BRUSSELS - The Anticancer Fund and Barts Charity are co-funding the ACTOv-trial, which has enrolled its first patients in the United Kingdom. This study is investigating a new personalised treatment approach for ovarian cancer that has returned after previous chemotherapy. The aim is to prolong patients’ survival and reduce side-effects.

Gynaecological cancers are one of the focus areas of the Anticancer Fund, as each year 207.000 women die from ovarian cancer around the world.

The ACTOv-trial (Adaptive ChemoTherapy for Ovarian cancer) is testing a novel treatment approach for women with ovarian cancer. The approach, known as adaptive therapy, aims to prevent the development of drug resistance by fine-tuning the treatment dose given to each individual patient as their tumour evolves over time in response to therapy. The phase II trial has included its first patients in the UK.

Adaptive therapy in ovarian cancer

The main treatment strategy for ovarian cancer, which is diagnosed in around 314.000 women each year worldwide, consists of a combination of surgery and chemotherapy. The aim of chemotherapy is to kill as many cells as possible, using the highest dose of drug tolerated by the patient.

Although this approach can reduce the size of the tumour initially, after multiple treatment rounds, cancer cells that survive and become resistant to the drug will still be able to grow.

Instead of trying to kill as many cancer cells as possible, the goal of adaptive therapy is to maintain a small number of cells that are sensitive to chemotherapy throughout a patient’s treatment. This could be achieved by using smaller doses of chemotherapy and adjusting the dose accordingly as a patient’s tumour shrinks, or slightly increasing the dose as the tumour grows. The sensitive cells that remain suppress the growth of the resistant cells, providing a long-term strategy to control the tumour, and preserve sensitivity to the same drug.

Why we believe in this trial

This research is important because it could provide a new, highly personalised therapeutic strategy for women with incurable ovarian cancer, which could prolong patient survival while giving a lower drug dose each time with fewer side-effects.

The Anticancer Fund and Bart’s Charity (*) fund the trial.

“We are incredibly happy the first patients were enrolled. Adaptive therapy today is mostly being tested in prostate cancer so if the results from this phase II trial are positive, it could lead to a larger phase III trial to test whether adaptive therapy can be established as a treatment option for women with incurable ovarian cancer. It will also provide invaluable support to continue investigating the adaptive principles in other cancer types,” says Rica Capistrano, Programme Director New Projects of the Anticancer Fund.

“Our local community in East London is disproportionally affected by cancer. That is why Barts Charity was keen to invest almost half a million pounds in this trial as this new treatment strategy has the potential to transform cancer care in the area. This could mean that patients would receive less drugs, less often, and live longer with fewer side-effects,” adds Dr Victoria King, Director of Funding & Impact at Barts Charity.

Eighty patients will participate

ACTOv is a phase II randomised trial, which will include eighty women with ovarian cancer across nine hospitals in the UK. Half of the patients will receive six cycles of the standard dose of carboplatin chemotherapy, while the other half will receive an adaptive therapy regimen of chemotherapy, meaning the dose of carboplatin will be adapted during treatment.

The clinical trial is UK’s first to test adaptive therapy in ovarian cancer. Professor Michelle Lockley, Group Leader in the Centre for Cancer Genomics and Computational Biology at Barts Cancer Institute (BCI), Queen Mary University of London and Medical Oncology Consultant at University College Hospital (UCH), leads the trial: “The ACTOv trial will test a new treatment strategy known as Adaptive Therapy. Adaptive Therapy could mean that patients receive lower doses of drugs but live longer with fewer treatment-related side-effects. So, if ACTOv is successful it could transform the way we use anti-cancer drugs such as chemotherapy and provide real benefit to patients.”

“This is a pioneering approach to treat cancer. The evolution of treatment-resistant cancer cells is what stops our treatments from working. The ACTOv trial aims to stop treatment resistance evolving by carefully adjusting the doses that patients receive. Our hope is that overall, the people in the trial will receive less treatment but live longer and with better quality of life,” says co-investigator Professor Trevor Graham, Director of The Centre for Evolution and Cancer at The Institute of Cancer Research, London, who helped conceive and design the trial.

(*) Barts Charity is dedicated to supporting improvements to healthcare and transformative research with a primary focus on the issues that matter to the people of East London.

Additional information

More details about the trial here.
More on adaptive therapies.