June, 2014

Celebrating Birmingham’s Past and Present

Dr Mike Beazley

Director of the Centre for Urban and Regional Studies (CURS)

I went to a very interesting event last night organised by MADE in association with Birmingham City Council, the Royal Town Planning Institute (RTPI) and sponsored by Glancy Nicholls architects, No.5 Chambers and JMP. It was a celebration of 100 years of architecture as part of the ongoing events associated with the RTPI Centenary year. The RTPI was founded in 1914. MADE is an organisation dedicated to improving the quality of our towns, cities and villages. They believe in good place-making and that a high quality built environment is essential for economic prosperity and wellbeing (www.made.org.uk).

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Speakers were given the job of championing the various decades of architecture in the city from the 1910’s onwards to the current day. It became evident that some decades were easier to champion than others but there was a wide variety of buildings put forward as being good examples of architecture from each period. What became clear is that there is a rich tapestry of buildings in the city ranging from the relatively modest to the rather grander iconic buildings. People were asked to vote for the best decade and it came down to a run-off between the 1930s and the 2000s in which the 1930s won with a clear margin – including illustrious buildings such as our own Barber Institute here on the campus being part of the offering from that period.

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What was captured by the event was the story of the building of Birmingham and the wide variety of beautiful and interesting buildings we have in this city. The buildings on show ranged from housing with places such as the Moorpool Estate – the relatively undiscovered “garden city” in Birmingham to the prefab housing that exists on the Wake Green Road in Hall Green that have now been listed.

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There were a number of important religious buildings identified including the Church of St. Matthews at Great Barr, a now grade II listed building that opened in the 1960s in the rather “brutalist” style of the day.

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Key buildings and spaces reflecting the economic development of the city such as the Aston Science Park that were reflective of the city finding a new role for itself as manufacturing began to decline in the 1960s. These spaces might not be as visually attractive but constitute an important part of the backcloth of the city.

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Key civic spaces such as the Hall of Memory in Centenary Square were identified both for the architectural but also symbolic value of marking the contribution of those Birmingham residents who sacrificed their lives in the World Wars.

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In the same square was another important building of architectural merit – the Birmingham Repertory Theatre that has of course had a recent major renovation as part of the construction of the new library and is likely to be a celebrated building long into the future.

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The Bull Ring development both old and new came in for quite a bit of coverage. The initial Bull Ring shopping centre modelled on North American shopping mall with the famous Rotunda was heavily featured and was the arrival of the now iconic Selfridges Building which has already become synonymous with Birmingham.

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It was not only a story of buildings it was also a story of roads and Birmingham’s post-war legacy of the worship pf the motor-car and the building of the ring roads and the now infamous concrete collar around the city centre and how this had been broken on both the east and the west to allow the city centre to breathe.

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What became so evident was the richness of the architecture in the city and how much we have to celebrate. These buildings also tell us much about how the city has developed and evolved over the years and the kind of thinking that lay behind the city building that went on. They are also a major testament to the robustness and resilience of many of the buildings as they evolved and changed over the years.

So next time you are wondering around the city – have a look at the buildings. If you are in the city centre gaze up beyond the ground floor level and marvel at the wonderful sights you might behold. Think about what your favourite building might be and why and what it tells us about the development of the city.

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June, 2014

Garden Cities – An old solution to a new problem – a return to socialist principles?

Dr Mike Beazley

Director of the Centre for Urban and Regional Studies (CURS)

Urban planning is becoming a bit of theme for this week. I was mulling over the significant housing crisis with a colleague and the recent discussion in the press about a potential return to the concept of garden cities as a means to address this. Garden cities have been a major achievement of the British planning system and widely copied all over the world as examples of planned settlements and a testament to the power of conscious urban planning. The founder of the garden cities movement was Ebenezer Howard who along with colleagues campaigned for the development of both Letchworth (1903) and Welwyn Garden City (1920).

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These settlements are still celebrated today as examples of good planning and they had a major impact of course on the development of the new towns in the post-war period following the introduction of the 1946 New Towns Act as part of the impressive legislative planning machinery that was set up at that time.

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So although garden cities are over a hundred years old it is interesting to see that the Coalition Government are returning to this idea as part of the answer to the contemporary housing problem to contribute toward promoting large scale house building to alleviate the shortage.

