0:00:04 > 0:00:07There is one disease that touches all of our lives.
0:00:07 > 0:00:10A disease whose diagnosis can be devastating.
0:00:12 > 0:00:16One of the hardest things was actually telling the family, especially our three children.
0:00:17 > 0:00:20More than one in three of us will get it in our lifetime.
0:00:21 > 0:00:24Nobody knows if it's going to be the last Christmas,
0:00:24 > 0:00:29the last birthday, the last holiday, and it's just that uncertainty.
0:00:29 > 0:00:32Cancer is one of the most complex diseases to treat,
0:00:32 > 0:00:34because it's a part of us.
0:00:36 > 0:00:39Cancer isn't an alien invasion from outside,
0:00:39 > 0:00:42it's actually part of the price we pay for being human.
0:00:44 > 0:00:47This programme follows three people through
0:00:47 > 0:00:49one of the most difficult times of their lives.
0:00:50 > 0:00:52I'm just repeating history now.
0:00:52 > 0:00:54Dad died of it and it looks like I'm going to.
0:00:54 > 0:00:59Horizon has been given unprecedented access behind the doors
0:00:59 > 0:01:02of the Royal Marsden Hospital in London,
0:01:02 > 0:01:06where they are pioneering some ground-breaking new treatments.
0:01:06 > 0:01:10This is new to us, we've not done it before, we've not given
0:01:10 > 0:01:12this kind of dose, with this technology.
0:01:12 > 0:01:15On the day, it will be nerve-wracking.
0:01:15 > 0:01:20For Ray, Phil and Rosemary,
0:01:20 > 0:01:22these treatments offer new hope.
0:01:23 > 0:01:26And for all of us,
0:01:26 > 0:01:29they hold the possibility that we could one day defeat cancer.
0:01:47 > 0:01:48It's summer 2011.
0:01:50 > 0:01:54And Ray Dean is about to face the biggest challenge of his life.
0:01:56 > 0:01:58I used to be a professional footballer,
0:01:58 > 0:02:01played against some of the best footballers in the country.
0:02:03 > 0:02:07The most famous being Georgie, Georgie Best.
0:02:07 > 0:02:10And, er, yeah, played at Liverpool.
0:02:10 > 0:02:16On the famous turf at Anfield, in the cup match, yeah.
0:02:17 > 0:02:20That was in the, erm, in the younger days.
0:02:23 > 0:02:26Seven years ago, Ray was diagnosed with prostate cancer
0:02:26 > 0:02:30and underwent an intensive period of radiotherapy treatment.
0:02:31 > 0:02:36It was seven weeks, five days a week, I had 35 sessions.
0:02:38 > 0:02:42So I started at about five o'clock in the morning so that I could do
0:02:42 > 0:02:45a bit of work, earn a bit of money, and then go up there for the treatment.
0:02:47 > 0:02:51His treatment held the cancer at bay for nearly five years.
0:02:51 > 0:02:54But then Ray received the news he'd been dreading -
0:02:54 > 0:02:56the cancer had returned.
0:02:56 > 0:03:00You get more and more confident as the years go by that it's not
0:03:00 > 0:03:03going to come back, but, unfortunately, it has come back.
0:03:05 > 0:03:09This time, Ray's options for treatment are limited.
0:03:09 > 0:03:14Now, his best hope lies with radical developments in cancer medicine.
0:03:15 > 0:03:18Hopefully, everything's going to be all right.
0:03:18 > 0:03:22I don't think the nerves will kick in, I'm too old to have nerves now!
0:03:23 > 0:03:25So, erm, yes.
0:03:27 > 0:03:29It's just the build-up.
0:03:49 > 0:03:52This robot could offer Ray some hope.
0:03:54 > 0:03:57It's part of a new generation of advanced radiotherapy machines,
0:03:57 > 0:04:00one of only a handful of its type in the UK.
0:04:05 > 0:04:09In charge of getting it up and running is Dr Nick Van As.
0:04:12 > 0:04:16Radiation remains the most effective way of killing a cancer cell.
0:04:16 > 0:04:20We could kill all cancer cells if we could give them enough radiation,
0:04:20 > 0:04:23the problem is we'd have to spare the normal tissue around it.
0:04:23 > 0:04:29So, the challenge is to get the high dose of radiation to a cancer
0:04:29 > 0:04:32and minimise the dose to those surrounding tissues.
0:04:33 > 0:04:36The robot is the newest arrival at
0:04:36 > 0:04:38the Royal Marsden Hospital in London.
0:04:38 > 0:04:44Together with its scientific partner, the Institute of Cancer Research,
0:04:44 > 0:04:47the hospital pioneers and researches cutting-edge treatments.
0:04:49 > 0:04:53It's nice to be working in a place where we have the ability to invest
0:04:53 > 0:04:57in new techniques and be, hopefully, at the forefront of
0:04:57 > 0:04:59developing where treatments are going to be in ten years' time.
0:05:02 > 0:05:06This robot is the hospital's latest way of using radiation to kill
0:05:06 > 0:05:07cancer cells.
0:05:08 > 0:05:12It targets the cancer with pin-point accuracy,
0:05:12 > 0:05:15even as a patient moves and breathes.
0:05:18 > 0:05:22On the ceiling you can see that there's two X-ray units,
0:05:22 > 0:05:26one on each side, that's for visualising the tumour, and then
0:05:26 > 0:05:30that allows the robot to correct for movement of the tumour in real time.
0:05:31 > 0:05:36And then this over here is a light detector.
0:05:38 > 0:05:42And for patients who we are treating a lung or a liver cancer or
0:05:42 > 0:05:44something that's moving with respiration,
0:05:44 > 0:05:48as the chest moves up and down this system detects that
0:05:48 > 0:05:51breathing motion, so the two systems then work together.
0:05:51 > 0:05:54And then the whole robot moves over and treats the patient
0:05:54 > 0:05:59and then this part, that arm will be fixed
0:05:59 > 0:06:03and then the head will move with respiration to follow the tumour.
0:06:03 > 0:06:08And that's really what makes this technology unique.
0:06:10 > 0:06:14And we've got a nice mural on the ceiling for patients to look at.
0:06:17 > 0:06:21Known as "CyberKnife", the robot will allow the team to use
0:06:21 > 0:06:28far higher doses of radiation per treatment session than they have ever done before.
0:06:30 > 0:06:33Lead radiographer Helen Taylor is responsible for delivering
0:06:33 > 0:06:37the treatment, but before seeing real patients,
0:06:37 > 0:06:39she has to test every element of the machine.
0:06:40 > 0:06:43It's a bit tricky in a static patient,
0:06:43 > 0:06:48because they don't normally behave quite so well.
0:06:48 > 0:06:51But it's all we can do at this stage until we get the real thing.
0:06:53 > 0:06:56The team have been preparing for this for two years.
0:06:58 > 0:07:00It's been an exciting project,
0:07:00 > 0:07:04we've been doing our normal jobs every day for years and years
0:07:04 > 0:07:07and can do it in our sleep, but this is new to us, we've not done it before,
0:07:07 > 0:07:11we've not given this kind of dose with this technology before.
0:07:12 > 0:07:15If we put that dose, for instance, in the wrong place
0:07:15 > 0:07:18we could do some serious harm, so it's important we get it right.
0:07:22 > 0:07:24The staff at the hospital are pushing at the boundaries
0:07:24 > 0:07:29of medicine, because cancer is so notoriously difficult to treat.
0:07:34 > 0:07:40The problem is that cancer is a disease created by our own bodies.
0:07:41 > 0:07:44Cancer isn't some sort of alien invasion from outside
0:07:44 > 0:07:48that has got into us, it's actually our own cells.
