Dr David Thomson, Consultant Clinical Oncologist at The Christie Hospital in Manchester is the Chief Investigator for the TORPEdO (TOxicity Reduction using Proton bEam therapy for Oropharyngeal cancer) trial. He talks to us about this ground-breaking clinical trial, and how collaboration through NCRI’s CTRad was pivotal in getting it off the ground.

TORPEdO is set to be the first clinical trial performed in the UK involving protons. It aims to assess the benefit of proton beam therapy (PBT) in terms of patient-reported toxicities, quality-of-life and cost-effectiveness versus intensity-modulated radiotherapy (IMRT) which is the accepted standard of radiotherapy for the treatment of oropharyngeal cancer. Patients with this type of head and neck cancer often present at a younger age and the survival rates are high, meaning quality of life improvements are extremely important. The trial has recently been funded by Cancer Research UK with a grant of approximately £850k, and patient/carer travel costs are supported by The Taylor Family Foundation. The Foundation will also support important translational and exploratory science embedded in the trial, which is being led by Prof Catharine West (Professor of Radiation Biology, The University of Manchester). TORPEdO is now in setup stage, with patient recruitment to start at the end of this year.

The guidance and strategic oversight provided by NCRI’s CTRad was pivotal in developing this trial. The original idea for TORPEdO came in to being when CTRad’s Proposal’s Guidance group reviewed my centre’s trial idea along with that of another PBT trial for head and neck cancer that had been submitted independently by Prof Chris Nutting (Professor of Clinical Oncology, The Royal Marsden NHS Foundation Trust). The Group saw that there were similarities between the two trials and thought we would benefit from each other’s expertise, so they linked us up for discussion and that was the start of a new collaboration on TORPEdO. This has been a superb collaboration and Professor Emma Hall, the Deputy Director of The Institute of Cancer Research, is our trial scientific and methodology lead.

NCRI’s CTRad fostering essential collaboration

With further advice from NCRI CTRad’s Proposals Guidance meetings and NCRI’s Head and Neck Group to develop the trial idea, in December 2017, we organised a workshop with the help of CTRad and Cancer Research UK’s Advanced Radiotherapy Technologies Network (ART-NET), to discuss trial methodology, ethics, patient pathway, feasibility and logistics of randomisation aspects of TORPEdO. The workshop provided an opportunity to develop guidance for planning of future PBT trial grant applications, and it was a good learning opportunity for all involved. After further work and linking with European and US centres for collaboration, the grant outline was submitted to Cancer Research UK in March 2018 and the trial funding was awarded in February 2019.

Through lots of hard work, including important patient and public involvement in the design of the trial with focus groups in Manchester, Leeds and Sheffield, NCRI’s CTRad helped lead us to a multi-centre collaboration and a successful trial application. We hope TORPEdO will lead the way with other PBT trials coming through the pipeline shortly.