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Prime Minister Cameron, Chancellor Osbourne and Deputy Prime Minister Clegg have all been advocating the potential of garden cities – with the Chancellor announcing plans for a new garden city for 15,000 homes in Ebbsfleet in Kent and Deputy Clegg releasing a prospectus outlining plans for three garden cities across the country.

The Town and Country Planning Association (formerly the Garden Cities Association set up by Howard) – the long term advocate of garden cities and new towns and sustainable development see this as an important moment for planning. The key questions that they raise are how to make garden cities a reality again and whether or not the Ministers really understand the whole concept. If you look closely as some of the original garden city principles – they were quite radical for the day and do have a bit of a socialist feel to them. Howard had been very much influenced by Robert Owen (one of the founders of the co-operative movement) and his new community as New Lanark and the Utopian Socialists such as Fourier and Saint-Simon. Some of the key principles are:

  • A fair distribution to the community of the profits that result from new development
  • Strong political support and leadership – with a firm commitment to community engagement
  • A suitable body to manage community assets
  • Mixed tenure homes and housing types – with a majority being affordable
  • Full range of employment opportunities
  • Beautiful and imaginatively designed homes with gardens
  • Development that enhances the natural environment and promotes bio-diversity
  • Opportunities for residents to grow their own food
  • Strong cultural, recreational and shopping facilities in walkable vibrant communities
  • Integrated and accessible transport systems with a focus on public transport as the dominant them

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These principles if followed can make exciting and very liveable communities for the future and the Coalition Government is to be applauded for considering going down this route. Although you have to wander however how many of these principles might be sacrificed along the way.

 

 

June, 2014

The Political Nature of Planning: What Happens if UKIP Get In?

Dr Mike Beazley

Director of the Centre for Urban and Regional Studies (CURS)

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I have always thought that planning is critical to the saving human’s agenda. The origins of planning that were tied up with a housing and public health legislative response to the squalor and deprivation we found in our 19th century cities provided a strong drive to improve the quality of life for people living in our cities. The concept of the “public interest” has been a central feature of the system since then – although this concept has been contested at times planning has been very much about making our towns and cities better places to lives and to improving the quality of life for local residents. Recently it is a very interesting time for the urban planning in England. Planning in many ways has been under attack. We have witnessed considerable planning reforms since the Coalition Government were in power with the arrival of the National Planning Policy Framework, the revocation of the Regional Spatial Strategies and introduction of the neighbourhood planning and community rights agenda under the Localism Act 2011. Moreover, planning never seems to be far from the news particularly in relation to the current housing crisis, building homes on the green belt, the potential re-emergence of garden cities, major infrastructure projects such as HS2, developers potentially running amok in the British countryside and this government’s clear antipathy towards wind farms.

The recent surge in the popularity of UKIP got me thinking about what might happen to planning if UKIP got into power and having control over local councils in any meaningful way. According to a recent edition of Planning magazine their manifesto has some interesting planning proposals including:

  • Measures to attack “major developers with large cheque books”
  • Pledges to protect the countryside from house building by controlling immigration
  • Identifies potential “incentives” to bring 800,000 empty homes into use
  • Pledges for referenda on major local schemes
  • A proposal to scrap planning gain mechanisms such as section 106 agreements
  • A proposal to return the old system of local and county development plans
  • Opposition to both HS2 and wind farms

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It seems that a lot of these proposals are actually a bit contradictory and certainly do not seem to add up to a sensible way forward. Certainly the proposal to potentially scrap section 106 agreements is highly questionable as this has been an important tool for planners to negotiate important community benefits from developers in return for planning permission including affordable housing. These are described as “community bribes” in the manifesto but are in reality an important part of the planner’s toolkit to secure appropriate development.

Unlike the other parties the UKIP agenda presents a very anti-development stance and certainly flies in the face of the pro-growth planning agenda of this government. But it could appeal to a number of voters who potentially feel threatened by recent housing proposals or major projects such as HS2 and provides and interesting challenge for both planners and developers should UKIP manage to gain any further momentum in future local elections. But I suppose the issue is to watch this space and to see how UKIP’s stance on planning and development issues develops into the future and toward the next elections.