0:07:48 > 0:07:53And cancer is a consequence of what happens to our own cells
0:07:53 > 0:07:57when they go wrong and, in a sense, it's kind of part of the price
0:07:57 > 0:08:01we pay for being human and being composed of all these cells.
0:08:02 > 0:08:05Our cells are constantly dividing.
0:08:05 > 0:08:09They grow, repair and replenish our bodies.
0:08:09 > 0:08:12It's an astonishingly accurate process, most of the time.
0:08:16 > 0:08:19Of course, not all our cells will function normally all the time,
0:08:19 > 0:08:22things will go wrong, and we need to have a mechanism to get rid
0:08:22 > 0:08:25of cells that aren't working properly.
0:08:26 > 0:08:30When cells go wrong, the body has a particular way of dealing with them.
0:08:32 > 0:08:34The cells can kill themselves.
0:08:38 > 0:08:42It may sound strange, but this is essential to keeping us healthy.
0:08:42 > 0:08:46If cells don't die, and continue to divide without stopping,
0:08:46 > 0:08:51they can grow out of control, creating cancer.
0:08:54 > 0:08:56What we can see here is actually
0:08:56 > 0:09:00cancer cells which are growing in the laboratory.
0:09:00 > 0:09:04So this is a film that's been taken over a day or two, obviously with time lapse.
0:09:06 > 0:09:08It's chaotic, it's disorganised.
0:09:08 > 0:09:10The cells, you get the impression,
0:09:10 > 0:09:13are not really paying any heed to what's going on around them.
0:09:13 > 0:09:17And it's worth saying that actually to even grow in the laboratory,
0:09:17 > 0:09:21to grow in plastic in the first place, is highly abnormal.
0:09:25 > 0:09:27Once the cells have become cancerous,
0:09:27 > 0:09:29the body can no longer control them.
0:09:31 > 0:09:34These are cells that become very difficult to kill
0:09:34 > 0:09:37and the way we would describe that is being immortalised,
0:09:37 > 0:09:41so the cells have the potential to become immortal
0:09:41 > 0:09:44and to grow forever, and that's clearly a highly abnormal behaviour.
0:09:47 > 0:09:50The ultimate aim of a cancer treatment is to target
0:09:50 > 0:09:52these abnormal cells,
0:09:52 > 0:09:57leaving a patient's healthy cells untouched, killing only the cancer.
0:10:08 > 0:10:10For much of his adult life,
0:10:10 > 0:10:1459-year-old Phil Garrard has lived in the shadow of cancer.
0:10:14 > 0:10:18Running is important, it takes your mind off things, it relaxes you.
0:10:18 > 0:10:21Once you get the heart pumping,
0:10:21 > 0:10:23you always feel good afterwards.
0:10:25 > 0:10:27I'm feeling fit and healthy at the moment.
0:10:27 > 0:10:32I don't feel any different to when I was 20 years old, to be honest.
0:10:35 > 0:10:38Phil has good reason to worry about his health.
0:10:39 > 0:10:4217 years ago, he witnessed his father die from prostate cancer.
0:10:46 > 0:10:48He was diagnosed, I think, too late
0:10:48 > 0:10:52and the cancer had spread to the bones.
0:10:52 > 0:10:55And, I have to say, it's a painful way to die.
0:10:55 > 0:10:58It really shocked me.
0:10:58 > 0:11:02It took him four or five years.
0:11:02 > 0:11:05Yes, it wasn't good, it wasn't a pretty sight.
0:11:08 > 0:11:13It was so devastating that, in truth, I think I ran away.
0:11:15 > 0:11:16I couldn't cope with it.
0:11:19 > 0:11:22To add to the pain of his father's death, Phil was told
0:11:22 > 0:11:24there was a chance he too would develop the disease.
0:11:28 > 0:11:32So, for the last 17 years, he's been going for regular tests,
0:11:32 > 0:11:33to pick up any early signs.
0:11:36 > 0:11:41Three months ago, Phil and his wife, Marie, received the latest results.
0:11:43 > 0:11:46When we went that day to get the results, do you remember?
0:11:46 > 0:11:51We sat down and he said it in the nicest possible way,
0:11:51 > 0:11:54- "Well, we found cancer."- Yeah.
0:11:54 > 0:12:00- And for me, it was, "Wow, cancer, the big C."- I know. Total disbelief.
0:12:00 > 0:12:03My head just went.
0:12:03 > 0:12:07Because I just was obsessed almost with what had happened to my father.
0:12:07 > 0:12:11Having gone through the trauma of that, I just said,
0:12:11 > 0:12:12"I'm just repeating history now.
0:12:12 > 0:12:15"Dad died of it, and it looks like I'm going to."
0:12:15 > 0:12:17And I just couldn't get myself out of that thinking.
0:12:20 > 0:12:22But now Phil has been given the chance to leave
0:12:22 > 0:12:24the shadow of his father's death behind.
0:12:25 > 0:12:29By having his prostate removed in an operation at
0:12:29 > 0:12:31the very forefront of surgical development.
0:12:37 > 0:12:40In the corner of an ordinary operating theatre,
0:12:40 > 0:12:42stands another extraordinary robot.
0:12:47 > 0:12:50Known as the "da Vinci", it's promising to change the way
0:12:50 > 0:12:53prostate cancer surgery is performed.
0:12:57 > 0:13:00The robot is the pride and joy of Chris Ogden,
0:13:00 > 0:13:03one of the world's most respected prostate surgeons.
0:13:05 > 0:13:09He has pioneered this new surgical technique in an attempt to
0:13:09 > 0:13:12improve the experience of patients undergoing surgery.
0:13:14 > 0:13:18It means he must work in a very different way to other surgeons.
0:13:20 > 0:13:22Chris, why are you taking your socks off?
0:13:22 > 0:13:25Well, yes, most surgeons operate with their socks on.
0:13:25 > 0:13:30In fact, I used to, until I started doing da Vinci surgery.
0:13:32 > 0:13:38And it was after about three or four months, when I was getting through so many pairs of socks
0:13:38 > 0:13:44with... For mysterious reasons, they kept on getting holes in.
0:13:44 > 0:13:51But it turns out that the pads that prevent your feet from slipping
0:13:51 > 0:13:57were causing my socks to wear through, so now I operate barefoot.
0:14:10 > 0:14:13Using the robot means Chris can eliminate any natural tremor
0:14:13 > 0:14:15from his hands.
0:14:17 > 0:14:21And the tiny instruments are highly manoeuvrable, allowing
0:14:21 > 0:14:24delicate, accurate movements, all without him
0:14:24 > 0:14:26even touching the patient.
0:14:30 > 0:14:34It was evolved for remote operating, originally through a joint effort
0:14:34 > 0:14:37between the American military and NASA,
0:14:37 > 0:14:43the theory being that it would offer surgical expertise in space
0:14:43 > 0:14:47without having to send up your trained surgeon.
0:14:48 > 0:14:52Chris is aiming to increase the accuracy of surgery,
0:14:52 > 0:14:54and using this technology, he hopes
0:14:54 > 0:14:58to see his patients recover more quickly from their operations.
0:15:06 > 0:15:09In October 2010,
0:15:09 > 0:15:13unfortunately there was evidence of local recurrence at that site...
0:15:13 > 0:15:15As new treatments are developed,
0:15:15 > 0:15:18the doctors at the hospital must decide just which treatment
0:15:18 > 0:15:20is likely to help each patient.
0:15:20 > 0:15:22..imaging, which was part of the screening process...
0:15:22 > 0:15:25Currently under discussion is a revolutionary new drug they
0:15:25 > 0:15:30have been trialling for treating melanoma, a type of skin cancer.
