Over the last few decades there have been tremendous advances in the care of children and young people with cancer.
Around 80% of sufferers now survive. This is in part due to laboratory based research that has led to a far better understanding of the causes of cancer and the development of new drugs and techniques. This knowledge is then applied in clinical trials that are available for the majority of children with malignant disease.
The Liverpool childhood oncology research theme is wide-ranging; addressing the two main challenges for paediatric cancer; improving the survival rate of patients with aggressive tumour types and decreasing toxicity from treatments like chemotherapy and radiotherapy.
Clinicians at Alder Hey have a long-standing and productive relationship with scientists at the University of Liverpool. Research focuses on the processes by which tumour cells become more aggressive and spread throughout the body (metastasis) and why tumour cells become resistant to chemotherapy.
A principal investigation taking place at Alder Hey is around tumour hypoxia. Tumours require a blood supply to grow and as this happens, the centre of a tumour mass may develop areas of low oxygen (hypoxia). Although this may limit the growth of tumours, hypoxic cells become more resistant to chemotherapy. This line of research is focused on neuroblastoma, a solid tumour in young children and two highly malignant brain tumours, medulloblastoma and glioblastoma.
Clinical research in this theme aims to lead and support clinical trials and to conduct novel in-house research that will have a clear benefit for children with cancer.
Alder Hey continues to have an excellent record of participation in national/international trials. We consistently achieve more than 90% entry of patients into available main line trials. We have a strong commitment to early phase (drug development) trials as one of ten member centres of the UK Paediatric Experimental Cancer Medicine Network and we are a member of the European Innovative Therapies in Childhood Cancer Group.
Alder Hey’s brain tumour service has an international reputation of excellence and our clinicians have a major influence in the development of paediatric neuro-oncology. We have a very strong publication record of our clinical experience of a variety of tumour types, consistently producing papers of international importance in the surgical management of brain tumours.
There is particular focus on ‘posterior fossa syndrome’, a common and often severe complication of surgery for tumours at the back of the brain. We have undertaken the world’s first systematic comparison of ataxia scales and a novel investigation of so-called socio-cognitive functioning in survivors of posterior fossa tumours.
Alder Hey has the UK’s first high field (3 Tesla) intra-operative MRI facility, funded by the Barclay Foundation so we have a very strong programme of research in MRI imaging in paediatric neuro-oncology. This includes the world’s first study of the utility of injectable small gas bubbles (microbubbles) as an MRI contrast agent and the investigation of a novel MRI technique called arterial spin labelling in CNS tumour imaging.
A number of clinical research projects are taking place relating to the side-effects of chemotherapy and supportive care for children and young people with cancer.
We are currently investigating two chemical tests for chemotherapy effects on the kidney that may help detect damage early and prevent long-term damage. We are also leading on a new project investigating two new tests (bacterial DNA and APTT waveform) that may help in the diagnosis and management of often life-threatening bacterial infections that are associated with the use of central venous catheters.
In collaboration with Professor Munir Pirmohamed at the University of Liverpool, a programme of research is being developed to explore genetic differences (pharmacogenetics) in individual patients that determine whether or not they are prone to developing particular side-effects of chemotherapy.
As part of our research into the side effects of chemotherapy and alongside the Better and Safer Medicines for Children research theme, we have recently begun working with Professor William Hope at the University of Liverpool to apply new techniques to determine how drugs are handled in the body (pharmacokinetics).
Eight year old Jacob was just 11 months old when he was first diagnosed with Acute Lymphoblastic Leukaemia (ALL) in 2009. Jacob had no real symptoms, but his mum Claire had noticed he had some unusual bruising. His local GP referred him to Alder Hey where doctors there quickly made the diagnosis just weeks before his first birthday.
Jacob was treated at Alder Hey and was put on an international collaborative trial for the treatment of children with ALL under one years old. This included an intense six month chemotherapy programme, which included blood transfusions, bone marrow tests and lumbar punctures. On top of this, Jacob required platelet transfusions to improve blood clotting after his platelet rate was measured at six instead of the normal 400 when diagnosed.
Jacob beat his cancer and successfully finished his treatment in 2011 but, during a routine check-up in 2012, doctors found a lump and it was discovered that Jacob’s cancer had returned. He faced further bouts of chemotherapy and radiotherapy.
Despite being able to have treatment locally again, Jacob’s family decided to stay and receive his treatment on the Oncology Unit at Alder Hey. Jacob was put on another research trial for relapsed and refractory ALL which used further chemotherapy and localised radiotherapy.
In April 2015, Jacob beat his cancer once again. He continues to undergo small monthly doses of chemotherapy and regular monthly check-ups.
Jacob’s mum Claire, said, "When we were told Jacob had leukaemia, we were totally devastated and shocked. It was much easier for him coping with the treatment as a baby, but he was still incredibly brave when he had to go through it all again. Alder Hey have been amazing and continue to be so with Jacob's follow up care and support. All the staff on the ward have been great; the nurses have been brilliant with Jacob. They are all so supportive and caring."