 

June, 2014

Clinical Trials in Skin Cancer at the CRCTU

Dr Joshua Savage (@joshsavage)

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About 115,000 people are diagnosed with skin cancer every year in the UK. The majority of these cases are the non-melanoma types of disease, such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), although there are rarer sub-types of the disease. Despite being very common, non-melanomas are less life threatening and are often successfully treated if caught early, which is more achievable compared to other cancers due to the visibility and palpable nature of skin cancer.

Around 13,000 patients have the more serious, and often more aggressive, malignant melanoma which results in over 2000 deaths per year. In the last 30 years, the rate of malignant melanoma has risen faster than any of the other 10 most common cancers, and its incidence is disproportionately higher in younger people compared to other cancers, with a 1/3 of cases being in people under 55. As with all cancers, there are many risk factors involved in the development of the disease but sun exposure is thought to be the main cause, with most lesions occurring on sun exposed areas of skin. Genetics, namely skin colour, and a history of sunburn and the use of sunbeds also increase the risk of the disease.

There have been great improvements in the treatment of malignant melanoma in the last 30 years, with 5 year survival now at 84% for men and 92% for women. These patients are usually treated with surgery then a combination of radiotherapy and chemotherapy. Earlier this month, very promising results were presented at the annual American Society of Clinical Oncology (ASCO) meeting in Chicago and widely covered in the media, for a “ground-breaking” new immunotherapy by pharmaceutical company Merck, called MK-3475, or more commonly known as pembrolizumab. This drug works by targeting PD-1, or Programmed Death receptor, a protein used by cancer cells to avoid detection by the immune system. This is one of several drugs in a new class of treatments called ‘immune checkpoint blockers’, that ‘modulate’ the immune system allowing the body’s own defences to combat the disease in a more targeted manner than conventional chemotherapy that non-discriminately kills rapidly dividing cells. Currently, 1 year survival for advanced melanoma is 10% for men and 35% for women; encouragingly, 70% of patients on pembrolizumab were still alive after 1 year. These exciting developments are welcome news that will hopefully result in new treatments and a change in standard care for this group of patients who previously had a very poor prognosis.

At the Cancer Research UK Clinical Trials Unit (CRCTU) at the University of Birmingham, we have a growing portfolio of skin cancer trials. UKMCC-01, is a phase II study using pazopanib to treat patients with metastatic merkel cell carcinoma (MCC), a very rare (400 patients per year in UK) and aggressive form of non-melanoma cancer with a poor prognosis after first line treatment. Pazopanib is currently licensed in the UK to treat advanced renal cell carcinoma and works by targeting platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) receptors, amongst other targets, both which have been shown to be mutated or over-expressed in MCC tumours.

We will also soon be opening another phase II trial called SPOT; Squamous cell carcinoma Prevention in Organ transplant recipients using Topical treatments. SPOT aims to prevent the development of cutaneous SCC from actinic keratoses, asymptomatic red scaly lesions on sun exposed areas of the skin, which are generally regarded as precursors to cSCC. This feasibility study will examine how patients cope with two different topical treatments, 5-fluorouracil and imiquimod versus standard care (sunscreen). SPOT will observe this in a sub-set of patients who have received organ transplants and are taking immunosuppressive medication to prevent organ rejection. These patients have previously been shown to have a much higher incidence of cSCC and other cancers, which once again demonstrates the vital role that the immune system plays in combatting cancer.

Researchers at the CRCTU are working with colleagues across the science and research community to maximise on developments and ensure they reach patients rapidly and change the course of this devastating disease. Novel treatments along with early diagnosis and prevention are key to changing the course of this cancer, Justine a survivor of skin cancer reminds us why we must continue with this plight.

Dr Joshua Savage is a Trial Coordinator at Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham. Follow Dr Savage on Twitter @joshsavage

Further useful links:

June, 2014

How the CRCTU is addressing overtreatment of ductal carcinoma in situ (DCIS)

Miss Claire Gaunt

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The NHS Breast Screening Programme was established in the late 1980’s with the aim of detecting invasive disease at an early stage and reducing deaths from breast cancer. This has been achieved but, an incidental consequence has been the increasingly common finding of DCIS, a diagnosis almost unheard of before mammographic imaging. Historically, DCIS was thought of as a form of early breast cancer that would become an invasive breast cancer if left untreated.