0:15:31 > 0:15:35The team have been inundated with enquiries from patients.
0:15:36 > 0:15:40There's an understandable demand from patients to get access to this drug.
0:15:42 > 0:15:47Given, in the last sort of 10, 20, 30 years,
0:15:47 > 0:15:49there haven't really been any sort of major breakthroughs
0:15:49 > 0:15:52in treating melanoma, to actually be in a position
0:15:52 > 0:15:55where we can talk about potentially effective drugs to patients for the first time
0:15:55 > 0:15:58is a great position to be in, so I'm not complaining.
0:16:00 > 0:16:03For Dr James Larkin, it's crucial that his team ensures
0:16:03 > 0:16:05the right patients receive this new drug.
0:16:05 > 0:16:07..progression in the interim.
0:16:07 > 0:16:11Fine, OK, thanks very much, Angela. So, the next patient, Alison?
0:16:11 > 0:16:14I spoke to her yesterday, she's fine...
0:16:14 > 0:16:18They must be careful that the benefit to the patient is great enough to outweigh
0:16:18 > 0:16:20any risks from side effects.
0:16:20 > 0:16:24..she's feeling a lot better and she's weaning off the steroids.
0:16:24 > 0:16:27So the plan is we're going to see her in clinic this afternoon
0:16:27 > 0:16:32and consider her for PLX4032 in the expanded access programme,
0:16:32 > 0:16:34if everybody agrees?
0:16:34 > 0:16:37OK, thanks very much, everybody, I think that's it.
0:16:37 > 0:16:39So we can go to clinic. Cheers.
0:16:39 > 0:16:44The new drug, Vemurafenib, is not yet widely available,
0:16:44 > 0:16:48but could help around half of people with the very worst cases of melanoma.
0:16:55 > 0:16:59For retired teacher, Rosemary Reid, the new drug offers a ray of hope.
0:17:00 > 0:17:04She was diagnosed with malignant melanoma four years ago.
0:17:06 > 0:17:07It was devastating
0:17:07 > 0:17:13because it just was a whole new, unknown, fearful thing
0:17:13 > 0:17:16that was in my life, which I hadn't ever come across before.
0:17:18 > 0:17:22Rosemary's illness has forced her to end a lifelong passion,
0:17:22 > 0:17:24travelling the world.
0:17:25 > 0:17:27Over the last four years,
0:17:27 > 0:17:31she's undergone both surgery and chemotherapy.
0:17:31 > 0:17:34One of the strange things about cancer treatment is
0:17:34 > 0:17:38that it's a bit like backpacking round Vietnam or something,
0:17:38 > 0:17:40you don't know what's going to happen in three days' time.
0:17:40 > 0:17:43It might be good, it might be bad, but let's hope it's good.
0:17:44 > 0:17:48Despite the best efforts of the doctors, the cancer returned.
0:17:50 > 0:17:52It has now spread to her internal organs.
0:17:54 > 0:17:57The lesions had spread to different parts of my liver and I've
0:17:57 > 0:18:00now got it all over my liver, and so I couldn't have an operation.
0:18:02 > 0:18:06And it had also spread into my lungs as well, not so much.
0:18:06 > 0:18:10Um, so I couldn't have the operation.
0:18:10 > 0:18:16So it was decided that I would have dacarbazine as a chemo treatment.
0:18:19 > 0:18:23So I had two sessions of that to see if it was going to work,
0:18:23 > 0:18:26and it didn't have any effect at all, the lesions are still growing.
0:18:27 > 0:18:31And we realised that, actually, when cancer gets to that stage
0:18:31 > 0:18:36that it's sooner or later terminal, and that was a very hard thing
0:18:36 > 0:18:42to come to terms with and, um... to tell our children, really.
0:18:51 > 0:18:57For decades, medicine didn't have much to offer patients like Rosemary.
0:18:57 > 0:19:00But now there's a real sense of optimism about the potential
0:19:00 > 0:19:02of this new drug.
0:19:03 > 0:19:06Working with Dr James Larkin on the trial
0:19:06 > 0:19:09is the hospital's medical director, Professor Martin Gore.
0:19:12 > 0:19:14We're really very excited, it's a real -
0:19:14 > 0:19:18that rather over-used word - breakthrough, for melanoma.
0:19:18 > 0:19:22I wasn't entirely sure I was going to see it in my professional life,
0:19:22 > 0:19:28but I have, and it's really tremendously exciting.
0:19:32 > 0:19:36Rosemary and her husband, Peter, have travelled into the hospital,
0:19:36 > 0:19:38because the team have discovered
0:19:38 > 0:19:42she's one of the 50% of patients who could respond well to the drug.
0:19:43 > 0:19:47Without treatment, Rosemary may only have months to live.
0:19:51 > 0:19:52KNOCK ON DOOR
0:19:52 > 0:19:53Come in.
0:19:53 > 0:19:55Hello, nice to see you again.
0:19:55 > 0:20:00- Hello, take a seat.- Hello. - Hello, nice to see you again.
0:20:00 > 0:20:05- So, are we all set?- I hope so.
0:20:05 > 0:20:08- You've read the information sheet? - Yes.
0:20:08 > 0:20:11Do you understand what taking the drug entails?
0:20:11 > 0:20:16I think so, yes. I'll take pills twice a day and hopefully
0:20:16 > 0:20:21it will reduce the tumours that I have in my liver and in my lungs.
0:20:21 > 0:20:27So it's got a very good chance of either stabilising the disease
0:20:27 > 0:20:29or causing some shrinkage.
0:20:29 > 0:20:31And there's about a 50% chance
0:20:31 > 0:20:36that it will cause substantial shrinkage of the tumours, which would be very good.
0:20:36 > 0:20:37That's very good news.
0:20:37 > 0:20:40Do you understand about the side effects?
0:20:40 > 0:20:44I understand that they are mainly connected with skin and that
0:20:44 > 0:20:50I mustn't be in the sun too much, or at all,
0:20:50 > 0:20:52and that there can be some rashes.
0:20:52 > 0:20:56Probably the other main side effect is a bit of fatigue.
0:20:56 > 0:21:00- But not in any serious way. - Yes, yes.
0:21:00 > 0:21:03So Rosemary would be bonkers not to take it?
0:21:03 > 0:21:05The answer is yes!
0:21:05 > 0:21:10And you're probably going to say I would say that, wouldn't I?!
0:21:10 > 0:21:15But actually, there are treatments that we give where
0:21:15 > 0:21:19we have very long conversations about whether it's worth it or not.
0:21:19 > 0:21:22But I think, in this case, it's one of those occasions where
0:21:22 > 0:21:28we can put our hand on our heart and say, look, you really should take it.
0:21:30 > 0:21:32And we're going to start today.
0:21:32 > 0:21:36- Carla has already got the drugs ready for you.- OK?
0:21:36 > 0:21:41- Yes, that's fine.- They are the drugs. - Lovely, fine...
0:21:41 > 0:21:45This revolutionary drug fights cancer in a new and powerful way.
0:21:46 > 0:21:50It's one of the new generation of drugs that have been made possible
0:21:50 > 0:21:55by a vast improvement in our understanding of what cancer is.
0:21:57 > 0:22:02Cancer occurs when our cells divide out of control
0:22:02 > 0:22:05and develop the potential to become immortal.
0:22:07 > 0:22:12This happens because the DNA, the genes at the very heart of the cell, have gone wrong.
0:22:17 > 0:22:21It's Professor Naz Rahman's job to hunt down those defective genes.
