Manifesto calls for action on cancer drug access as survey shows patient delays

Institute of Cancer Research | April 2019 | Manifesto calls for action on cancer drug access as survey shows patient delays

The Institute of Cancer Research has issued a 10-point manifesto which calls for action to accelerate access to innovative cancer drugs. The manifesto is the result of a survey conducted by the ICR, which involved over 1000 people who had been treated for cancer to contribute to shape recommendations to improve access to the latest treatments. 

The 10 points are:

1. NICE needs to prioritise the most innovative cancer treatments with the greatest potential to deliver step-change advances for patients. That means changing NICE’s definition of innovation to promote treatments that tackle cancer in brand new ways.

2. We need radical action to bring down the extremely high prices of modern cancer drugs, allowing as many patients as possible to benefit from advances in cancer treatment while not overburdening the NHS.

3. We need to embrace personalised medicine by developing tests for every drug developed. Better access to biomarker tests can ensure modern targeted drugs are directed at those who will benefit. This is better for patients and more efficient for the NHS.

4. We need to test drugs in smaller, smarter clinical trials to generate findings more quickly and cheaply – giving the NHS fast access to drugs at affordable prices.

5. We need to incentivise pharmaceutical companies to trial new medicines in novel combinations – including with other drugs manufactured by commercial rivals.

6. Drug regulators need to be more flexible in assessing evidence, so that innovative new treatments can reach patients as quickly as possible.

7. We need to ensure all cancer patients have access to suitable clinical trials at all appropriate stages of their disease, irrespective of where they are treated.

8. We need to increase access to precision medicine for children with cancer – so they can benefit from the same kind of advances in treatments that adults have.

9. We must be flexible on the age limits for clinical trials to avoid denying older children and young adults access to new treatments simply because they are judged too young or old.

10. We need to incentivise companies, universities and charities to work together to turn research into innovative, medicines for patients (Source: Cancer Drug Manifesto).

Full details from Institute of Cancer Research Cancer Drug Manifesto 

Press release Institute of Cancer Research  Manifesto calls for action on cancer drug access as survey shows patient delays

In the news:

The Daily Telegraph One in six cancer patients is being denied drugs recommended by doctors

The Independent One in 10 cancer patients denied drugs recommended by their doctor, study says

The Daily Mail Cancer drugs are NOT reaching the patients: One in six sufferers have faced an NHS block to treatments that are recommended by their doctors, report warns

University of Leicester research: Breast cancer relapse could be found two years earlier

University of Leicester | April 2019 | Breast cancer relapse could be found two years earlier

Research undertaken by the University of Leicester and Imperial College London and funded by Cancer Research UK,  has shown that a blood test was able to detect 89 per cent of all relapses for patients with breast cancer, with the blood test on average detecting the cancer 8.9 months quicker than imaging.

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The prospective national study enrolled 49 patients with early-stage breast cancer from three NHS trusts in the UK  who had recently completed treatment with surgery and adjuvant chemotherapy.

The study included a cross section of breast cancer subtypes, including HER2-positive, hormone receptor-positive, and triple-negative. Blood samples were collected every 6 months for up to 4 years from each patient, and results were correlated with radiographic and clinical outcomes.

Although this was an observational study, knowing that early detection of relapse could be possible presents the opportunity to conduct trials of treatments to prevent patients relapsing with symptomatic metastatic breast cancer (Source: University of Leicester).

Full press release from  University of Leicester

The study has been published in Clinical Cancer Research 

Full reference: Coombes, C. et al | 2019|Personalized detection of circulating tumor DNA antedates breast cancer metastatic recurrence |Clinical Cancer Research |  10.1158/1078-0432.CCR-18-3663

Abstract

Purpose: Up to 30% of breast cancer patients relapse after primary treatment. There are no sensitive and reliable tests to monitor these patients and detect distant metastases before overt recurrence. Here we demonstrate the use of personalized ctDNA profiling for detection of recurrence in breast cancer.

Methods: Forty-nine primary breast cancer patients were recruited following surgery and adjuvant therapy. Plasma samples (n=208) were collected every 6 months for up to 4 years. Personalized assays targeting 16 variants selected from primary tumor whole exome data were tested in serial plasma for the presence of ctDNA by ultra-deep sequencing (average more than100,000X).

Results: Plasma ctDNA was detected ahead of clinical or radiological relapse in 16 of the 18 relapsed patients (sensitivity of 89%); metastatic relapse was predicted with a lead time of up to 2 years (median=8.9 months; range: 0.5-24.0 months). None of the 31 non-relapsing patients were ctDNA-positive at any time point across 156 plasma samples (specificity of 100%). Of the two relapsed patients who were not detected in the study, the first had only a local recurrence, while the second patient had bone recurrence and had completed chemotherapy just 13 days prior to blood sampling.