DCIS describes abnormal cells in the milk ducts of the breast. It is divided into 3 types; low, intermediate and high grade. Low grade DCIS looks similar to normal breast cells and high grade DCIS looks similar to cancer cells. When diagnosed, all DCIS is currently removed by surgery because of concern that it may progress to an invasive cancer. If DCIS is indeed an early form of breast cancer, then removing it would have lead to a decrease in the incidence of invasive breast cancer. This has not been the case but, surgical treatment of DCIS, often mastectomy, has remained unchanged since the 1950’s, despite evidence that removing DCIS does not prevent invasive cancers. DCIS is almost always diagnosed as a result of calcification found on mammograms and accounts for 20% of all breast ‘cancers.’ Evidence shows that many women are being treated for a condition that will never become a clinical problem if left undiagnosed. This is known as ‘overdiagnosis’ and ‘overtreatment’. Experts agree that not all untreated DCIS will become breast cancer.

An independent review of the UK National Health Service Breast Screening Programme reported on the benefits and harms of breast screening. This concluded that breast screening saves lives but acknowledged the existence of overtreatment. Consequently, randomised trials were recommended to elucidate the appropriate treatment of screen-detected DCIS and to gain a better understanding of its natural history. The aim of overtreatment trials is to stop treating women who do not need treatment and to better treat those who do.

The Low Risk DCIS Trial (LORIS) is a large phase 3 trial designed to address the recognised issue of overtreatment of low risk DCIS. This trial is not for patients with high grade (the most common) DCIS.

The study is being run by the Cancer Research UK Clinical Trials Unit (CRCTU) which has a long history of running successful breast cancer treatment trials and is an integral part of the Birmingham Surgical Trials Consortium (BiSTC) at the University of Birmingham. The trial is led by Miss Adele Francis, Consultant Surgeon at the University Hospitals Birmingham NHS Foundation Trust. The trial will recruit almost a 1000 women with low risk DCIS, who will be randomised to the current standard treatment which is surgery or to omit surgery and have active monitoring with annual mammograms. The LORIS trial, through it’s clinical and translational research will establish whether patients with newly diagnosed low risk DCIS can safely avoid surgery without detriment to their wellbeing (both psychological and physical) and whether those patients who do require surgery can be identified by pathological and radiological means. When this trial is reported, patients and clinicians will be able to make an informed choice about treatment options.

University Hospitals Birmingham NHS Foundation Trust will be the first centre to begin recruit patients in to this ground-breaking trial. In the coming months, you can follow our progress on twitter at @CRCTU

Miss Claire Gaunt is a Team Leader in the Cancer Research UK Clinical Trials Unit at the University of Birmingham.

Further useful links:

June, 2014

Quality Management at the Cancer Research Clinical Trials Unit (CRCTU)

Isobel Hawley – Quality Assurance Manager

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When I was a child my father drummed into me the importance of paying attention to detail. His actual words were, “always pay absolute attention to absolute detail”. I remember a lot of rolling of eyes (on my part), but he was right (and still is for that matter – thanks Dad!). Now it’s my job to pay attention to detail – as Quality Assurance Manager at the Cancer Research UK Clinical Trials Unit (CRCTU). It certainly wasn’t what I was planning when I graduated with a degree in Russian and French…but many years later, my focus in life changed when a friend’s 3 year old child died of cancer. My previous mild interest in things medical (a lifelong addiction to watching Casualty on Saturday nights) developed into an earnest desire to make a contribution to cancer research, and in 2006 I applied for a job as a Clinical Trial Monitor at CRCTU in the University of Birmingham and I’ve been a member of the Quality Management Team ever since.

Clinical Trials are vital for improving cancer treatments and making them available to patients. The Quality Management Team plays an important role in supporting the conduct of clinical trials at CRCTU, by developing and maintaining a Quality Management System which provides a framework of Standard Operating Procedures, tools and templates to assist all staff in conducting trials to the highest possible standards and ensures adherence to relevant legislation. In the UK, the conduct of clinical trials of Investigational Medicinal Products (trial drugs) is governed by complex legislation and guidance including the 2004 Medicines for Human Use (Clinical Trials) regulations, the Data Protection Act, the Research Governance Framework, Good Clinical Practice and the Declaration of Helsinki.

