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'Phenomenal' - study hailed a significant milestone in child cancer care

James Doyle and his sister Kate Doyle pictured with Professor Owen Smith who treated James in the trial when he was a child
James Doyle and his sister Kate Doyle pictured with Professor Owen Smith who treated James in the trial when he was a child

A five-year project using genetics, genomics and data to improve cancer diagnostics and treatment for children could "change what we consider to be a 'cure' for cancer," according to a paediatric consultant.

Professor Owen Smith, Consultant Paediatric Haematologist at Children's Health Ireland (CHI) at Crumlin, has launched Ireland's first clinical study of genomics approaches in cancer care.

Prof Smith, who is the principal investigator in Molecular and Genomic Interrogation of Childhood Cancer - Ireland (MAGIC-I) and Systems Biology Ireland (SBI) explained that genomic sequencing allows medical teams to better identify cancerous cells and target them specifically.

"We need to stop carpet bombing cancers and go for a more sniper fire or precision way of killing the cancer and reducing the side effects to the patient," Prof Smith said.

"It was phenomenal for us to hear that research had done so good by these children."

"MAGIC-I will allow us to do just that. In other words, we will redefine what we call a 'cure'," he added.

Speaking on RTE's Morning Ireland, Prof Smith said there are two aspects to the study and "once we unravel the genome of the cancer, we can then find the Achilles heel of that cancer and really go after" it, and also look at the genetics that the child or the adolescent gets from his mum or dad and address that in particular to see is there a genetic predisposition".

Prof Smith said that currently about 95% of children survive leukaemia but doctors want to redefine what "cure" is.

"We want to redefine cure. Cure at the moment is, are you free of cancer in five years? But we want to know what are your toxicities like? So, we're redefining cancer, you're not just alive without cancer, but you're alive without cancer and the toxicities that are presently the situation," he said.

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'It was full on' - mother of son diagnosed with leukaemia

Mother-of-four Noreen Doyle has witnessed first-hand the difference in children's cancer care thanks to the advancement of genomic techniques.

When her second son James was two years old, he was diagnosed with leukaemia.

"His treatment started straight away, it was full on," Ms Doyle said.

From start to finish, James's treatment took nearly four-and-a-half years.

James Doyle pictured in hospital during his treatment

During his treatment, James was a frequent patient at CHI at Crumlin, sometimes for weeks on end.

Prof Smith was his oncologist and suggested to his parents that James joined a clinical trial.

"We were happy to do so," Ms Doyle said.

She added: "He was going to get the best opportunity to get completely better and our understanding as well was that maybe from the learnings of the trial we signed James up to, another family down the road, in years to come, might benefit from that.

"We felt it was the right thing to do."

James finished his treatment in 2012 but in 2017, the Doyle family received another shock.

Ms Doyle's youngest daughter, Kate, who was eight years old at the time, was sent home from school.

"I just knew almost immediately by the look of her," Ms Doyle said.

Kate was diagnosed with the same leukaemia as her brother had had.

"That was a bombshell for us. We were absolutely bowled over. I was very angry with the universe," she said.


At the time, Ms Doyle had four children ranging in age from eight to 14.

"For the first couple of days [after Kate's diagnosis], all we could think about was what had happened previously with James, how long it had taken and how ill he had become.

"She was eight, she was much more aware of how she looked," she said.

However, Prof Smith told the family that the trial James had been in ten years earlier would mean that Kate would have an easier treatment than her brother.

Kate Doyle's treatment benefitted from her brother's involvement in the trial ten years earlier

The were told that Kate's quality of life during her treatment, due to the previous clinical trial, was going to be much better than James's and the duration of the treatment was going to be much shorter.

"Some of the toxic chemo drugs that James had to endure, she wasn't going to have to endure those," Ms Doyle said.

She added: "Medicine had moved on so much in those ten years. It was phenomenal for us to hear that research had done so good by these children.

"And my son, his trial was a part of that research. And now suddenly we're the people benefiting."

Speaking to RTÉ’s Morning Ireland, Ms Doyle said that having this explained to her was like "winning the lotto".

"We took the attitude that this is wonderful news.

"This is the best hope that anyone could give a family: Second time around it's not going to be anywhere near as bad."

Kate's cancer treatment took less than half the time that her brother's had taken.

"She sailed through it," Ms Doyle said.

"She's now a very healthy, very enthusiastic, young 15-year-old; loving life, loving sport. I have four very healthy children."

'Significant milestone in Irish cancer care'

In Ireland, 85% of children and teenagers with cancer are cured.

However, this comes with a cost of long-term toxicities, Prof Smith explained.

"All organs in the body are affected, bone, heart, kidney, brain," Prof Smith said.

Around one in children with a cancer have a predisposition because of genetic factors. This is the case for James and Kate.

The Doyle family pictured recently while on holiday

"Genomic sequencing of the cancer and the patient will allow us to define the patients where chemotherapy can be safely reduced," Prof Smith said.

This means that some patients may not need as much chemotherapy or the treatment for as long.

The primary objective of MAGIC-I is to evaluate the clinical and health economic impact of implementing genomic diagnostics in paediatric cancer care in Ireland

HSE Chief Clinical Officer Dr Colm Henry called the project a "significant milestone in Irish cancer care".

Director of SBI Professor Walter Kolch called the project a "trailblazer in incorporating new concepts for personalised medicine".