New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

Queen Mary University | September 2019 | New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

A blood test developed by experts at Queen Mary University marks a ‘paradigm shift’ in the way prostate cancer is diagnosed. 

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The new prostate cancer test detects early cancer cells, or circulating tumor cells (CTCs), that have left the original tumour and entered the bloodstream prior to spreading around the body. By measuring intact living cancer cells in the patient’s blood, rather than the PSA protein which may be present in the blood for reasons other than cancer, it potentially provides a more accurate test for prostate cancer.

The study tested the use of the CTC test in 98 pre-biopsy patients and 155 newly diagnosed prostate cancer patients enrolled at St Bartholomew’s Hospital in London.

The research team found that the presence of CTCs in pre-biopsy blood samples were indicative of the presence of aggressive prostate cancer, and efficiently and non-invasively predicted the later outcome of biopsy results.

When the CTC tests were used in combination with the current PSA test, it was able to predict the presence of aggressive prostate cancer in subsequent biopsies with over 90 per cent accuracy, better than any previously reported biomarkers.

Additionally, the number and type of CTCs present in the blood was also indicative of the aggressiveness of the cancer. Focusing on more aggressive prostate cancer may reduce over-treatment and unnecessary biopsies for benign and non-aggressive conditions.

(Source Queen Mary University) 

Full reference: Xu, L. | 2019|Non-invasive Detection of Clinically Significant Prostate Cancer Using Circulating Tumor Cells | Journal of Urology | https://doi.org/10.1097/JU.0000000000000475

Purpose:

PSA testing results in unnecessary biopsy and over-diagnosis with consequent over-treatment. Tissue biopsy is an invasive procedure, associated with significant morbidity. More accurate non- or minimum-invasive diagnostic approaches should be developed to avoid unnecessary prostate biopsy and over-diagnosis. We investigated the potential of using circulating tumor cell analysis in cancer diagnosis, particularly in predicting clinically significant prostate cancer in pre-biopsy patients.

Material and Methods:

We enrolled 155 treatment naïve prostate cancer patients and 98 pre-biopsy patients for circulating tumor cell numeration. RNA was extracted from circulating tumor cells from 184 patients for gene expression analysis. Kruskal-Wallis, Spearman’s rank, multivariate logistic regression and random forest were applied to assess the association of circulating tumor cells with aggressive prostate cancer.

Results:

In localized prostate cancer patients, 54% were scored as circulating tumor cell positive, which was associated with higher Gleason score ( p=0.0003), risk group ( p<0.0001) and clinically significant prostate cancer. In pre-biopsy group, positive circulating tumor cell score in combination with PSA predicted clinically significant prostate cancer with AUC=0.869. A 12-gene panel prognostic for clinically significant prostate cancer was also identified. Combining PSA level, circulating tumor cell-score and the 12-gene panel, AUC for clinically significant prostate cancer prediction was 0.927 and in cases with multi-parametric MRI data, adding these to multi-parametric MRI significantly increased the prediction accuracy.

Conclusions:

Circulating tumor cell analysis has the potential to significantly improve patient stratification by PSA and/or multi-parametric MRI for biopsy and treatment.

The Library can provide the full article to Rotherham NHS Staff, request here

 

See also:

Science Daily New blood test for prostate cancer is highly-accurate and avoids invasive biopsies

Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer

NICE | August 2019 | Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer| Technology Appraisal Guidance

NICE has published Evidence-based recommendations on ribociclib (Kisqali) for hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer in adults who have had previous endocrine therapy.

Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer

See also:

Breast cancer drugs option joins cancer drugs fund

 

Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy

NICE |  August 2019 | Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy

Olaparib (Lynparza) is available through the Cancer Drugs Fund. It is a possible treatment for advanced ovarian, fallopian tube or peritoneal cancer in adults, if:

  • they have a BRCA mutation and
  • the cancer has been treated with 1 course of platinum-based chemotherapy.

More evidence on olaparib is being collected, until September 2023. After this, NICE will decide whether or not to recommend it for use on the NHS and update the guidance. It will be available through the Cancer Drugs Fund until then.

Full details from NICE

GPs diagnosing cancers earlier

New study concludes that GPs appear to be diagnosing cancers earlier, helping to reduce the numbers of cancer patients receiving their diagnosis in accident and emergency (A&E) departments, thereby improving their chance of survival British Journal of General Practice | via OnMedica

In this large study, the researchers studied Routes to Diagnosis data on 554,621 patients with cancer in England who presented as emergencies between 2006 to 2015. They found there was a decline in the annual rate of emergency presentations, with emergency referrals from GPs falling by about a half.

The authors suggested this was likely to reflect increasing use by GPs of the two week wait referral pathways, as well as reductions in emergency presentations following a GP referral, likely indicating a trend towards earlier diagnosis in general practice.