The regulator in the UK is the MHRA (Medicines and Healthcare Products Regulatory Agency) and CRCTU is subject to inspection at regular intervals. The legislation has recently undergone a review and will soon be replaced by a new European Clinical Trials Regulation which aims to speed up and streamline the conduct of trials across Europe. It is hoped that the new Regulation will achieve its aims – many of the paediatric trials coordinated by CRCTU need to embrace international collaboration in order to recruit sufficient patients to complete the trial in an appropriate timeframe; recently the BEACON trial for children with neuroblastoma opened to recruitment in France and will open in further European countries over the coming months.

Our team of dedicated Monitors travel the length and breadth of the UK, visiting the hospitals where the clinical trials take place. The team is currently responsible for on-site monitoring of more than 30 trials, across multiple diseases (breast cancer, prostate cancer, lung cancer, leukaemia, sarcoma and all paediatric cancers) including the AdUP prostate cancer trial mentioned in Monday’s blog and the STOMP trial for lung cancer patients discussed in Tuesday’s blog. The Monitors meet with the Clinicians and Research Nurses to discuss the trial, providing training, updates and feedback from the Trials Office and a friendly face to help out with any queries. They perform checks on the paperwork at the hospital site – reviewing the medical notes of the trial patients to ensure that all patients are eligible for the trial according to the protocol criteria, checking that the patients have given their written consent to participate in the trial, that the correct trial treatment protocol has been followed and any adverse effects of the treatment have been reported to CRCTU. These on-site monitoring visits help to safeguard the rights and well-being of the trial patients and ensure high-quality data is obtained for analysis by the trial statisticians, ultimately leading to evidence-based improved treatments for patients with cancer.

Further useful links:

June, 2014

Early Phase Clinical Trials in Lung Cancer at the CRCTU

Dr Laura Crack

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Lung cancer is a devastating and very common healthcare problem. Lung cancer is the biggest cause of cancer death in the UK, accounting for more than one in five cancer deaths and is the second most common cancer in both men and women. Recent campaigns such as the plain packaging campaign aim to reduce the numbers of people smoking, particularly targeting children and young adults. Whilst these campaigns targeting environmental and lifestyle factors are crucial to reducing incidence of lung cancer, new and more effective treatments are urgently needed to increase the chances of surviving this devastating disease.

The Cancer Research UK Clinical Trials Unit (CRCTU) has designed and run many clinical trials for both main types of lung cancer (small cell and non-small cell lung cancer) patients over the past 2 decades. A good example of this is in small cell lung cancer (SCLS), the STOMP Trial, which is investigating the safety and activity of a drug (Olaparib) which prevents cancer cells from repairing damage to their DNA; by inhibiting a molecule called PARP. This trial, led by Professor Penella Woll, is actively recruiting patients around the country. The STOMP trial is due to run for another year and will be asking if Olaparib can be used as maintenance therapy for people with SCLC, whether it can increase the length of time people live with the disease and can it be used as maintenance therapy for SCLC.

Because of this expertise, the CRCTU and the University of Birmingham’s Gary Middleton, Professor of Medical Oncology, have been selected to lead on the National Lung Matrix trial; a joint initiative between the University of Birmingham, Cancer Research UK with pharmaceutical partners AstraZeneca and Pfizer. This trial will utilise an existing network of Experimental Cancer Medicine Centres (ECMCs) across the UK to deliver a plethora of drugs to lung cancer patients. Patients will be stratified according to genetic abnormalities in their cancer. This information will be generated in phase 2 of Cancer Research UK’s Stratified Medicine Programme, which was launched in April this year. The trial is due to open to recruitment later in 2014. Once open the National Lung Matrix trial will see cancer treatment moving towards the promise of personalised medicine where a patient’s treatment is guided by the individual genetic make-up of their cancer.

