Primary school headmaster Richard Jackson loves to plan ahead for holidays, upcoming parties or just meals out with family and friends.
Nothing unusual, you may think, especially for someone working in the hectic environment of teaching.
But the reason Richard delights in organising his diary is that, 12 years ago, he was told he would be dead within nine months.
Doctors diagnosed malignant melanoma, the most aggressive form of skin cancer, and said it had already spread to his lymph nodes, the route by which aggressive tumours usually travel round the body to major organs.
He was 39 and married with two children.
But after taking just one dose of a novel immunotherapy drug called ipilimumab – a treatment which harnesses the body’s own immune cells to fight cancer – Richard and his wife, Judith, watched in amazement as his tumours began to shrink.
Cancer survivors Deborah James (left), Lucy O’Donnell (centre) and Richard Jackson (right)
‘We rushed to see my oncologist at the Christie Hospital in Manchester and he took a good look, taking measurements and photographs,’ says Richard, now 50, from Ellesmere Port in Cheshire.
‘I remember saying to him, “It feels like they’re shrinking. But we don’t want to get too excited.” I’ll never forget the doctor’s exact words. “Oh no,” he said. “Let’s all get very excited.” ’
Within months, 60 per cent of the tumours had gone. After a year and five cycles of treatment, they had all but disappeared.
His medical team were astonished. Not least because at the time, Richard’s diagnosis was expected to be terminal.
I should be dead… but I’m doing a triathlon instead!
Later this month, Deborah James will compete against 5,000 amateur athletes in what’s billed as a ‘fun-sized’ triathlon – swimming 16 lengths of a pool, cycling 10km and then running a further 2km.
But unlike her rivals, Deborah, left, will take on the exhausting feat just three weeks after major cancer surgery and having had no fewer than 12 malignant tumours removed from her bowel, lungs and liver in the past couple of years.
First diagnosed in 2016 with aggressive bowel cancer that had spread to her lungs, Deborah – who presents the BBC’s You, Me And The Big C podcast – was given just seven months to live.
Two-and-a-half years later she is stable and even enjoyed a brief period of complete remission – she was temporarily cancer-free.
Deborah, 37, mother to Hugo, 11, and Eloise, nine, says: ‘I had three months when all the tumours had been removed from my lungs and there was no evidence of the disease.
‘My oncologist was saying, “We’ve reached a place we’d hope to be but never thought we’d achieve.” ’
This remarkable recovery is due largely to a cocktail of new cancer drugs being given by doctors at London’s Royal Marsden Hospital.
Two of them, dabrafenib and trametinib, are known to work on skin cancer with the same genetic mutation as Deborah’s bowel tumour.
The third is a bowel cancer drug, panitumumab.
This combination blocks three pathways around the tumour, preventing it from spreading further.
Although it’s not a cure, it has stabilised her condition.
Deborah says: ‘Research has kept me alive. I know I shouldn’t be here.
‘I live with hope, not with resignation. It’s about embracing what you’ve got.’
Later this month, Deborah James, 37 (pictured), will compete in a triathlon just three weeks after major bowel cancer surgery
Today, he is healthy, happy and the subject of cancer only crops up in his annual check-ups.
‘With the cancer, I felt I didn’t own my own future, that it wasn’t mine. Now, I’ve effectively had a second chance,’ he says.
Richard’s case does not exist in isolation. He was, in fact, at the forefront of a revolution in cancer treatment that has completely transformed the way many experts now think of the disease.
Thanks to blockbuster treatments that stop tumour cells dividing, many top oncologists argue that cancer – even when diagnosed at an advanced stage – is now far from a certain death sentence.
The fact is that while more patients are surviving for longer, a small group are seeing astonishing results.
Others, sadly, still fail to respond to therapy.
Scientists’ main interest is now in investigating why – and the tentative hope is that in doing so, even more patients could benefit.
It means the most aggressive growths may one day become nothing more than a chronic illness managed with drugs – much like asthma, diabetes or high blood pressure.
While one in two of us will get cancer – 166,000 every year – the reality is we have never been more likely to survive.
Twenty years ago, just one in four patients lived beyond a decade. Today half of patients do, and by 2030, experts predict, it will be three-quarters.
Doctors are even tentatively talking of curing patients with metastatic disease, known as stage 4, where the cancer has spread to other parts of the body – traditionally considered ‘incurable’.
Professor Charles Swanton, chief clinician at Cancer Research UK, said: ‘It’s really amazing. In the 1990s, cancer was still seen as bed rest and palliative care, which involved simply managing symptoms until patients died. Now, with new drugs, there’s much more optimism than there’s ever been. There is real scope for hope.’
Remarkably, as many as a quarter of those with stage 4 tumours are living months – even years – past their predicted survival time.
In melanoma, the fifth most common cancer in the UK, immunotherapy drugs, such as ipilimumab, mean that half those diagnosed with metastatic disease now survive.
There are similar increases in survival for about 20 per cent of patients with advanced kidney, lung and bladder cancer, while a boom in drugs known as targeted therapies, which alter the DNA of cancer cells, limiting their growth, is delivering further benefits.
While some drugs are already available on the NHS, other newer therapies are offered only to eligible patients via the Cancer Drugs Fund or through clinical trials.
Dr Fiona Thistlethwaite, medical oncologist at The Christie Hospital, said: ‘Almost always when the cancer has spread, it’s about control rather than cure. But we’re seeing a small proportion of patients having very good responses to the point where no disease is identifiable, which we call complete remission. Some are being kept in remission for more than ten years, which may mean these patients are cured.’