0:22:23 > 0:22:25BEEPING
0:22:26 > 0:22:30We get DNA, from individuals who've had cancer,
0:22:30 > 0:22:34and then we sequence that genetic code, and then we compare that
0:22:34 > 0:22:39with similar data from people who are well, who haven't had cancer,
0:22:39 > 0:22:42so we can look to see what the differences are there.
0:22:42 > 0:22:46So that we can try to identify what may be the causative genes
0:22:46 > 0:22:49that have led to that person developing cancer.
0:22:54 > 0:22:57In some cases, faulty genes are inherited,
0:22:57 > 0:23:01and can increase the likelihood of getting cancer.
0:23:05 > 0:23:08But less than 10% of cancers are caused by inheriting faulty genes.
0:23:11 > 0:23:15The majority of cancers are not due to something that's been inherited,
0:23:15 > 0:23:17they're due to genetic changes that have
0:23:17 > 0:23:22happened during life in a particular set of cells that then start
0:23:22 > 0:23:25growing uncontrollably and become a cancer.
0:23:25 > 0:23:31These types of genetic faults can happen to any of us, at any time.
0:23:31 > 0:23:34There are certain things that increase
0:23:34 > 0:23:37the likelihood of that kind of damage occurring, for example,
0:23:37 > 0:23:42UV light can make that happen more likely, the carcinogens in smoke
0:23:42 > 0:23:45also lead to DNA being damaged.
0:23:45 > 0:23:47In fact, just as we get older,
0:23:47 > 0:23:51we gradually accumulate more changes in our DNA and that's part of
0:23:51 > 0:23:55the reason why you are more likely to get cancer as you get older.
0:24:01 > 0:24:05Naz's team is part of a worldwide network of genetic scientists,
0:24:05 > 0:24:07carefully decoding our DNA.
0:24:10 > 0:24:14Looking for a fault among the six billion letters in the human genome
0:24:14 > 0:24:17is like looking for a needle in a haystack.
0:24:17 > 0:24:20But finding one is crucial to developing
0:24:20 > 0:24:22a genetically targeted drug.
0:24:25 > 0:24:28You get a sense that when you're making that discovery,
0:24:28 > 0:24:31just at that moment at least, you're the first person that knows
0:24:31 > 0:24:34that that gene has caused that disease, and also you have
0:24:34 > 0:24:38an insight into the hope that that's going to be useful
0:24:38 > 0:24:42down the line in terms of helping patients getting better treatments.
0:24:44 > 0:24:46Discoveries like these have triggered
0:24:46 > 0:24:49a revolution in cancer treatment.
0:24:49 > 0:24:54The promise that, one day, if we are struck down by cancer,
0:24:54 > 0:24:58keeping it at bay could be as simple as taking some pills.
0:24:59 > 0:25:03The process of hunting for genes has led to the new melanoma drug
0:25:03 > 0:25:07they've been trialling at the Royal Marsden.
0:25:07 > 0:25:10The question now is whether these innovative new treatments
0:25:10 > 0:25:13will deliver the results they are hoping for.
0:25:13 > 0:25:15WHIRRING
0:25:26 > 0:25:28After six weeks,
0:25:28 > 0:25:33the radiotherapy team have completed the installation of their robot.
0:25:33 > 0:25:36And Dr Nick Van As has begun to look for suitable first patients.
0:25:36 > 0:25:38..50, 55 minutes...
0:25:40 > 0:25:42Ray Dean has come to find out
0:25:42 > 0:25:45whether he may be eligible for the treatment.
0:25:47 > 0:25:50I don't know whether or not it's going to be suitable for me
0:25:50 > 0:25:52until I see the consultant.
0:25:52 > 0:25:57As I say, hopefully they're going to be able to do it
0:25:57 > 0:26:01and, hopefully, that's going to give me a bit of extra life.
0:26:04 > 0:26:07Ray's cancer has spread to a lymph node.
0:26:08 > 0:26:10Unfortunately, it is not operable,
0:26:10 > 0:26:15and he has already had the maximum amount of standard radiotherapy.
0:26:16 > 0:26:19But now there is a chance that the new technique could offer
0:26:19 > 0:26:20a crucial lifeline.
0:26:23 > 0:26:26Mr Raymond Dean?
0:26:28 > 0:26:32It all depends on Ray's latest scan results.
0:26:32 > 0:26:35If the cancer has spread beyond the lymph node,
0:26:35 > 0:26:37it will be too late for the treatment to go ahead.
0:26:43 > 0:26:47Hi, have a seat, nice to see you again. So, you've had the scan.
0:26:47 > 0:26:50Do you want to just go over
0:26:50 > 0:26:53the rationale for doing the scan, do you understand why we did it?
0:26:53 > 0:26:56Yes, basically to see if it was just in the one place.
0:26:56 > 0:26:57Yes, OK, so...
0:26:57 > 0:27:00And is it just in the one place?
0:27:00 > 0:27:02- It is.- Oh, thank God for that!
0:27:02 > 0:27:03That's the first bit of good news.
0:27:03 > 0:27:06It's been a really informative scan. I'll show you the pictures.
0:27:06 > 0:27:12That node that we saw on the CT is this little orange blob that
0:27:12 > 0:27:13lights up.
0:27:13 > 0:27:18But what we wanted to see was, did it light up, because if it did
0:27:18 > 0:27:22it's very highly suggestive that that is prostate cancer,
0:27:22 > 0:27:25and the other thing is that nothing else lit up, and nothing else has.
0:27:26 > 0:27:31This lymph node is very close to the area we irradiated before
0:27:31 > 0:27:35and that's why we weren't particularly keen on giving you
0:27:35 > 0:27:37standard radiotherapy again.
0:27:37 > 0:27:41But I think we can do this, we can give that a very high dose,
0:27:41 > 0:27:45using the CyberKnife, and really minimise the dose elsewhere.
0:27:45 > 0:27:48- But there's not no risk, I'm afraid. - Oh, yeah.
0:27:48 > 0:27:51I think the risk we can make is relatively low, but there is a risk.
0:27:51 > 0:27:54- Yes.- But I think it's worth doing. - Definitely.
0:27:54 > 0:28:00For Ray and his wife, Janet, it's an end to weeks of anxious waiting.
0:28:00 > 0:28:01'I'm lost for words, really.'
0:28:01 > 0:28:07Yes, you know. You come up here very hopeful that everything's going to come out right,
0:28:07 > 0:28:11and, you know, this CyberKnife has come along at just the right time.
0:28:11 > 0:28:14Six months ago, I wouldn't have been offered the treatment.
0:28:14 > 0:28:17It's good news for us.
0:28:17 > 0:28:20Despite it all glowing up there.
0:28:20 > 0:28:23- And you know, I told you I'd glow in the dark.- Yes!
0:28:24 > 0:28:25But...
0:28:25 > 0:28:28Well, we've got a few more years to do caravanning, haven't we?
0:28:28 > 0:28:32Well, that's right, yes, I mean to say, yeah,
0:28:32 > 0:28:34absolutely overjoyed, brilliant.
0:28:36 > 0:28:38Following his scan results,
0:28:38 > 0:28:43the team have decided Ray will be their very first patient.
0:28:43 > 0:28:46And for Nick, the reality of what they're about to do
0:28:46 > 0:28:48is beginning to sink in.
0:28:48 > 0:28:52Now that I'm talking to real patients about treating on the CyberKnife,
0:28:52 > 0:28:56I must say for the first time in the whole process, I've got nervous,
0:28:56 > 0:29:00so now I realise that we're going to be doing something we've
0:29:00 > 0:29:03not done before, and this is for real.
0:29:03 > 0:29:06I'm confident we can do this, and we can do it safely,
0:29:06 > 0:29:10but I will be quite relieved when the first treatments are behind us.