This advancement has been made possible through the Cancer Research UK Stratified Medicine Programme which has looked to establish a network for nationwide molecular testing that will form a vital platform to launch future targeted treatments. Colleagues in Birmingham have been acting as a technology hub for the stratified medicine programme and are in an excellent position to help inform this new stage of cutting edge early phase clinical trials.

TraxerX is another exciting example of the rapidly developments in personalised medicine for lung cancer patients across the country. Researchers in Birmingham are working with nationwide colleagues to further their understanding of lung cancer, how it adapts and responds to treatment along with where its Achilles heels are.

A new era is dawning and Lung Cancer researchers and clinical teams are pushing boundaries to change the devastating effects of a lung cancer diagnosis. Birmingham’s CRCTU is working collaboratively with many leaders in the field to ensure that effective developments reach patients faster.

Dr Laura Crack is EDD Team Leader in the School of Cancer Sciences at the University of Birmingham.

Further useful links:

 

 

June, 2014

Spotlight on the Cancer Research UK Clinical Trials Unit (CRCTU) at the University of Birmingham

Mr Clive Stubbs and Dr Steve Johnson

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Hello and welcome to the first contribution to this blog from The Cancer Research UK Clinical Trials Unit (CRCTU), which forms part of the School of Cancer Sciences at the University. Over the next five days we are going to share with you some of the exciting clinical research being done at the unit. We will also be touching on related topical events throughout the week.

The CRCTU is one of the largest cancer trials units in the UK and has been in existence for more than 30 years. We are one of three trials units at the University that form the Birmingham Centre for Clinical Trials and also form an integral part of the Birmingham Experimental Cancer Medicine Centre. The unit receives core funding from Cancer Research UK.

We specialise in the design, conduct and analysis of all phases of trials, from phase I, largely concerned with the safety of treatments, all the way through to phase IV cancer clinical trials, looking at the long term risks and benefits of treatments.We work with a wide range of investigators nationwide and internationally in a number of specialist areas including Breast cancer, Lung cancer, Paediatric cancer, Skin cancer and Urological cancer.

The CRCTU has experience in trials involving pharmaceutically active substances, the testing of new treatments on human subjects for the first time, radiotherapy, devices, surgery, allogeneic stem cell transplantation, gene therapy, immunotherapy and biomarker discovery and development.

With this week being international men’s health week, we thought it fitting to focus on two prostate cancer trials that are the product of our unit, one that has closed to recruitment and one that began recruiting patients just over a year ago.

Prostate cancer is by far the most common cancer in men (excluding non-melanoma skin cancer), accounting for one in four cases. In 2011 in the UK, over 41,000 men were diagnosed with the disease. Whilst being relatively indolent, with most men dying with prostate cancer rather than because of it, almost 11,000 men died from their prostate cancer in 2011.

The ‘Trapeze’ study, an academic clinical trial for patients who have Prostate Cancer which has spread to include the bone (metastatic prostate cancer), was coordinated by The CRCTU with Professor Nick James the Chief Investigator and is now closed to recruitment.

This trial compared different combinations of treatment in patients whose prostate cancer that had spread to the bones and had not responded to hormone therapy, to determine whether or not the upfront use of bone targeting agents with chemotherapy improves clinical outcomes.757 patients took part. The trial started out as a ‘Phase II’ study, investigating the effectiveness of giving docetaxel together with prednisolone, with or without zoledronic acid and/or radioactive strontium and the side effects.This was then expanded into a phase III trial with a larger number of patients. This is a novel approach, as normally differing phase trials are separate.

The results, presented at the American Society of Clinical Oncology meeting in 2013 showed that radiotherapy with injectable strontium given after chemotherapy with docetaxel, increased the length of time until the disease progressed. In addition, it was shown that zoledronic acid significantly reduced the average time until the occurrence of ‘skeletal-related events’ caused by bone metastases. These ‘events’ include pathological fractures, spinal cord compression, or the need for radiation or surgery to the bone. Further health economic and quality of life analyses are pending.

Another exciting prostate cancer trial that is being run by the CRCTU and has recently opened is the ‘AdUP’ trial, investigating a new gene therapy treatment that helps the body’s own immune system fight prostate cancer, in addition to targeted ‘suicide gene therapy’. The trial is aimed at prostate cancer patients whose cancer has returned after being treated with radiotherapy and is no longer responsive to hormone therapy, but remains contained within the prostate. This condition affects around 3,000 patients every year.

