Hopes for new cancer vaccine

0:00Hello, I'm James Kamara Sami. Thank you for downloading the BBC's World Tonight podcast for Wednesday, August 19th. An experimental vaccine has shown encouraging signs of being able to prevent melanoma, a common form of skin cancer, from returning. We speak to a skin cancer expert who's been involved in vaccine trials. Also on the programme, Ukraine's widening corruption scandal leads President Zelensky to fire one of his top aides a day after a popular ex-defence minister called for new election. So how much danger is the Ukrainian leader in? We have some news about some returning royals. We speak to a 78-year-old British widow who's been threatened with deportation from Sweden, a place where she's lived for more than 20 years.

0:42And we hear about a giant operation to remove thousands of coins from the giant's causeway. And we begin tonight with a potentially big moment in cancer treatment. It is news about a possible vaccine for melanoma, a common type of skin cancer. In trials, the experimental personalised treatment from the US pharma giants Moderna and Merck was tested on patients after undergoing surgery and it extended the length of time that they were cancer-free. Well, Dr Hugo de la Peña is a consultant oncologist who's been directly involved in research into cancer vaccines. He's a trustee of the charity The Melanoma Trust and joins me now.

1:21Good evening, Dr de la Peña. Good evening, James. Can you explain how this particular vaccine works? Well, the first thing to say, and very important for everyone to understand, is that melanoma is one of the worst cancers out there. I will put melanoma in the same bracket as pancreatic cancer, triple negative breast cancer, small cell lung cancer. So these cancers, if you leave them alone, they kill very quickly. So of course, what we want to do is to cure more patients and to cure more patients at the first time of asking, because we only have one chance to cure patients and we have to get it right.

1:58Sometimes you can escalate treatment, sometimes you can de-escalate treatment. So this is a strategy when you are curing more patients from the first time of asking by adding after surgery. So you're very right in saying that these patients already have melanoma. And this is very important because the frustration is that 9 out of 10 patients with melanoma, 9 out of these 10 cancers are caused by excessive sun exposure, which sometimes is accidental, sometimes is intentional. But this is a preventable cancer, and I will come back to this. But what happens is you have a melanoma, you resect the melanoma, and then you give patients either pembrolizumab.

2:37Pembrolizumab is one of these drugs that won the Nobel Prize in 2018 for the Nobel Prize in medicine because they have changed the way we treat cancer. So you can either give this pembrolizumab or you give pembrolizumab plus the mRNA vaccine. And this vaccine, what it allows you to do is it's almost like Christmas for the immune system. What we need to understand is that these melanomas are surrounded by T-cells. T-cells are the good guys. T-cells are the heroes of the story. T-cells are our immune system. And T-cells are the most powerful killing machinery known to man. And what happens is that these melanomas are surrounded by T-cells.

3:19And these T-cells, you have an army of T-cells ready to kill the melanomas. but the T cells don't kill and they don't kill because the melanoma tells the T cells don't touch me so these trials just to be sort of clear where where things are at these are late stage trials and that's the first time that they have produced these kind of results is that is that correct right so it's a phase three randomized international clinical trial using more than a thousand patients more than 1 ,000 patients. And it's the first time. Now, the full results of the trial haven't been released, but what we do know from the previous phase two trials, so this is a phase three trial, but from the phase two trial, we know that you can prevent or reduce the risk of recurrence by 50 % and reduce the risk of recurrence, not only of a local recurrence, but a recurrence that is a distant recurrence that can potentially kill a patient.

4:12Because if you have a local recurrence, you can remove that surgically and you can cure the patient again. And just to be clear, these are preliminary findings. So how cautious should we be about drawing too much from these results? So this is not ready for prime time yet. Once the phase three trial is fully, fully published, then it has to be analysed by all the medical authorities to then say, OK, this is significant and it's cost effective. And then you can then approve and then NICE has to approve and NHS the singling has to say, yes, we're happy to pay. So it's not ready for prime time yet, but it is the first time that you can, with a vaccine that is personalised, and that's very important, that is personalised to the individual cancer that that patient already had, that you can prevent the risk of recurrence.