Full story at OnMedica

Full article: Herbert A, Abel GA, Winters S, et al. | Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015 | British Journal of General Practice 2019

Oral antibiotic use and risk of colorectal cancer in the United Kingdom, 1989–2012: a matched case–control study

Zhang, J.Haines, C.Watson, A.J.M., et al | 2019| 
Oral antibiotic use and risk of colorectal cancer in the United Kingdom, 1989–2012: a matched case–control study | 

 

Researchers behind a population-based study of oral antibiotic exposure and risk   looked at the association between oral antibiotic use and (colorectal cancer) CRC risk have published their findings in the BMJ Journal Gut. 

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Abstract

Background Microbiome dysbiosis predisposes to colorectal cancer (CRC), but a population-based study of oral antibiotic exposure and risk patterns is lacking.

Objective To assess the association between oral antibiotic use and CRC risk.

Design A matched case–control study (incident CRC cases and up to five matched controls) was performed using the Clinical Practice Research Datalink from 1989 to 2012.

Results 28 980 CRC cases and 137 077 controls were identified. Oral antibiotic use was associated with CRC risk, but effects differed by anatomical location. Antibiotic use increased the risk of colon cancer in a dose-dependent fashion. The risk was observed after minimal use, and was greatest in the proximal colon and with antibiotics with anti-anaerobic activity. In contrast, an inverse association was detected between antibiotic use and rectal cancers, particularly with length of antibiotic exposure more than 60 days as compared with no antibiotic exposure. Penicillins, particularly ampicillin/amoxicillin increased the risk of colon cancer, whereas tetracyclines reduced the risk of rectal cancer. Significant interactions were detected between antibiotic use and tumour location. The antibiotic–cancer association was found for antibiotic exposure occurring more than 10 years before diagnosis.

Conclusion Oral antibiotic use is associated with an increased risk of colon cancer but a reduced risk of rectal cancer. This effect heterogeneity may suggest differences in gut microbiota and carcinogenesis mechanisms along the lower intestinal tract. (Source: Zhang et al, 2019)

The full article is available from BMJ Gut 

In the news:

OnMedica Oral antibiotic use linked to heightened bowel cancer risk

New lung cancer treatment option approved by NICE

NICE | August 2019| New lung cancer treatment option approved by NICE

NICE has approved another new life-extending treatment for some people with lung cancer is to be made available on the Cancer Drugs Fund (CDF) following its approval by NICE in draft guidance

The immunotherapy drug pembrolizumab (also known as Keytruda) used with chemotherapy drugs carboplatin and paclitaxel will now be an option for adults with squamous non-small-cell lung cancer (NSCLC) which has spread to other parts of the body and who haven’t had any previous treatments.

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Evidence from an ongoing clinical trial suggests that people who have pembrolizumab combination therapy could live longer than those who have standard chemotherapy. It also suggests people could have additional time without their cancer progressing compared with standard chemotherapy.

However, because the clinical evidence is immature, the cost-effectiveness estimates for pembrolizumab combination therapy are very uncertain. The committee recognised that it has the potential to be cost-effective, and therefore recommended it for use on the CDF. This will allow more evidence to be collected to address the uncertainties around overall survival.

Director of the NICE Centre for Health Technology Evaluation Meindert Boysen, said: ““The committee heard from the patient experts that people with squamous non-small-cell lung cancer often have a poor quality of life, and that treatments that have the potential to extend life would be of great importance.” (Source: NICE)

Full press release available from NICE

Read the draft guidance on pembrolizumab here

[NICE Appraisal consultation] Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

NICE | August 2019| Approval for treatment option for early breast cancer after adjuvant trastuzumab [ID981]

Today (7 August 2019) The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending neratinib as an additional treatment for some people with early hormone- receptor-positive human epidermal growth factor receptor 2 (HER2)- positive breast cancer. 

In a press release, NICE recommends Neratinib (also called Nerlynx and marketed by Pierre Fabre), under the terms of a commercial arrangement, for people with this type of breast cancer who are less than 1 year from completing trastuzumab (Herceptin)-based treatment following surgery (called adjuvant treatment).

The clinical trial evidence showed that people who had treatment with neratinib have less risk of disease recurrence than people who had treatment with a placebo. Despite there being no available data about how this might translate into increasing the overall length of time people live, the committee concluded that the cost-effectiveness estimates for neratinib made it an acceptable use of NHS resources.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: “Breast cancer remains the most common form of cancer in the UK, accounting for around 30% of all cancers in women. And although there have been advances in the treatment of early stage HER2-positive breast cancer, around a quarter of people treated with trastuzumab following surgery will have a recurrence of their cancer.

“We are therefore pleased to be able to recommend neratinib as a further treatment option for people with this type of breast cancer, based on the benefits it provides in extending the time before the disease gets worse and on its important potential to reduce the risk of the cancer returning.”

Neratinib, which is taken as 6 x 40 mg tablets daily for 1 year, is recommended provided trastuzumab is the only HER2-directed adjuvant treatment people have had (Source: NICE).

The guidance is in development, comments can be made via the  Appraisal consultation

The closing date for comments is Wednesday 28 August 2019

Related:

NICE [press release] NICE recommends additional treatment option for people with early breast cancer   NICE

See also:

OnMedica Approval for treatment option for early breast cancer