The treatment is in 2 parts. The first part is an injection directly into the prostate of modified adenovirus (the virus responsible for the common cold). The virus is unable to replicate in the body and can produce an enzyme called nitroreductase (NR) and an immune agent called GM-CSF. Once inside the cells, one of the genes carried by the virus causes the cells to produce GM-CSF, which activates the body’s own immune system, attracting white blood cells to attack the cancer. Two days later, patients receive an infusion of a drug, which becomes active on coming into contact with NR and starts to kill cancer cells. The aim of this trial is to investigate the safety of this combined treatment.

The modified adenovirus was developed by the Gene Therapy Group, led by Dr. Peter Searle, in the School of Cancer Sciences at Birmingham and has taken 15 years of work with support from the Medical Research Council.

There is currently no approved curative treatment for these patients. The Chief Investigator, Mr Prashant Patel is hopeful that the AdUP treatment could delay or prevent the progression to metastatic disease, offering new hope to patients with prostate cancer.

“If this works, 15 to 20 years from now, we could be using the patient’s own immune system in this way to fight early onset prostate cancer so that patients won’t need painful treatments or even surgery” his colleague Mr Richard Viney said.

Last year when the first patient underwent treatment, the trial made headlines: Cold virus ‘treats prostate cancer’ for Birmingham patient (BBC News).

Though the focus of men’s health week this year is relating to health at work and stress, there are other men’s health and cancer awareness initiatives running throughout the year. Movember is well supported at The CRCTU and from the above video Mr Prashant Patel can be seen supporting the initiative with his Mo proudly!

We hope you found this insight interesting. Coming up in tomorrow’s post, a piece on an exciting and pioneering new project known as the National Lung Matrix trial for patients with advanced lung cancer.

To find out more about what goes on at The CRCTU you can follow our twitter feed here.

Further useful links:

June, 2014

Why transitional justice proponents say the field is important: The risk of leaving things as they are

Christalla Yakinthou

Continuing on from yesterday, generally, regardless of the focus, TJ presupposes that there is a significant risk in leaving things the way they are, after conflict.

War is the most extreme form of conflict: violent and usually protracted, where systematic torture, disappearance, rape, the death and/or physical and psychological harm of loved ones, forced displacement, and the loss of everything that represents safety are all commonplace occurrences. So it is understandable when entire communities retract into themselves after war.

Usually, to make sense of what happened and why, a shared narrative is built within societies over time. But when societies that were previously mixed, after conflict, become dramatically mono-identity or ideological – essentially when they hold only one perspective about who did what to whom, and why it was done – understandings of the past can become locked into a dangerous ‘we’ and ‘they’ narrative. The trust that one will not be harmed again is damaged, as well as the ability to empathise with people from the other group/s. This is a natural result of living through violent conflict. But what this often builds is a future based on continued suspicion and fear. Feelings of threat often spike at a number of points, but especially when communities hear each other talk about, or ‘perform a remembering act’ of the past and why it happened.

Feed into this vision core institutions that are broken or no longer exist at all. And by broken institutions, think about whether you would trust a police force or a military that was made up of people who had been responsible for policing concentration or detention camps, possibly where you had been detained, or which had held people you care about, or for disappearing people, for example, for torturing people. And a judiciary that either supported these things, or that is completely unable afterwards to handle enormously complex legal frameworks that sit around war crimes prosecutions, genocide cases, or crimes about humanity. Would you trust the law to protect you? Think about a civil service that either has no capacity to provide any kind of meaningful service to society because there is no funding or the infrastructure is damaged, or where the people in the institutions during the conflict were corrupt or abusive, and part of a corrupt and abusive system. Think about a society, perhaps like Lebanon, where every political group also had a paramilitary wing. After a conflict is officially over, what do you do with thousands, or hundreds of thousands of ex-combatants who were allied to a particular group but now are out of work? And competing demands, as in Rwanda, to both reintegrate former combatants but also provide support to their victims in a context of limited resources? Think about how to educate children that have already seen the worst there is to see in life, and who, in addition to that, have probably also lost their carers, several years of their education, and core years of their development. Think about a generation of children that have been targeted specifically during a conflict – and children are often a large segment of affected post-conflict populations.