0:29:10 > 0:29:11MURMUR OF CONVERSATION
0:29:13 > 0:29:17You have to set a VOI, but you can set a very broad...
0:29:17 > 0:29:20Nick must now start to design a unique treatment plan
0:29:20 > 0:29:21specifically for Ray.
0:29:22 > 0:29:25To do this, he calls on a team of experts.
0:29:26 > 0:29:29As well as the doctors and radiographers,
0:29:29 > 0:29:34there are full-time physicists whose job it is to work out
0:29:34 > 0:29:38exactly how the robot will move around Ray to deliver the radiation.
0:29:38 > 0:29:40We're going to force the target dose into the shell, aren't we?
0:29:40 > 0:29:44Yeah, you need... You can't mix and match structures.
0:29:44 > 0:29:48Right now we have no idea what is the right steps to follow.
0:29:49 > 0:29:53So the role of defining the areas we want to and don't want to treat
0:29:53 > 0:29:57is the doctors', and the physicists then create the plan for us.
0:29:59 > 0:30:01The workhorses and the brains.
0:30:02 > 0:30:03That's nice!
0:30:07 > 0:30:09- Which way round was that, Nick? - THEY ALL LAUGH
0:30:09 > 0:30:11The physicists are the brains here!
0:30:13 > 0:30:16Because the level of radiation is so much higher
0:30:16 > 0:30:18than they would usually give a patient like Ray,
0:30:18 > 0:30:21their plan must be extremely precise.
0:30:23 > 0:30:26If they get it wrong, it could cause serious damage to Ray's body.
0:30:29 > 0:30:31Using scans of Ray's abdomen,
0:30:31 > 0:30:36the doctors create a 3D model to see where to avoid and where to target.
0:30:37 > 0:30:41As the plan takes shape, it's possible to see clearly
0:30:41 > 0:30:43what makes this type of treatment different.
0:30:46 > 0:30:49What we're looking at now is the radiation plan.
0:30:49 > 0:30:53These lines represent the angles or the number of beams
0:30:53 > 0:30:55that are coming in in order to create the dose.
0:30:55 > 0:30:57As opposed to a normal plan,
0:30:57 > 0:31:01which we just have dose just coming in from maybe the sides and one from the front,
0:31:01 > 0:31:06you can see that there's loads, hundreds of lines going in.
0:31:06 > 0:31:10By splitting the overall radiation into individual beams,
0:31:10 > 0:31:15delivered from different angles, each beam only delivers a low dose,
0:31:15 > 0:31:18causing less damage to healthy tissue.
0:31:18 > 0:31:23This approach to radiotherapy has huge potential advantages.
0:31:23 > 0:31:27So if you just use three beams, you've got to put about 30%,
0:31:27 > 0:31:3033% of the dose from each beam.
0:31:30 > 0:31:32If you're using 100 beams,
0:31:32 > 0:31:35you're only going to put 1% of the dose, theoretically,
0:31:35 > 0:31:38so you put a very little amount of dose through each beam
0:31:38 > 0:31:40but the centre is hot.
0:31:42 > 0:31:44Radiation is concentrated on the target
0:31:44 > 0:31:47and falls quickly away either side.
0:31:47 > 0:31:51At a centimetre distance, the dose is just 10% of the full amount.
0:31:54 > 0:31:57If we did this with standard radiotherapy, we'd still be
0:31:57 > 0:32:00at 50-60% of the dose in that region, possibly even higher.
0:32:00 > 0:32:03So we want this very rapid fall-off of dose,
0:32:03 > 0:32:08and that's what we've achieved by using all these beams converging on one target.
0:32:12 > 0:32:16In less than 24 hours this plan will become reality,
0:32:16 > 0:32:19as Ray becomes the hospital's first patient
0:32:19 > 0:32:21to be treated with the robot.
0:32:23 > 0:32:27You realise there's a lot of responsibility now to make sure this goes right.
0:32:27 > 0:32:29I wouldn't say I'm stressed about it,
0:32:29 > 0:32:33but I want tomorrow to come and tomorrow to go!
0:32:33 > 0:32:35But we'll get there, you know.
0:32:35 > 0:32:38Today's about making sure the plans are correct,
0:32:38 > 0:32:42and we'll probably be here quite late into the evening.
0:32:55 > 0:32:57For Phil, the waiting is over.
0:32:57 > 0:33:01He's travelling into the hospital for his operation
0:33:01 > 0:33:02on the da Vinci surgical robot.
0:33:04 > 0:33:07Goodbye, house. Next time I see you I'll be without a prostate.
0:33:09 > 0:33:12If it goes well, he could be cancer-free.
0:33:16 > 0:33:20'It's almost like you feel you're going round with a label.
0:33:20 > 0:33:24'There's this burden, there's this tag on you saying,
0:33:24 > 0:33:26'"This is Phil and he's got cancer."
0:33:29 > 0:33:32'So I want to get to a point where I can go round
0:33:32 > 0:33:35'and think to myself, "No, I'm Phil without cancer,"
0:33:35 > 0:33:37'and just move on.'
0:33:37 > 0:33:39- All right?- I'll need that!
0:33:40 > 0:33:45- Put your bag down there and make yourself comfortable.- OK.- Thank you.
0:34:01 > 0:34:04Before the robot can be put in place,
0:34:04 > 0:34:07the surgical team need to make preparations to insert the instruments
0:34:07 > 0:34:11and inflate Phil's abdomen with carbon dioxide
0:34:11 > 0:34:13to create space for the robot to work.
0:34:23 > 0:34:26The robot can now be brought in
0:34:26 > 0:34:28to replace Chris Ogden at the operating table.
0:34:29 > 0:34:30That's good.
0:34:30 > 0:34:33Make sure we don't clash the arms.
0:34:39 > 0:34:41Great.
0:34:42 > 0:34:44Great.
0:34:45 > 0:34:52That's just placing the instruments inside the patient,
0:34:52 > 0:34:56and...the robot's engaged.
0:35:01 > 0:35:04Across the room, Chris takes his position at the console...
0:35:07 > 0:35:08Thank you.
0:35:08 > 0:35:10..and the operation can begin.
0:35:17 > 0:35:22The mechanical movements of his hands are scaled by the robot,
0:35:22 > 0:35:30then translated into precise micro-movements of the instruments inside the patient.
0:35:30 > 0:35:33He can switch between three instrument arms
0:35:33 > 0:35:36and operate the camera with a foot pedal.
0:35:36 > 0:35:43The camera arm contains two high definition cameras, which together give a 3D view,
0:35:43 > 0:35:47enabling Chris to get a sense of depth and perspective.
0:35:47 > 0:35:50You start to feel you really are inside the space,
0:35:50 > 0:35:55which is an amazing feeling, really, because that's exactly
0:35:55 > 0:35:59where you want to be as a surgeon - right in where the action is.
0:36:01 > 0:36:05You become part of it and it becomes part of you.
0:36:13 > 0:36:18Prostate surgery is particularly difficult because all of the cancer
0:36:18 > 0:36:22must be removed without damaging any of the close-lying nerves or organs.
0:36:22 > 0:36:27Any complications could leave the patient impotent or incontinent.
0:36:27 > 0:36:32The precision of the robot promises to reduce these risks.
0:36:34 > 0:36:38So now we take this, which is the prostate. That goes into a bag,
0:36:38 > 0:36:43which we'll retrieve when we remove the instruments.
0:36:53 > 0:36:57Just like obstetrics. And there's our prostate.
0:37:01 > 0:37:05The operation is over and Phil is taken to recovery.
0:37:09 > 0:37:13When patients have their prostate removed with open surgery,
0:37:13 > 0:37:16they can expect to stay in hospital for up to a week.
