitment process for his successor as ICR/RM Professor of Paediatric Oncology Drug Development and Academic Lead is currently underway.
The joint ICR/RM Centre’s comprehensive Paediatric and Adolescent Oncology Targeted Drug Development Programme comprises drug discovery, pre-clinical evaluation, early clinical trials and the Oak Foundation clinical facility. The clinical facility includes 18 children’s inpatient beds, a dedicated 13 bed TYA Cancer unit, outpatient chairs and day care beds for both children and TYA patients, (including those on Phase I/II clinical trials), together with an adjacent on site laboratory for pharmacokinetic and pharmacodynamic sample processing, and two suites for radioisotope therapy to help facilitate novel studies involving radioisotope components eg MIBG therapy. We are one of very few European centres with the facilities and expertise to run functional imaging biomarker studies within the context of Paediatric/TYA early clinical studies.
The goal of the Paediatric and Adolescent Oncology Targeted Drug Development Programme research strategy is to improve the five year survival of childhood and adolescent cancer by accelerating drug development for children and young people, via the following specific aims:
To increase the number of hypothesis-driven, first-in-child early phase clinical studies of molecularly targeted anticancer agents with embedded predictive and pharmacodynamic biomarkers, initiated and led by the RM/ICR Paediatric and Adolescent Drug Development Team.
To develop functional imaging approaches for incorporation into early clinical trials of molecularly targeted agents for childhood cancers.
To increase the number of children and young people in early clinical studies.
Over the past 9 years, investment by the Oak Foundation and other key sources such as the ECMC and NIHR Biomedical Research centre (BRC) has facilitated the development of a strong Paediatric and Adolescent Drug Development Team with knowledge and expertise in the field of drug development, and provided crucial infrastructure for the successful running of early clinical trials, in partnership with international academic networks major and pharma companies.
The team includes Paediatric and Adolescent Drug Development Consultants (integrated closely with the wider Consultant team within the Children & Young People’s Unit, who provide additional disease-specific expertise and who are chief investigators on international clinical trials themselves), Drug Development Fellows, Research Nurses, Trial Co-ordinators, Data Managers, and Tissue Collectors. The Team also integrates closely with translational scientists with extensive international research experience.
This supporting infrastructure has allowed the Paediatric and Adolescent early phase clinical trials portfolio to increase from just 2 open studies in 2006 to 26 open studies in 2015-16 (18 phase I, 8 phase II; 18 molecularly targeted agents; 15 first in child), with further new studies opening this year. This is the largest portfolio of paediatric early phase trials in the UK and one of the largest in Europe.