Research Interests
Professor Alan Horwich is Head of The Institute of Cancer Research’s Division of Radiotherapy and Imaging.
Radiotherapy is used widely in the curative treatment of localised cancers, a goal which becomes increasingly important as advances in chemotherapy improve the control of micro-metastases. One of the Division’s main research areas focuses on evaluating and improving intensity-modulated radiotherapy techniques, in which radiation is precisely targeted at tumours to enable a higher dose while reducing damage to surrounding normal cells. The Division is developing the best way to define the exact tumour location, size and shape, known as target volume, and assessing different methods of tailoring treatment – using medical imaging and computer modelling – to patients. There is also evaluation of new techniques of radiation beam delivery such as stereotactic radiotherapy to define indications and benefits.
Intensity Modulated Radiotherapy
The new techniques of intensity modulated radiotherapy coupled with functional imaging permit radiation dose boosting to resistant sub-targets within a tumour, such as areas of hypoxia or rapid proliferation. One limitation of these approaches is target mobility due to respiratory, cardiac, bowel and bladder movement. Methods to identify and treat sub-targets and to measure and account for these movements – image guided radiotherapy (IGRT) – need to be developed and applied in clinical practice. Precise radiation targeting also provides the opportunity to intensify treatment with concomitant relevant biologically-targeted agents. Our research extends from conceptual and laboratory developments to translational pre-clinical studies and clinical trials and include analyses of physics and outcome data as well as tissue from these trials. The overarching aim is to increase cancer control and cure whilst moderating treatment related side effects.
Urological Malignancies
Professor Horwich undertakes clinical research in the management of patients with urological malignancies with chemotherapy and/or radiotherapy and also specialises in radiotherapy of lymphomas. He has written a number of review articles and edited books about clinical oncology, and is on European Guideline committees for prostate cancer and for testicular cancer.
Carboplatin
Professor Horwich led the investigation of the role of the chemotherapeutic agent carboplatin in the treatment of patients with testicular germ cell cancers and developed the policy of surveillance in stage 1 seminoma as an alternative to radiotherapy. He currently leads an international study of radiation carcinogenesis in this context.
Carboplatin was invented at the Institute of Cancer Research and Professor Horwich led pilot studies of this drug in both seminomas and non seminomas and subsequently led national trials coordinated through the Medical Research Council Testicular Tumour Working Party of which he was the Chairman. These clearly established the toxicity profile of the drug as both single agent and in combination with other drugs and also the relative efficacy.
Trials
Professor Horwich is Co-investigator on the following trials currently open to recruitment:
- A phase I dose escalation study of the use of intensity modulated radiotherapy (IMRT) to treat the prostate and pelvic nodes in patients with prostate cancer.
- STAMPEDE – Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy.
- A phase III study to evaluate the efficacy and safety of docetaxel and prednisone with or without lenalidomide in subjects with castrate-resistant prostate cancer.
- A randomised phase III toxicity study of short vs long infusion bleomycin for patients with IGCCCG good prognosis germ cell tumours.
- Phase I/II multicentre trial of salvage chemotherapy with Gem-TIP for relapsed germ cell cancer.
- A single arm multicentre study evaluating a single cycle of BEP as adjuvant chemotherapy in high risk, stage I non seminomatous germ cell tumours of the testis (NSGCTT).
- A double blind, randomised, multiple dose phase III multicentre study of Alpharadin in the treatment of patients with hormone refractory prostate cancer with skeletal metastases.
- Predictive planning for hypofractionated bladder radiotherapy.
- Intensive modulated pelvic node and bladder radiotherapy.