0:37:20 > 0:37:22But because this procedure is less invasive,
0:37:22 > 0:37:25Phil is discharged in less than 24 hours.
0:37:27 > 0:37:32In three months' time, tests will reveal what effect the operation has had.
0:37:45 > 0:37:50For some people, even the very best surgery is not an option.
0:37:50 > 0:37:54Rosemary Reid is one of the first patients to be given
0:37:54 > 0:37:57a ground-breaking new drug for melanoma.
0:37:57 > 0:38:00She hopes it will extend her life.
0:38:00 > 0:38:03We're very lucky that we're part of the trial
0:38:03 > 0:38:08and we're hoping that it will improve things, and that we will be...
0:38:08 > 0:38:10or that I will be one of the lucky ones that it works for.
0:38:10 > 0:38:13Rosemary had two bouts of chemotherapy
0:38:13 > 0:38:17and they didn't work, so now we've got some hope.
0:38:17 > 0:38:20Yep. So...
0:38:20 > 0:38:25We'll take it from here and hope that it will work.
0:38:25 > 0:38:30Many of the new treatments being pioneered at the Royal Marsden
0:38:30 > 0:38:34evolved out of work done here, at the Institute of Cancer Research.
0:38:35 > 0:38:41The drug that Rosemary is taking was the result of an international collaboration of scientists
0:38:41 > 0:38:44and close to £1 billion of investment.
0:38:47 > 0:38:51It began with the hunt for a gene that drives melanoma.
0:38:52 > 0:38:56After looking at hundreds of samples from melanoma patients,
0:38:56 > 0:38:58geneticists made a major discovery.
0:38:59 > 0:39:03They found that one gene was mutated in about half of the patients,
0:39:03 > 0:39:06but was normal in healthy people.
0:39:06 > 0:39:08It was a gene called BRAF.
0:39:09 > 0:39:14About half of the melanomas will have that specific change in BRAF.
0:39:14 > 0:39:17If you look at the DNA in normal individuals,
0:39:17 > 0:39:19you will almost never see that change.
0:39:19 > 0:39:23So what that's telling you is that that isn't chance.
0:39:23 > 0:39:27That there is a specific causal relationship, is what we call it.
0:39:27 > 0:39:31That change in that gene is critically important
0:39:31 > 0:39:35for why those cells have become melanoma cancers.
0:39:36 > 0:39:41People with melanoma are far more likely to have the mutated BRAF gene
0:39:41 > 0:39:45than healthy people, and scientists here played a key part
0:39:45 > 0:39:48in turning this knowledge into a treatment.
0:39:49 > 0:39:53We have the green China tea, very nice.
0:39:53 > 0:39:57Jasmine with flowers. That's very nice, that smells nice, actually.
0:39:57 > 0:40:01Darjeeling, rooibos, Earl Grey and Ceylon.
0:40:01 > 0:40:03(I don't like Earl Grey.)
0:40:03 > 0:40:05When Naz's colleague, Professor Richard Marais,
0:40:05 > 0:40:09heard about the mutation, he knew it was a major find.
0:40:09 > 0:40:13When I heard that BRAF was mutated in half of human melanomas,
0:40:13 > 0:40:17I was beside myself with excitement, because that really tells you
0:40:17 > 0:40:19that here, probably for the first time,
0:40:19 > 0:40:25we're starting to understand the processes that drive the formation of this one type of cancer.
0:40:25 > 0:40:30I think it's very difficult to try and convey how exciting that was.
0:40:33 > 0:40:38His day-to-day work involved studying normal cell division,
0:40:38 > 0:40:42and he suspected the BRAF gene was involved in that process.
0:40:43 > 0:40:47If the BRAF gene was mutated, he thought that might cause
0:40:47 > 0:40:50the cell division to go wrong, triggering cancer.
0:40:52 > 0:40:58To test his theory, he removed the mutated BRAF from some melanoma cells in his lab
0:40:58 > 0:41:03and amazingly, the cancer cells stopped dividing and died.
0:41:05 > 0:41:10That tells you then that this is not just a silent passenger
0:41:10 > 0:41:12that's not doing anything in the cancer.
0:41:12 > 0:41:15It tells you that it's what's driving the cancer.
0:41:15 > 0:41:20It really speaks to you and says, "This is where you should be putting your effort."
0:41:20 > 0:41:24He began to examine the damaged BRAF gene further.
0:41:24 > 0:41:31The normal BRAF gene produces a protein which activates cell division.
0:41:31 > 0:41:35And it is this protein that's critically important in the cancer cells.
0:41:35 > 0:41:40This is actually the shape of the BRAF protein,
0:41:40 > 0:41:43and what you can see is that it's got lots of lumps and bumps,
0:41:43 > 0:41:46but the most important part of the molecule is this, here.
0:41:46 > 0:41:51You can see this very deep cleft that really runs into the heart of the protein,
0:41:51 > 0:41:54and that's the business end of the molecule.
0:41:54 > 0:42:00In the normal BRAF protein, this cleft is closed off unless the cell needs to divide.
0:42:02 > 0:42:06Now, the problem with the mutant form of BRAF, what we discovered
0:42:06 > 0:42:09is that the gate won't close, so the protein remains active all the time.
0:42:09 > 0:42:13I think I can actually illustrate it using this tea caddy here.
0:42:13 > 0:42:15You see that it's got this nice catch on it.
0:42:15 > 0:42:20If we imagine that this is the BRAF protein, this is the cleft on the inside,
0:42:20 > 0:42:24and by locking the tea caddy, we can turn the protein off and keep it off.
0:42:24 > 0:42:29But when this catch is broken, the protein stays open all the time.
0:42:29 > 0:42:34It's constantly active and constantly driving the growth of the cancer cells.
0:42:34 > 0:42:38So then we need to develop drugs to stop that protein from working.
0:42:38 > 0:42:42We can use these tea bags to illustrate the drug
0:42:42 > 0:42:45and the idea is that if we put enough of these tea bags in here,
0:42:45 > 0:42:49we'll block up the cleft and that'll stop the protein from working
0:42:49 > 0:42:52and that means that the cells won't be forced to proliferate.
0:42:52 > 0:42:56Lipophilic pocket, which is...
0:42:58 > 0:43:02The next step in developing any genetically targeted drug
0:43:02 > 0:43:08is for the drug designers to find a chemical which can block the cavity in the crucial protein.
0:43:08 > 0:43:15For Professor Paul Workman, designing a drug can be a problem of geometry,
0:43:15 > 0:43:20and it is being transformed by the latest 3D technology.
0:43:20 > 0:43:23So what we're looking at here is the surface of the protein,
0:43:23 > 0:43:27a small part of it - the bigger protein surface is all around here.
0:43:27 > 0:43:34In this cavity is the essential part of this molecule that makes it cause cancer.
0:43:34 > 0:43:40With the target identified, Paul and his team screen over 100,000 chemicals,
0:43:40 > 0:43:43to see if any show signs of binding into the cavity.
0:43:45 > 0:43:49When they find one with potential, they turn it into a virtual model.
0:43:49 > 0:43:54Here you can see it fills quite a bit of the cavity, but not as much as we would like.
0:43:54 > 0:43:59It did actually have some anti-cancer activity, albeit quite weakly, and we needed to make it more effective.
0:43:59 > 0:44:04Using the 3D model, the team can fine-tune the drug,
0:44:04 > 0:44:08atom by atom, to perfectly fit the entire cavity.
0:44:10 > 0:44:15So here you can see the structure of the much more advanced compound.
0:44:15 > 0:44:20You can see it's a more complex structure, it's bigger, there's more complexity in geometry,
0:44:20 > 0:44:23and as a result it binds much more effectively.
