Somnath Mukherjee, Senior Clinical Researcher
The focus of my research has been to develop novel and early phase trials in pancreatic and upper gastro-intestinal cancers. One of my key aims is collaboration with other group leaders within Oxford and in other centres to translate basic science into clinical practice (bench-to-bedside).
The ARC I and II studies (Brunner T et al JCO 2008, Wilson JM, Radiotherapy and Oncology 2016) demonstrated the feasibility of combining nelfinavir, a radiosensitizer, with conventional chemoradiotherapy in locally advanced pancreatic cancer (LAPC). This has led on to the SCALOP2 trial, a multi-centre randomised phase II trial which is now evaluating the benefits of radiotherapy dose escalation and addition of nelfinavir to conventional chemoradiation in LAPC. This study opened in 2016 and in June 2017 completed accrual to the initial safety cohort assessing full dose nelfinavir with capecitabine plus radiotherapy in LAPC. The trial is now open in multiple radiation centres across UK recruiting patients into the 2 x 2 assessment of addition of nelfinavir and increase in dose form 50Gy to 60GY. In addition to the scientific questions being addressed within the trial, the radiotherapy quality assurance component of the trial has been instrumental in establishing a national technical radiotherapy protocol for pancreatic cancer.
The NEOSCOPE trial was the first UK multi-centre randomised trial of pre-operative chemoradiotherapy in oesophageal cancer, which demonstrated the safety and feasibility of this treatment. Pre-op chemoradiotherapy had been previously abandoned in the UK because of high post-operative mortality rates (~10%). This study demonstrated a post-operative mortality of <3% and has this approach has since been adopted as a standard of care in the UK. The study also supported the improved efficacy of combination of radiotherapy with carboplatin and paclitaxel in that this combination acheiveing 29% pathological complete response to neoadjuvant chemoradiotherapy compared to 11% with Oxaliplatin and capecitabine combination (EJC 2017).
The CYTOFLOC study is testing the feasibility of a novel device, Cytosponge (sponge-in-a-capsule) for collecting oesophageal samples following chemoradiotherapy for oesophageal cancer. The work is being conducted in collaboration with Professor Rebecca Fitzgerald, University of Cambridge. Currently endoscopy, an uncomfortable procedure, is the only way to detect presence of residual oesophageal cancer following treatment. Cytosponge is a minimally invasive technique, which can be performed in clinics and GP surgeries, and has the potential to shift standard of care in oesophageal cancer.
Stratified medicine in oesophageal and pancreatic cancer: I provide clinical leadership of the pancreas research group (in collaboration with surgeons, and group leaders from the Oxford institute). A key area of interest is development of molecular markers of locally recurrent versus metastatic disease, and blood biomarkers for detection of early response failures – both of which can assist personalisation of treatment strategies. I am involved in the CRUK funded national personalised medicine initiative in pancreatic cancer, PRECISION-PANC; I am also involved in developing a similar CRUK initiative in oesophageal cancer in collaboration with Cambridge, Cardiff, Dundee, ICR and Southampton.