620 - Kings College London Doctor on Reinstating a new Type of Liver Cancer Treatment on the NHS

SPEAKER_1 (0:01)

Welcome to Modern Mindset, the show that picks the brains of the world's leading minds to help you unlock yours. Decoding the beliefs and strategies of global experts to give you an updated mindset to make the most of modern life.

Rory McGowan (0:21)

This is Modern Mindset, the show that picks the brains of the world's leading minds to help you unlock yours. My name is Rory McGowan, and this week, MPs have met in parliament to talk about a new type of cancer treatment that's currently not available on the NHS. It's called Selective Internal Radiation Therapy or CERT, and campaigners have been fighting for it to get funded as a new way to primarily deal with types of liver cancer.

So to figure out what this treatment is and what it could mean for you and the future of liver cancer care in the UK, I'm joined by Dr Raj Sri Rajaskanthan, a Professor of Gastroenterology at King's College London, who's also pushing for better access to CERT for more patients. Raj, thank you very much for joining us today on the show.

Raj Srirajaskanthan (1:07)

Morning, Rory, and thank you for the invitation.

Rory McGowan (1:10)

No worries. So give us a little bit of background as to what this type of cancer treatment will be. Why are so many people pushing for it to be funded on the NHS?

Raj Srirajaskanthan (1:21)

So in terms of this specific treatment, maybe I'll run into kind of how that works, and then we can talk about kind of the issues in regards to funding and access. So basically, commonly, tumors that occur within the liver, they can either arise within the liver primarily, and those are called hepatocellular carcinomas, and those are what we historically call as liver cancers. But more commonly, a lot of tumors arriving in other organs can actually spread to the liver, and so those are called metastases or liver metastases. Now, this CERT therapy is a very clever therapy because basically it allows us to target the tumor specifically and then pass radioactive beads around those tumors to then cause them to die off and can treat very specific areas within the liver, so very specific tumors. So, it works really well for a number of different cancers. Now, the limitations currently are that historically it was available and then since kind of early 2020, it's not been available on the NHS anymore and it was re-evaluated and it's been given use in some types of cancer, for example, colorectal liver metastases and primary hepatocellular carcinoma. So, those two groups can access CERT therapy.

There's another group of patients, people called neuroendocrine tumors, who can also benefit from this therapy.

However, it's not been funded for that group. We've got NICE approving that it does work as well. Yet, there's no funding for us to actually provide the treatment to patients on the NHS.

Rory McGowan (3:16)

That is strange, and you said it was previously funded, but that funding since 2020 was taken away.

Raj Srirajaskanthan (3:21)

Yes. Historically, for example, at King's and around the country, we have treated patients, which we've treated about 25 at King's and other centres in the past have treated. We know it works very well for those patients. When you select them well, the treatment works very well.

Then I think it went into, it was withdrawn and because of it, I suppose it was re-evaluated as a high-cost intervention. Then when it was reintroduced, it was not approved for use in neuroendocrine tumours but was given a licence for funding and approval for using colorectal liver metastases and also paticellular carcinoma.

Rory McGowan (4:09)

So I guess then kind of sitting here trying to represent the common person here, Raj, how many people do these kind of liver cancers affect every year? And where is this treatments place, I guess, in amongst the different treatments that people can have, treatments that potentially people are more familiar with, like radiotherapy, chemotherapy, et cetera?

Raj Srirajaskanthan (4:32)

That's a really good question. So in terms of the frequency of these tumors, so the neuroendocrine tumors are classed as kind of relatively rare. And the overall incidence is about 9 to 10 per 100,000 people per year. Okay. Now for ones arising within the gut, which makes up about half of those cases, about 50 to 70% of those patients will develop liver metastases. So it's quite a high number of patients will have liver metastases.

In terms of from that group of patients, the number that are most likely suitable for certain therapy in a year, it would most certainly only be in the whole of England, would maybe be around 50 to 100 patients per year. So not massive numbers, actually.