The women behind breakthrough cervical cancer trial

Abbie was 27 years old when she invited her closest friends over for dinner to break the news. She had been diagnosed with cervical cancer. 

“There were tears and sobbing,” she remembers. “We were all similar ages and we’d never known someone as young as me get cancer. I’d never even had someone close to me get it, so it was a big shock.”

It was the end of summer and the last thing Abbie had expected to be doing.

“I was having a really nice few months, meeting friends, having drinks, the usual. I’d not long started a new job, which I was really happy with. I just wasn’t expecting it.”

Commuting to central London from Hertfordshire, she had started to feel unusually tired, and had been told by her GP that this was likely due to hormones. But, after she passed out during one journey home, she was sent for a scan.

“I was just treating it as a routine check-up. Then, after I had the scan, I was sent a letter asking me to come in again the same week. My mum said it sounded serious and that she’d go in with me. That’s when I started panicking.”

Abbie remembers attending the appointment and being told about her diagnosis: “I was still thinking ‘are you sure it’s this?’ while they were asking me which hospital I wanted to be treated at. It wasn’t sinking in at all.”

Dr Mary McCormack, consultant clinical oncologist at UCLH, knows the reaction well: “You’re telling someone in the prime of their life that they have a disease where, even if the statistics are in their favour, there’s a possibility they might die. It’s just devastating.”

But she was able to offer reason for hope.

The INTERLACE trial

A focus of Mary’s career to that point had been cervical cancer trials. “In the early 2000s, we were looking at patients with locally advanced cervical cancer. We were still finding that 30-40% of patients were relapsing, so there was a definite need to improve the outcome for those patients.”

Mary’s concept was to administer six weeks of additional chemotherapy to patients with cervical cancer before they went on to receive the current standard of care, which is a combination of chemotherapy and radiation therapy. A small study involving 46 patients confirmed the feasibility of this new intervention, and funding was secured for the INTERLACE trial to begin comparing the new treatment with the old treatment in 2012. Coordinated by UCL’s Cancer Trials Centre, and with Mary as the lead investigator, the trial was well under way by the time Abbie was referred to her.

Mary explains why a trial is necessary for new treatments to be accepted: “If your hypothesis is that your new treatment is better than the standard of care, you have to be able to compare the two. And for it to be accepted, you need to compare them in enough people to ensure that the results haven’t arisen by chance.”

In theory, the more trials that are conducted, the more opportunities exist for treatment outcomes to improve: “I usually cite breast cancer as a comparison. The reason that outcomes have improved so much in the last 10 to 15 years for patients with breast cancer is because so many patients are offered participation in a clinical trial, and the trial scene is so active internationally. This was really lacking in cervical cancers.”

Abbie says meeting Mary gave her a reassurance she needed. “I just remember her being so warm and lovely. She went ‘don’t worry, we’re going to fix this, and this is what we’re going to do’. And I thought, ‘OK, that’s what we’re doing then’.”

Abbie was eligible to take part in INTERLACE and was randomly assigned to the half of the trial where she would receive the new, additional treatment, which began soon after. A special cooling cap worn during chemotherapy meant she was able to avoid losing her hair.

Abbie kept working throughout her hospital visits, but once the standard combination of chemotherapy and radiation therapy began, things got tougher. “It was a case of me being in the office and saying, 'I'm just off to get my radiotherapy, I’ll be back in an hour or two', which is mad to think about now. I was knackered. About a week in, it was having a really tiring effect on me.”

Mary confirms: “It's a tough course of treatment, and it’s tough to get through. But Abbie was determined.”

Abbie had her final treatment visit in the first week of December. She remembers: “I took a picture of myself on the day it finished. I didn’t have any eyelashes, I had no eyebrows; I just looked absolutely done. But it was over, and I was happy that Christmas was coming up and I could just try to recover.”

In the following weeks, Abbie started to feel better, and she remembers the milestone of being able to wear mascara again once her eyelashes grew back. Meanwhile, her follow-up scan, which would confirm how her cancer had responded to the trial, was due to take place three months after the end of her treatment.