5:02Well, the question then is, if this is a personalised treatment, can it work potentially for other cancers? Correct. So melanoma is in many ways ahead of most cancers. So the same technology is now being used in breast cancer, in lung cancer, in bowel cancer, in kidney cancer. So then the door opens to all other cancers. But when a cancer cannot be prevented, then, of course, that is very important. But the frustration, again, is that melanoma is a cancer that can be prevented. And what we do with the Melanoma Fund especially is to protect our kids and our young adults. because what we are seeing is a huge increase in metastatic melanoma in young people you know people that are footballers rugby players that are healthy and we can prevent it and briefly and i know this is the question that's always asked at this stage and it's a difficult one to answer but from this stage to actually being available on the market for people to to actually use what are your thoughts no so for patients that already have melanoma it will happen so i'm very confident And in a couple of years, this will be standard of care for most patients that have had cancer already.

6:15But to use these vaccines in the general population, that's a different story. So in patients that have and people that have never had cancer, that's different. And I would be ashamed to live in a world where we use a vaccine when a cancer is preventable. And the problem is that within the melanoma, we know that most of the sun, that the damage that the sun causes is done by the time we are 18. And that's why we need to protect our kids and our teenagers. And that's why the songguarding lessons that we have as part of the melanoma fund are so important. But I think it will become part of clinical practice for sure.

6:49Dr. Hugo de la Peña, a consultant oncologist, trustee of the charity The Melanoma Fund, is he correct to me there. Thank you very much indeed for joining us. Now, there have been reports in the past half hour of explosions in the centre, being heard in the centre of Kiev. but earlier today the streets of the Ukrainian capital were filled not with the sounds of war but of popular discontent.

7:19People who turned out to express their opposition to the official appointment of a new defence minister, supporters of the recently ousted one, Mikhailo Fedorov. He had made his own dramatic public intervention last night using a video in which he had called out a culture of corruption to call for new elections. We must answer a fundamental question. How should the state function if the war lasts for years? Can Russia in effect gain the right to decide when Ukrainians will again be able to elect their authorities? I am convinced that it cannot.

7:58Well, that call for new elections, something that is currently ruled out under the Ukrainian constitution because of the ongoing state of emergency has today been largely brushed away. Not so, though, his allegations of corruption, which he says are harming Ukraine's war effort, because today a senior figure in President Zelensky's office, a senior aide called Irina Mudra, was abruptly removed from her office after she was linked to a widening corruption probe. The country's top anti-corruption body, the initials NABU, announced a new investigation. It's called Operation Forrest Gump, and it's come out of another operation, Operation Midas, which is a wider ongoing investigation into an alleged multi-million dollar money laundering scheme, allegedly involving top officials.

8:45Well, I've been hearing more about the latest development and its implications from Olena Tregoob. She's a member of the public body that oversees the work of that anti-corruption body, NABU. It's called Forrest Gump because one of their suspects in phone conversation was mentioning that they need to save Private Ryan. And Private Ryan apparently is German Galushenko, who is the former minister of energy. And as you know, he was in jail and there was a very large bail required for him to get out. And the whole case is about money laundering operation, about how this group of people wanted to acquire around like 3 million euros to get this private Ryan out of jail.

9:32So tell us about what it tells you then that this operation has been launched. NABU investigation is showing us the different parts of the state which were captured. The first case showed us the capture of the Energoatum, of the Ministry of Energy, of the Ministry of Defence, partially. And now we see this continuation. So different institutions within the state are captured and they are identifying who did it and exposing it and removing this individual. Well, I was going to say, well, today the individual who's been removed is a senior member of the president's office, isn't it? Irina Mudra.