Conclusions: This study demonstrates that patient-specific ctDNA analysis can be a sensitive and specific approach for disease surveillance for breast cancer patients. More importantly, earlier detection of up to two years provides a possible window for therapeutic intervention.

Rotherham NHS staff can request this article from the Library 

Redesigning cancer screening technology

University of Leeds | April 2019 | Redesigning cancer screening technology

Engineers at the University of Leeds have developed a prototype that could reduce the cost of manufacturing an endoscope from £800000 to £40. The team’s prototype is redesigned to make the endoscope cheaper to make, it is more intuitive to operate. It also does not need sterilising between patients as in this model- a narrow silicone tube and a tiny capsule housing the camera – a part of the device can be disposed after each endoscopy. 

Their innovation also has the potential to revolutionise cancer screening in low-to-middle income countries where the cost of equipment makes screening prohibitively expensive.

Project leader Pietro Valdastri, Professor of Robotics and Autonomous Systems at Leeds, said the international consortium of engineers had had totally redesigned the endoscope which had remained largely unchanged for the last 60-plus years.

The next stage for the research team is to trial the effectiveness of the low-cost device against conventional endoscopes (Source: University of Leeds)

Read the press release in full from the University of Leeds

 

Annual NHS cancer checks top two million for the first time

For the first time last year, the NHS in England carried out more than two million checks on people who feared they might have cancer.

In 2018, patients underwent a record 2.2 million cancer checks following urgent referral by their GP, almost 6,000 a day or more than four every minute. That was an increase of almost a quarter of a million on the 1.9 million people who were seen in 2017.

Record numbers of people also received treatment for cancer, with 308,058 receiving a first treatment in 2018, almost 13,000 more than in 2017 and the first time the number has topped 300,000.

Cancer survival is at an all time high with new figures showing 10,000 more patients surviving for at least 12 months after diagnosis than five years earlier. However, the NHS Long Term Plan aims to increasing the proportion of cancers caught early from half to three quarters, an improvement that will save up to 55,000 more lives each year.

Full story at NHS England

Diet and colorectal cancer in UK Biobank: a prospective study

Bradbury, K.E.,  Murphy, N., Key, T. | 2019| Diet and colorectal cancer in UK Biobank: a prospective study|  International Journal of Epidemiology| dyz064| https://doi.org/10.1093/ije/dyz064

A research team behind a study into diet and the impact of diet on colorectal cancer used data from the UK Biobank research project in conjunction with  questionnaires to learn about the dietary habits of men and women aged between 40- 69 years and their potential risk of developing colorectal cancer. 

At follow up five years later the participants who had consumed (on average) 76g of red meat, compared to 21g, had a higher risk of developing cancer than other participants.

Participants who ate red meat on four or more occasions a week had a fifth increased risk of developing colorectal cancer compared with subjects who ate red meat twice weekly. 
Subjects who consumed the most wholegrains had a 14% lower risk of developing  colorectal cancer.
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Key Messages
  • Previous studies have found an increased risk of colorectal cancer in those with high intakes of red and processed meat. Most previous studies collected information on dietary intakes during the 1990s or earlier and patterns in meat consumption have since changed.
  • In addition, few studies have used re-measured intakes to reduce the impact of measurement error, and to quantify the amount of red and processed meat that is associated with an increased risk. Measurement error generally biases the associations towards the null value; the associations observed in previous studies that did not re-measure intakes may be underestimated.
  • Our study found that people who were consuming red and processed meat four or more times per week, had a 20% increased risk of colorectal cancer compared with those who were consuming red and processed meat less than twice a week.

Abstract

Background

Most of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s.

Methods

We used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40–69 years at recruitment (2006–10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time.

Results

During an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% lower risk of colorectal cancer. Alcohol was associated with an 8% higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk.

Conclusions

Consumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (less than or equal to 90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk.

 

The article is available to read in full in the International Journal of Epidemiology 

In the news:

The Independent Even government guideline amounts of red meat and bacon increase risk of bowel cancer, study finds 

The Guardian Even moderate intake of red meat raises cancer risk, study finds

BBC News A rasher of bacon a day ‘ups cancer risk’ 

18F-fluorodeoxyglucose (FDG) positron emission tomography-computed-tomography (PET CT) as part of radical radiotherapy treatment planning for oesophageal cancer (all ages)

NHS England | April 2019 | 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed-tomography (PET CT) as part of radical radiotherapy treatment planning for oesophageal cancer (all ages)

NHS England will not routinely commission 18F-FDG-PET CT as part of radical radiotherapy treatment planning for oesophageal cancer in accordance with the criteria outlined in this document.

In creating this policy NHS England has reviewed this clinical condition and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources (Source: NHS England).

Further details including the evidence review, evidence report and clinical panel report are available from NHS England.