When the date of the scan arrived, Abbie was told her cancer had completely disappeared. It was an emotional day: “We were just constantly crying. I was at the hospital with my mum and my brother was waiting downstairs. We decided to find the nearest pub, get a bottle of champagne, and celebrate.”

Mary says: “Patients are usually so anxious by the time they come in for their scan and scan results. So to be able to sit in front of someone and tell them their cancer is in remission is fantastic.”

In addition, the number of these positive responses to treatment UCLH were seeing was encouraging news for the trial.

The outcome

The trial continued, and eventually treated 500 patients not only in the UK, but also at hospitals in Brazil, India, Italy, and Mexico.

Simran Vaja, a medical statistician at the UCL Cancer Trials Centre, was one of those tasked with piecing together the conclusions from 10 years of trial data.

She describes what the task involved: “Every patient has a different story and different data as a result. It takes a while to get your head around, but with time you begin to see the patterns.”

Simran says that soon after analysis began, the value of the INTERLACE trial became clear: death or return of cancer was reduced by 35% in patients who received the new treatment. She says: “Looking at the data and seeing the stark divide between how much more effective the new treatment was compared to the old, you really did realise how big a deal this was going to be, and the impact it could have.”

The trial was given a presidential slot to present its findings at the European Society for Medical Oncology meeting in Madrid last October. Mary was quickly drafted to appear on BBC Radio 4’s Today programme the following day, completing over a dozen other media commitments in 24 hours as the results of the trial made international headlines.

Part of the reason for the strong reception was the fact the treatment can be adopted globally. Mary explains: “Each year, there are 600,000 cervical cancer cases globally, of which 90% occur in low- and middle-income countries.”

The two drugs used in the additional cycles of chemotherapy which INTERLACE has pioneered, carboplatin and paclitaxel, are in relative terms cheap and readily available across the world, meaning the treatment can be adopted almost anywhere. “It means you can do something that’s simple and relatively cheap, then actually change things and improve outcomes. I think that’s why it’s created such a storm.”

For Simran too, the trial has a resonance: “I just turned 25 last year, which is when you start to get tested for cervical cancer, and it becomes something you talk about among your friends. The peak for diagnosis is among women in their early thirties, so it’s reassuring to know that this work is being done to help, and it does make you feel proud to be part of it.”

Mary and her UCLH colleagues’ efforts to promote the INTERLACE protocol mean the treatment is in the process of being adopted across the globe. Alongside the research team at UCL, the task is now to prepare the trial’s manuscript for submission to a journal.

Abbie, meanwhile, remains cancer free, living in West Yorkshire where she works at a design agency. “I’ve told people that if they’re ever offered a medical trial, don’t be scared of it. They’re not just researching things for the sake of it, they’re doing it to help the patient and future patients. I’m so chuffed I did it.”

The INTERLACE trial was initiated by Dr Mary McCormack at UCLH. It was run by the Cancer Research UK & UCL Cancer Trials Centre and took place from 2012-2022. It involved 500 patients who had been diagnosed with locally advanced cervical cancer at centres in the UK, Brazil, Italy, India, and Mexico. The trial treatment involved giving patients 6 cycles of additional chemotherapy before they went on to receive the current standard of care, which is chemotherapy and radiation therapy. Results showed that among the group receiving additional treatment, chances of death or return of cancer were reduced by 35%. The trial was funded by Cancer Research UK and the Cancer Trials Centre.

Further information

• UCL news: Better use of existing drugs increases cervical cancer survival and reduces recurrence
• UCL World Cancer Day 2024
• Professor Jonathan Ledermann's academic profile
• UCL Cancer Institute
• CRUK & UCL Cancer Trials Centre
• INTERLACE trial

Main image (left to right) Abbie, who took part in the INTERLACE trial after her cervical cancer diagnosis, Dr Mary McCormack, consultant medical oncologist at UCLH and lead investigator for the INTERLACE trial, Simran Vaja, Medical Statistician at the Cancer Research UK & UCL Cancer Trials Centre,