10:12Yes, she was removed immediately by Zelensky. Today, there are disputes whether she was in custody or not. But Zelensky reacted immediately today. And yes, she was removed. And what impact is this having on him? I mean, obviously, it comes just hours, literally, after former defence minister, popular defence minister, Mikhail Fedorov, had issued this call for elections and had specifically said one of the reasons that Ukraine needs elections is because of corruption. I don't think it will affect Zelensky much because it was already clear how much the state is captured by all these individuals around Zelensky, after Midas case especially.

10:55And the call for elections that Fedorov made is not really supported widely. And Fedorov himself was part of this very system. And Zelensky is seen as, OK, he's a president, he's immune to investigation, but all these people under him are very corrupt. And apparently Irina Mudra, I think it was Irina Mudra in this tape said, you can't fight corruption. You just need to control it and to kind of lead it. And is that seen what, as an expression of there's nothing we can do about it, that it's just so endemic? I think it's seen differently. It's seen that, look, we had this corrupt system inherited from Soviet Union.

11:40and what Ukraine is doing in our post-Soviet transformation, we are moving away from this state capture and from this system. And as of today, the independent anti-corruption bodies that Ukraine has created have gained significant strength and capability and they are able right now to show such results. And it's a good thing. And it's one of their mechanisms of democratic resilience in the absence of mechanisms such as election. There was the confrontation between Zelensky and Nabu. He wanted to put his own people on it, didn't he? And he lost out. Yes, he did. But he backed down last summer. And Nabu is able to do their work.

12:28And moreover, in this new investigation that was released today, we also hear that Irina Mudra apparently was trying to influence the election of people to the public council of NABU, of which I am currently a member. I remember those people who were running. And I remember that we as civil society, we did quick investigation on those people, quick background check, and we wrote all over social media, don't vote for these people because they seem very questionable. And now it turns out that those were the very people then the president's office was pushing. So in that case, civil society also won, by the way.

13:09That's another victory. Well, let me just return then to that call for an election from the former defence minister. The message that he gave about corruption, and he said that corruption is depriving the military of weapons and equipment and it's making it harder for Ukraine to win the war. Do you agree with him on that? Oh, yeah, of course I agree. The issue with Fedorov is that he said everything correctly, absolutely. but the way he said it and the time when he said it made him lose a lot of support that he initially had. He was working in this team for seven years in three different positions and he never had any conflicts about any of the corruption.

13:52He did not make any official complaints to law enforcement bodies. Do you think we can expect to see more of these operations, more people in senior positions being accused of corruption. Oh, definitely. That was Olena Tregu. She's a member of the public body that oversees the work of Ukraine's main anti-corruption body, NABU. Now, the five-time Grammy winner Angelique Kijo has become the first living black African to get a star on the Hollywood Walk of Fame. The singer, actress and activist from Benin in West Africa shared these reflections after the ceremony. The star for me means that my vision of the world as a small village is a reality.

14:37We have the same needs, doesn't matter where we come from, which language we speak, which skin colour we have. We are human. It's one human family. I don't believe in any other person telling me otherwise. The skin colour is just the cover. Beneath our skin, in our blood, That's where God lies, molecularly.

15:08Angelique Kijot grew up in Benin but left for Paris in 1983, saying she'd been oppressed by her native country's then communist government. She's been widely recognised for her work supporting girls and young women in Africa.

15:29But it's her music that's made her a star and has now earned her one. She's brought West African sounds to global audiences, blending influences from Benin with funk, jazz and R &B.

15:46Today, she said, We Africans just don't know what we've given to the world and what we continue giving to the world for the music to exist. Without us, there's no music possible on this planet. She's collaborated with a long and impressive list of artists, including Alicia Keys, John Legend, Bono, Pharrell Williams and Niall Rogers. And this is her distinctive voice, featuring on Sampa the Great's Let Me Be Great.