In this context, then, cast your mind forward and think about a society after a conflict that has forcibly or voluntarily moved populations and redistributed them into ethnically homogenous groups, but where the former enemy community, comprised often of your former neighbours, is five, fifteen, fifty, a hundred kilometres away from you. There, just over there, those who did this to you, those who caused you to live through this.

And then you can understand both why there is such desire to stay within your own community, and why there is such danger in building and embedding narratives that places ‘all of them’ as perpetrators of violence against ‘all of us’, the innocent party.

And perhaps it’s actually easier to understand why communities remain antagonistic than to understand the drivers and the processes through which conflict can be transformed.

Addressing the past in a new way often means taking a great risk. Voices that cross the physical and psychological landscape of a conflict and try to understand the perspective of the other become critically important, for a number of reasons. Part of the work that I do, as a practitioner-academic, is to look at how victims’ and survivors’ groups and education processes are using stories of loss to open a dialogue about the past, and their efforts to build a safer and less polarised future. My work at the moment is focusing on how organisations in Bosnia are going about this in a broader context of increasing instability and mistrust between communities, on the post-authoritarian transition in Tunisia, on confronting a long legacy of selective silences about the past in Cyprus and Lebanon, and on how transitional justice is being brought into high-level negotiations and constitutional design processes. For more, read my research!

 

 

June, 2014

Confronting legacies of violence after conflict: What is Transitional Justice?

Dr Christalla Yakinthou

Transitional justice (TJ) is essentially a field that grew around a single question: how do you address the legacy of conflict-related violence and widespread human rights abuses? The first time that we as an international community really had to think about how to address the mess of war and the impact of genocide and what consequently became known as crimes against humanity was of course at the Nuremburg Trials in relation to the holocaust in the wake of World War Two. But the field itself really grew out of the efforts in Latin American countries coming out of authoritarian regimes in the ‘70s and ‘80s. There, the human rights communities, lawyers, activists, families of victims and survivors in countries like Peru, Chile, Argentina, Guatemala and Colombia began developing strategies to help victims of human rights abuses by the state. At the same time, they began thinking about the process of establishing, or re-establishing rights-respecting democratic structures. By the mid-1990s the concept of TJ had been popularized by high profile, high visibility efforts to confront the past, the most recognisable of course being the South African Truth and Reconciliation Commission; a commission established in 1995 as part of South Africa’s transition to democracy, to deal with a limited number and range of Apartheid-era abuses. The idea that legacies of institutionalized violence needed to be addressed was consolidated over the 2000s, and the field continues to evolve, particularly in the wake of the Arab Revolutions.

What TJ does, essentially, is to suggest a number of concrete measures for dealing with legacies of conflict. While there is significant diversity within the field, most practitioners and theorists agree that some version of institutional reform, criminal justice, reparations, gender justice, and the documentation and acknowledgment of human rights violations as part of broader truth-seeking efforts are key to the repair of societies after deep trauma and widespread violations of people’s rights.

So in terms of the big picture, the motivation for transitional justice in post-conflict and post-authoritarian societies is political and societal transformation. There are institution-centred approaches, like judicial and police reform, criminal justice, reparations, and the documentation of human rights violations, which fit into truth-seeking efforts. And there are also less institution-focused approaches. Ideally, the two work hand in hand, but this is not always the case.

Less institution-focused approaches are looking at TJ as a tool for broader conflict transformation, and there is a great deal of debate over where the boundaries of TJ lie, and what sits outside. Some academics and practitioners are focusing on the value of TJ for countering denial and for promoting accountability: that is, if you think of Bosnia, the value of the Special Tribunal for the Former Yugoslavia to show that the killing of some 8,000 Bosnian Muslims in the town of Srebrenica was, in fact, a genocide. Or like the arguments of the Head of the SA TRC Archbishop Desmond Tutu, the value of TJ also lies in approaches that expand dialogue and create a space for marginalised voices. Or, for others, the goal of TJ processes is to transform victims so that they can become active, empowered citizens. And in many cases, the institutional and the individual are linked.

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