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

I head the Newcastle Cancer Centre Pharmacology Group at Newcastle University. We are heavily involved in the development of novel assays for the quantification of new drugs that are used in early-phase trials. This leads on to the analysis of clinical samples following patient recruitment.

We are particularly active in paediatric oncology, where we design studies to optimise the use of anticancer drugs for children and young people. We use several approaches, either real-time studies using therapeutic drug monitoring and adaptive dosing, or via generating data to support the implementation of new dosing regimens. ECMC and Cancer Research UK have been the predominant funders of the group for many years.

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

Therapeutic Drug Monitoring (TDM) involves the real-time measurement of drug levels in the blood to determine individual patient exposure. TDM aims to minimise harm and achieve the most clinically effective drug concentrations.

For a number of years, our research group has worked on developing a national TDM programme. This will assist in treating children with cancer who are particularly ‘hard-to-treat’, including pre-term infants and neonates, anephric patients, children with obesity and patients receiving high-dose chemotherapy.

Our recent studies 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 a 3 year TDM programme, which allows us to roll out a national study that will directly impact on the treatment of children with cancer.

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

We obtained all the necessary regulatory approvals earlier in the year and formally opened the trial in May, with our first patients now on study. We are 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.