16:21Angelique Kijow now on the Hollywood Walk of Fame. Well, there's some news about some residents of California coming back to this country that's just been developing over the last half an hour or so. Our correspondent Tom Simons is here with me to bring us up to date, Tom. Yeah, this is a story in the Daily Telegraph this evening, which dropped at 10 o 'clock, that Prince Harry is to move back to the UK six years after he left the UK, what a lot of people called Megxit at the time, a reference to the name of his wife, the Duchess of Sussex. We understand, and we understand this report is true, that he intends to relocate from the US back to a private non-royal residence thought to be outside London.

17:10Prince Archie, Princess Lilibet, the children are both enrolled to start at a British school in September. There are no current plans, we understand, for either the Duke or Duchess of Sussex to begin being working royals again. but of course being back in the UK means that that might be something that could happen in future. The King has been told and we believe that Prince Harry will continue doing his charity work here. So quite a big move. He has obviously been improving his relationship with the royal family which had been very difficult elements of the royal family in recent weeks. It was a huge moment when they decided to leave the country.

17:55this is going to be something pretty big as well isn't it the return absolutely I mean it's back in January 2020 when the Queen agreed a period of transition where they would work at that time in Canada and the UK they ended up in Montecito in California they had a property there they bought in Portugal I think as well and in that time in that six years there was clearly a lot of bad blood. I think a few things have happened since. Certainly one of the concerns the prince has had has been security and paying for that. We don't know how that's been resolved. We don't know if he's been told he will get more security from the police.

18:35He has dropped effectively his legal campaign against newspapers, having lost against associated newspapers in court, the publisher of the Daily Mail. That was never popular with Buckingham Palace. And also the Invictus Games James is one of his big passions. The British charity for veterans back in the UK, he will be able to work more rigorously on that project. And not a working royal anymore. No, it doesn't look like that. That is something effectively the Queen took away, the late Queen took away. And it is difficult to see how that would change very quickly. but clearly being back in the UK, having a better relationship with Buckingham Palace, with the King at least, I think the relationships with other senior royals are not as clear, does give him the opportunity to start at least looking more like a working royal even if he is not officially in that role.

19:34Tom, thanks for that update. Tom Simons there. Now the long tale of Brexit has come with something of a sting in it for some of the older Britons living in Sweden. At least two of them, both of them in their 70s and both of whom have lived in Sweden for more than 20 years, are being threatened with deportation because the Swedish authorities say they haven't filled in the correct paperwork that would allow them to stay. One of the cases is that of George Mason. He is 74. He lives with dementia and receives round-the-clock care. His family says that paperwork was filled in for him to receive Swedish residency in 2021, but it is missing.

20:10A court has given him until tomorrow to leave the country. The BBC spoke to his daughter, Michelle Torosian. He's very, very poorly. He's Parkinson's, he's got vascular dementia. He can't look after himself. It's not like he can just pack up and start a new life here in the UK. He's in 24-hour care. He's in a wheelchair. He can't do anything for himself. He can get the care he needs in the UK. That's actually not what this whole situation's about. He isn't well enough to make that trip. This could put a massive deterioration on his current mental health and his dementia. And they've just said, basically, it's a 12-hour journey from door to door, from where my dad is to where I live in the UK.

20:57It's a long, long journey. And they've not said he will be escorted by a medical professional or anything like that. They've basically not said anything. The other case we know about is that of a widow, 78-year-old Joyce Thomas, who moved to Sweden with her husband to be close to her son and grandchildren 21 years ago. She says that they only found out that he had to make a special application when they returned from the UK in 2022, but were told that they had already missed the deadline. Well, three and a half years later, she has been told that she has four weeks before she has to leave the country.

21:34She received a visit today from her local MP who has taken up the case. He is Hakan Sveneling. He's from the opposition left party. What we have seen during this term in Swedish politics is that their policy for migration has been tightened a lot. And these Brexiters, British citizens that are affected by Brexit, are part of this tightness of the legislation. So from my side of the political landscape, I think that we should change legislation back so that there are room for the authorities to consider the special circumstances during these cases that we have seen here coming up in Swedish media now.