0:44:23 > 0:44:29This drug was 1,000 times more effective on the cancer cells than the original hit.
0:44:31 > 0:44:37This 3D technology makes the development of a drug faster and more efficient
0:44:37 > 0:44:40than can be achieved in the lab alone.
0:44:40 > 0:44:43There's a beauty to this which is absolutely captivating.
0:44:43 > 0:44:48I continue to be delighted by seeing the beauty of the interaction.
0:44:50 > 0:44:52Finally, you've got the best satisfaction,
0:44:52 > 0:44:56which is that patients will benefit from that science.
0:44:57 > 0:44:59It's hard to beat.
0:44:59 > 0:45:01HE LAUGHS
0:45:03 > 0:45:07As more and more genes responsible for driving cancer are discovered,
0:45:07 > 0:45:11scientists will be able to design increasing numbers of targeted drugs.
0:45:11 > 0:45:14The ambition is that in the future,
0:45:14 > 0:45:18there will be drugs to act on every type of cancer.
0:45:22 > 0:45:25There's a picture of the day. Now, I can't find one.
0:45:25 > 0:45:29It's the morning of Ray Dean's first robotic radiotherapy session
0:45:29 > 0:45:35and the start of a treatment, which he hopes will extend his life.
0:45:36 > 0:45:40Some of it is just the waiting, going back to the old days,
0:45:40 > 0:45:45when you're playing football, tension all builds up inside you.
0:45:45 > 0:45:49Once you get on the pitch there, completely different. It just goes.
0:45:49 > 0:45:52Once you're out there, then it's all gone.
0:45:52 > 0:45:54So I suppose, you know, this is the same thing.
0:45:59 > 0:46:01FAINT BEEPING
0:46:01 > 0:46:03For the last two days,
0:46:03 > 0:46:06the radiotherapy team have been running final tests.
0:46:06 > 0:46:09Not everything has gone smoothly.
0:46:09 > 0:46:13You'll have to come round and let him in.
0:46:13 > 0:46:15Hugh, this...
0:46:15 > 0:46:19This is a whole series of error messages that's trying to,
0:46:19 > 0:46:22we're just trying to turn it all off and reboot it and start again,
0:46:22 > 0:46:24which is very frustrating.
0:46:24 > 0:46:28- I think it's got stage-fright this morning.- I know.
0:46:28 > 0:46:31Even a machine this sophisticated
0:46:31 > 0:46:34sometimes needs switching off and on again.
0:46:39 > 0:46:42WHIRRING
0:46:45 > 0:46:50The pressure must be on everybody involved at the Marsden,
0:46:50 > 0:46:53as well as myself and, um...
0:46:53 > 0:46:56let's hope everything goes well.
0:46:56 > 0:46:59A, B and C...
0:47:03 > 0:47:04- I'll go and find the case.- OK.
0:47:04 > 0:47:07Just sorting out the music.
0:47:11 > 0:47:14After years of planning and months of preparation,
0:47:14 > 0:47:17this robot is about to deliver radiation to a patient
0:47:17 > 0:47:19for the very first time.
0:47:32 > 0:47:35- Put your hand up if you need to say anything, we'll come through. - Cheers. Thank you.
0:47:37 > 0:47:39CONTINUOUS BEEPING
0:47:47 > 0:47:49Is that everybody?
0:47:58 > 0:47:59OK, so we'll see you at the end.
0:47:59 > 0:48:02- Mmm.- About an hour, we'll see you then.
0:48:12 > 0:48:15For the next 45 minutes,
0:48:15 > 0:48:18the robot delivers the highest dose of radiation
0:48:18 > 0:48:21they've ever given a patient like Ray.
0:48:21 > 0:48:25Because of this, his treatment will take only three sessions.
0:48:27 > 0:48:32A dramatic improvement on the 35 sessions of radiotherapy he had before.
0:48:35 > 0:48:37In four weeks' time, a blood test will reveal
0:48:37 > 0:48:40if the treatment has begun to take effect.
0:48:55 > 0:48:58Phil Garrard is back out running with his sons,
0:48:58 > 0:49:02three months after his operation with the surgical robot.
0:49:02 > 0:49:06He has been given the results of his blood test,
0:49:06 > 0:49:09which will reveal if his prostate cancer is still there.
0:49:11 > 0:49:14They said the result was unrecordable,
0:49:14 > 0:49:17which is what I think everybody's looking for.
0:49:17 > 0:49:20It wasn't even on the scale.
0:49:20 > 0:49:22So the lower it is, the better,
0:49:22 > 0:49:25but mine was unrecordable, because it was so low.
0:49:27 > 0:49:33You get confidence that they've cracked this horrible disease
0:49:33 > 0:49:37and it's not a thing to be so fearful as it used to be.
0:49:39 > 0:49:44The development of robotic surgery is promising to increase precision
0:49:44 > 0:49:50and dramatically reduce recovery times for patients of the future.
0:49:52 > 0:49:54Two months ago,
0:49:54 > 0:49:57Ray Dean was hoping a new form of radiotherapy
0:49:57 > 0:49:58would extend his life.
0:50:00 > 0:50:03He's now here for the results of his PSA blood test,
0:50:03 > 0:50:06a measure of the level of cancer that remains.
0:50:06 > 0:50:08- Well, the good news... - The good news?
0:50:08 > 0:50:10It's worked well.
0:50:10 > 0:50:15The PSA has fallen from 21 to 5.6. So..
0:50:15 > 0:50:17That's absolutely amazing.
0:50:17 > 0:50:21- We couldn't have wished for better news.- No, it's great, I'm delighted.
0:50:21 > 0:50:23I have to be honest, I was quite nervous...
0:50:23 > 0:50:24LAUGHTER
0:50:24 > 0:50:27- Yes, yeah, yeah.- So, very relieved.
0:50:27 > 0:50:31As I said to you, it's probably earlier I normally would be checking it,
0:50:31 > 0:50:34- although there isn't really a normal for us in this.- No, no.
0:50:34 > 0:50:39- So, but I mean, that's, I hope that it will continue to fall.- Yes.
0:50:39 > 0:50:43So to be so much lower in such a short period of time,
0:50:43 > 0:50:47- it's exactly what we wanted to see. - Yes. That's absolutely brilliant.
0:50:47 > 0:50:49Over the moon. Over the moon.
0:50:49 > 0:50:50I had every confidence,
0:50:50 > 0:50:53but it's nice to actually hear that it has worked.
0:50:53 > 0:50:56- Yeah.- And so well.
0:50:56 > 0:51:00The good thing is there that, as the doctor said, you know,
0:51:00 > 0:51:06I'm the first one and, you know, they're hoping for a good result,
0:51:06 > 0:51:09which is what they've got, and I mean to say, I've got a good result.
0:51:09 > 0:51:12So, it's celebrations time. LAUGHS
0:51:12 > 0:51:18It's great to have the very first patient we treated with a good outcome.
0:51:18 > 0:51:19As I said, it's very early days,
0:51:19 > 0:51:22but it's great to have a good outcome on number one.
0:51:22 > 0:51:25The fact that it's had such a significant fall,
0:51:25 > 0:51:30you know, suggests the decision we made to do it was the right one
0:51:30 > 0:51:32and the fact that he's almost more pleasingly,
0:51:32 > 0:51:34he's had no problem with the treatment.
0:51:34 > 0:51:39He's perfectly well and he's continuing to work full time
0:51:39 > 0:51:42and it hasn't really appeared to impact his quality of life at all.
0:51:45 > 0:51:49For Nick, this is just the beginning.
