A dear friend was diagnosed several years ago with head and neck cancer, which has since metastasised to multiple sites, including the brain. The prognosis is very poor, even with whole-brain radiotherapy, and his life expectancy is now extremely limited.

He was enrolled in a randomised trial of a novel drug at the Royal Marsden but was unfortunately allocated to the standard chemotherapy arm, which proved unsuccessful.

He is now at the point where he would be willing to try anything that might stabilise the brain metastases, as stability is a prerequisite for eligibility for most further trials. However, stereotactic radiosurgery (SRS) has been deemed inappropriate. He has two clusters of lesions, some in the cerebellum and others near the top of the brain.

He is emotionally exhausted, so I am trying to help by exploring what, if any, options might still be available. I cannot help wondering whether, at a major centre such as UCLH, there might be a consultant willing to consider a more experimental approach.

If such options do exist, how might one go about accessing them, given that time is quite literally of the essence?