So what are these revolutionary treatments? Here are the advances that the medical professionals are most excited about.
Magic bullet therapy boosts survival
Targeted drugs, often known as magic bullets, are extending life for a decade or more in patients who would otherwise have few options.
They resulted from the huge inroads scientists have made into understanding the genetic make-up of cancer cells and what drives them to multiply.
The drugs target particular components of the cancer cell known to help it survive.
For example, the breast cancer drug Herceptin, which has transformed treatment for the one in five sufferers with aggressive tumours known as HER2 positive cancers, works by attaching to the HER2 protein, which promotes the growth of tumour cells. This stops the cells from dividing.
Professor Andrew Wardley at The Christie Hospital, Europe’s largest cancer treatment centre, says: ‘When I started as a consultant in 2001, patients with this type of the disease that had spread would die very quickly. After the Herceptin trials, we saw patients living ten years or more. And it’s not uncommon to get patients living beyond five years with no evidence of cancer.’
Combining targeted drugs can prove even better. One major study found that 13 per cent of those given Herceptin and another targeted drug called Perjeta are in complete remission, Prof Wardley said.
Lucy O’Donnell, cancer counsellor and author of Cancer Is My Teacher, was diagnosed with advanced breast cancer that spread to her liver and bones in 2011. Only 20 per cent live past five years with this diagnosis.
But Lucy’s HER2 positive cancer has been curbed by a combination of Herceptin and Tamoxifen, a drug given to women with hormone-responsive tumours.
When – and if – that stops working, there are other therapies she can then try, such as Kadcyla, shown to extend life by an average of six months, with some patients surviving for several years.
‘My oncologist says I’m a walking miracle,’ Lucy says.
‘Herceptin has been a game-changer. My cancer has stayed the same for six years. I’m just so happy to be alive. I stay positive and active and I know I have other options if it does come back, so I’m very relaxed about it.’
A new targeted therapy generating much excitement is a drug called Alpelisib, which targets the PI3K gene that makes tumours resistant to treatment.
It could be lifesaving for the one in five women with so-called ‘triple negative’ breast cancer, for whom there is currently no targeted therapy.
And it’s not just in the field of breast cancer where prospects are brightening.
A medicine called Olapirib has prevented tumours from spreading for three years in women with ovarian cancer and shown promise in pancreatic and stomach cancer patients.
Others, like Tarceva and Iressa, are improving outcomes for lung cancer patients too.
Drugs that harness the immune system
Immunotherapy has transformed survival rates for a small but significant proportion of patients.
Instead of destroying cancer cells, they disable the brakes that cancer applies to the body’s immune system. If these brakes are in place, the immune system cannot fight the disease.
Releasing them means a person’s immunity can start to attack a tumour.
The therapy has had incredible results in melanoma, lung and kidney cancer and versions of the drugs are also being trialled in other tumour types.
Lucy O’Donnell was diagnosed with advanced breast cancer that spread to her liver and bones in 2011. She has taken a combination of Tamoxifen (left) and Herceptin (right), a drug given to women with hormone-responsive tumours. The growth of her cancer has stopped for six years
Professor James Larkin, medical oncologist at The Royal Marsden hospital in London, said: ‘Most solid, metastatic tumours have been regarded historically as incurable. With recent immunotherapy treatments we know many are long- term survivors.
‘With Ipilimumab, or ipi, there’s a 20 per cent chance of long- term survival. But when newer, emerging drugs such as nivolumab (Opdivo) and pembrolizumab (Keytruda) are used in combination with Ipilimumab, long-term survival could be as high as 40 or 50 per cent.
‘We’ve got a group who’ve been living more than ten years with a relatively good quality of life.’
However, some still do not respond. ‘If immunotherapy doesn’t work, you’re back to where you were, with limited drugs available,’ Prof Larkin added.
For patients who do respond, the future looks increasingly promising. Immunotherapy even continues to work long-term, without the cancer returning, when people stop taking the drug.
Prof Larkin said: ‘We’re recommending two years on these drugs. If patients can get to that point, they’ve got a very good chance of not needing further treatment.’
Retraining cells to cure leukaemia
While most children with leukaemia respond well to treatment, those who do not are left with little chance of surviving more than a year.
But a new technique called adoptive cell therapy is offering fresh hope.
A patient’s immune cells are removed from their blood, then reprogrammed in the laboratory to make them more effective at recognising and targeting cancer cells.
These revamped cells, known as CAR-T cells, are then infused back into the patient via a vein.
Within four weeks, most patients see their disease go into remission for two years or more.
A new technique called adoptive cell therapy is offering fresh hope for cancer patients. It involves cells being removed from their blood, then reprogrammed in the laboratory to make them more effective at recognising and targeting cancer cells (stock image)
Dr Karin Straathof, paediatric oncologist at Great Ormond Street Hospital, where the treatment is now available on the NHS, said: ‘These patients wouldn’t normally have any treatment options but instead, some are being cured.
‘When the cancer hasn’t come back after six months, it usually means it won’t come back.’
She added: ‘In the future, we may be able to use it instead of the standard treatments we’re using now for leukaemia.’
Dr Straathof is also trialling the therapy in neuroblastoma, an aggressive childhood cancer, and in hard-to-treat brain tumours.