0:51:49 > 0:51:53He is comparing the procedure to standard radiotherapy
0:51:53 > 0:51:54in a series of trials,
0:51:54 > 0:51:59and plans to start treating a wider range of cancers.
0:52:09 > 0:52:13Two months after starting on the genetically-targeted drug,
0:52:13 > 0:52:18Rosemary Reid is back for her scan, to see if it has had any effect.
0:52:20 > 0:52:26'Scans are always little peaks in one's treatment
0:52:26 > 0:52:29'and it's scary having the results.'
0:52:29 > 0:52:32Can I just get you to confirm your full name and date of birth?
0:52:32 > 0:52:36Unfortunately, after a week of taking the pills,
0:52:36 > 0:52:38Rosemary developed some side effects
0:52:38 > 0:52:40and had to have a temporary break in her treatment.
0:52:40 > 0:52:42Bring your arms right above your head for me.
0:52:42 > 0:52:44'I'm not sure how much success I'll have,
0:52:44 > 0:52:47'because I've had to be off for three weeks
0:52:47 > 0:52:50'because of the rashes I had.'
0:52:50 > 0:52:52Breathe normally.
0:52:52 > 0:52:57'So, it may not show to be as effective as I'd hoped.
0:52:57 > 0:53:00'It was very, very disappointing to have to come off it,
0:53:00 > 0:53:03'because I thought, I'm losing time here.
0:53:03 > 0:53:06'You know, all this time the tumour is growing,
0:53:06 > 0:53:09'and coming off it was the last thing I wanted to do.'
0:53:09 > 0:53:10It's all finished.
0:53:28 > 0:53:3224 hours later, in the melanoma clinic,
0:53:32 > 0:53:35Dr James Larkin has Rosemary's results.
0:53:41 > 0:53:42Hi.
0:53:42 > 0:53:43Hello, nice to see you again.
0:53:43 > 0:53:45Nice to see you again as well.
0:53:45 > 0:53:46Hi.
0:53:46 > 0:53:49Thank you. Nice to see you again as well, sir.
0:53:49 > 0:53:51Have a seat, James, please.
0:53:57 > 0:54:00- So, the scan was good. - Oh, really?
0:54:00 > 0:54:02- That's the most important thing of all.- Fantastic.
0:54:02 > 0:54:08So, definite shrinkage of pretty much all of the abnormalities
0:54:08 > 0:54:10we could see in the liver, significant shrinkage.
0:54:12 > 0:54:14That is fantastic,
0:54:14 > 0:54:16as I really didn't think there would be any change
0:54:16 > 0:54:18after the reduction in the dose.
0:54:18 > 0:54:19- Oh, really?- Yes.
0:54:19 > 0:54:24No, no, no. Definitely dramatic shrinkage, really.
0:54:24 > 0:54:25And certainly in the lungs,
0:54:25 > 0:54:28some of the abnormalities have disappeared altogether.
0:54:28 > 0:54:31- So it's great. - Wow, that's fantastic.
0:54:31 > 0:54:34What you can see here is a scan just before you started treatment,
0:54:34 > 0:54:37and then the scan from yesterday.
0:54:37 > 0:54:39And these sort of black areas are the lungs.
0:54:39 > 0:54:43For example, there, you see that sort of spot there,
0:54:43 > 0:54:46that's a bit of melanoma in the lungs before you started treatment
0:54:46 > 0:54:50and then there, I can't really see it at all.
0:54:50 > 0:54:52And, in fact, most of the abnormalities in the lungs
0:54:52 > 0:54:54have pretty much disappeared altogether,
0:54:54 > 0:54:57which is obviously great news.
0:54:57 > 0:55:00And then if we were to look at the liver,
0:55:00 > 0:55:04which is the other main place that we know there are abnormalities,
0:55:04 > 0:55:06you see the sort of darker grey areas,
0:55:06 > 0:55:09those are the lumps of melanoma
0:55:09 > 0:55:14- and then if we look at a scan from afterwards...- Good lord.
0:55:14 > 0:55:17..you can see there, it's pretty much half the size.
0:55:17 > 0:55:20- The other ones have got smaller as well.- Pretty much everything,
0:55:20 > 0:55:22everything you look at is smaller.
0:55:22 > 0:55:24- So it's wonderful. - That's wonderful news.
0:55:24 > 0:55:29So it's nice to be able to tell you that...
0:55:29 > 0:55:32- To actually see a reduction was fantastic.- Mm-hm.
0:55:32 > 0:55:36Because, it was just like a surprise.
0:55:36 > 0:55:38It was like getting As for A-level
0:55:38 > 0:55:40when you thought you were going to get all Cs.
0:55:40 > 0:55:43It was brilliant, absolutely wonderful news.
0:55:43 > 0:55:45- ..side effects.- Yes, yes...
0:55:45 > 0:55:47'Really for the last 20 or 30 years,'
0:55:47 > 0:55:51discussing scan results with patients on treatment,
0:55:51 > 0:55:54nine times out of ten, it would be a conversation about how the scan is worse
0:55:54 > 0:55:57and it's almost the opposite now.
0:55:57 > 0:55:59Eight or nine times out of ten with this treatment,
0:55:59 > 0:56:03you can say to the patients, things have got better
0:56:03 > 0:56:07which is a great feeling, particularly on a background of so little progress
0:56:07 > 0:56:09treating this disease, really, since the 1970s.
0:56:09 > 0:56:13It's given us a lot of time, yes, I think so. Yes.
0:56:13 > 0:56:15Shall we go to Nepal at the end of October?
0:56:15 > 0:56:18We could do, yes. SHE LAUGHS
0:56:18 > 0:56:22Yes, no, it certainly means we can plan for the future more now
0:56:22 > 0:56:26and look forward to things, and...yeah.
0:56:26 > 0:56:30So I shall not give my winter clothes to Oxfam.
0:56:30 > 0:56:34- Too right.- I shall buy some new ones. Yeah.
0:56:37 > 0:56:42Rosemary will keep taking the drug for as long as it continues to work.
0:56:42 > 0:56:45It's not yet a complete cure,
0:56:45 > 0:56:49but drugs like these, based on understanding cancer,
0:56:49 > 0:56:52offer our greatest hope that one day
0:56:52 > 0:56:54we'll be able to defeat this disease.
0:56:58 > 0:57:02We have to be cautious about all these claims
0:57:02 > 0:57:04that the cure is just around the corner.
0:57:04 > 0:57:07Cancer is a remarkably complicated problem,
0:57:07 > 0:57:13but we should understand that progress is being made.
0:57:13 > 0:57:17Understanding exactly what's causing cancer
0:57:17 > 0:57:20means that more drugs can be created,
0:57:20 > 0:57:25with the promise of increased life expectancy and future cures.
0:57:25 > 0:57:27In the next five to ten years, I think we'll have catalogued
0:57:27 > 0:57:30pretty much all of the cancer genes,
0:57:30 > 0:57:33we'll have a very good understanding of exactly how they work
0:57:33 > 0:57:36and how they interact with each other to cause cancer
0:57:36 > 0:57:40and develop inhibitors against the majority of those.
0:57:40 > 0:57:45By combining technology with scientific knowledge,
0:57:45 > 0:57:51the future of cancer treatment looks better for us all.
0:57:51 > 0:57:53We are making inroads at multiple different levels.
0:57:53 > 0:57:57So, from a genetic level to a drug development level,
0:57:57 > 0:58:02to accurately delivered radiation, or surgical techniques,
0:58:02 > 0:58:05I think it's a great time to be working in the field
0:58:05 > 0:58:09and I think we'll actually try and target tumours more scientifically
0:58:09 > 0:58:12and give us a much better chance of eradicating the cancers
0:58:12 > 0:58:13than we have done in the past.
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