22:14Well, earlier I spoke to Joyce Thomas and I asked her how she was feeling. It's hell. I can't sleep. I am absolutely sickening by the whole thing. to be uprooted after you lived in a country for 21 years, abide by the law, you don't take from the country and then to be told that you're gone. And when they decide, it's four weeks. So can you imagine me, in my age, to relocate and sell the house and do that? It's absolutely impossible. It's horrifying. There was never any attempt to contact you and say, you need to do this. You had to find out yourself, did you? No. You had to go on the internet and you'd have had to find out by yourselves.

23:05Yes, that's it. I'm not computer literate. You get what I mean. But if there was a letter, I mean, that would be fantastic. We would have known and we'd have done everything. Now, you were visited today, weren't you, by an MP from one of the opposition parties. Did he, did he, yes, did he, was he able to offer any practical help? He was, he was very good. And he is, he is helping, yeah. And he came to the house and with some other politicians and they were very, very sympathetic. They can't believe that this is happening to me. and even when I walk my dog and meet people, the Swedish people say, this is not Sweden.

23:49You can't just say to the old people, you just go. You know, Brexit was not our doing and we got into this mess and now we are suffering and it's horrible. I mean, I'm so emotionally upset and quite sick about the whole thing. It's horrible. It's absolutely awful. Is it making you think differently, Joyce, about the country you've called home for the last 21 years? No, I love the place. The place is super, but I just don't comprehend this thing of chucking at people. That I don't understand. I really don't understand. But the country is good. I've got lots of friends. I enjoy the walking and I enjoy everything.

24:36I'm quite, it's home and I've settled. Even children are coming. I'm saying, what have you done wrong? And I said, I haven't done nothing. I'm not a criminal. All I've done wrong is, was late with my application. And, you know, since my husband died, I've just, I've just started getting strong and living on myself. I've got myself a nice flat near the, near the harbor, which is super walks and with dogs and that. I like my life here. It's a horrible thought that you just told you can't have to be here in a country for all those years. And then they tell you, you've done this. It's horrible. And it's not only for me.

25:20It's for all the expat Britons that are in this country and in Europe. Joyce Thomas there. Well, joining us now from Stockholm is David Milstead. He volunteers for the Brits in Sweden group. David, good evening. Good evening. First of all, tell us a bit about Brits in Sweden. What exactly do you do? Well, Brits in Sweden is an online community and we discuss many things. Citizens' rights, of course, is one of them. And we take in a lot of experiences from people and we try to build a picture of, you know, what's been happening in Sweden since Brexit. And the picture which is being painted is unfortunately something of a distressing one.

26:02And that picture we just heard from Joyce, I mean, how many others are there out there? Well, Joyce, Mrs. Thomas and Mr. Mason, they are two very egregious examples of the failure of the withdrawal agreement. At the heart of this is the fact that this international treaty, the withdrawal agreement was negotiated, and it was certainly not intended by those who drafted it and those who sold it, that these types of cases should actually happen. Now, regarding the actual numbers, we've seen numbers quoted by Sweden from various official sources in Sweden. We talk about several thousand people being turned down for residents or several thousand applications being rejected.

26:47We're not quite sure of the total number. One can always find reasons why one country's number is not comparable with another country or maybe the effects which artificially employ a number. All we can say is that certainly a lot we've seen both in statistics and also on the ground. And I mean, how many EU states, I don't know if you know, actually had outreach campaigns to people who registered British residents in their country? I mean, some did, didn't they? But clearly the people we've spoken to here feel that they were not afforded that and they had to find out by themselves. Yes, exactly.

27:26I mean, the withdrawal agreement is pretty clear that countries need to mount some type of information campaign. And certainly in Sweden, it was empirically weak compared to other countries. Now, Sweden, unlike the UK, has an extremely good population register. The government knows exactly who we are, where we are, where we live. Many of us also have digital inboxes specifically for communications with government agencies. So the cheapest and most effective and easiest thing would have actually been just to send people emails or send people letters. Other countries did that, which is Denmark and the Netherlands.