PM announces funding for research into prostate cancer

NIHR | April 2018 | Prime minister announces £75 million to support new prostate cancer research

Prostate cancer is the most common cancer in men. It has recently overtaken breast cancer as the third most common cause of cancer deaths in the UK. Now, £75 million funding has been announced by the Prime Minister to support new research into early diagnosis and treatment of prostate cancer.  This will be used to complement and extend research undertaken over the past 15 years by the NIHR, Cancer Research UK, Prostate Cancer UK and the Medical Research Council.

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New studies will  test treatments such as more precise radiotherapy, high-intensity focused ultrasound, and cryotherapy, alongside supportive  interventions including exercise and dietary advice.

They will also particularly target groups at higher risk of prostate cancer, such as black men – one in four of whom will develop the disease – men aged 50 or over, and men with a family history of prostate cancer.

Dr Jonathan Sheffield, Chief Executive at the NIHR Clinical Research Network, said:

“Clinical research brings us closer to the development of new treatments for prostate cancer patients.

“The NIHR will work closely with the NHS, life sciences industry, charities and research funders to support the recruitment of 40,000 men into research studies over the next five years. This will provide more opportunities for earlier access to new drugs and therapies, which will ultimately lead to improved diagnoses and care in the future.”

Full story at NIHR 

In the media:

ITV News PM announces £75m for prostate cancer research

The Guardian Theresa May launches £75m drive against prostate cancer

 

Integrating systematic pain assessment and management into routine care using a simple tool improves pain outcomes for patients with cancer-related pain

 The findings of a cluster randomized (1:1) trial have been published in the Journal of Clinical Oncology’s website. The researchers leading the trial sought to compare the effect of a policy adding a clinician- delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes.

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Employing a two-arm, parallel group, cluster randomized (1:1) trial, the scientists observed pain outcomes in 19 cancer centres in the UK, these centres were randomly assigned to implement EPAT or to continue UC. As part of the trial they enrolled 1,921 patients, with a mean age of 60; 49% of whom were female with a variety of cancer types.

The findings of this multicentre, cluster randomized trial indicate that a policy of integrating systematic pain assessment and management into routine cancer centre care using a simple tool (EPAT) improves pain outcomes for patients with moderate or severe cancer-related pain.
The scientists conclude that the centres employing EPAT had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC.

Abstract

Purpose
 Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes.

Patients and Methods

 

The full article can be read at Journal of Clinical Oncology, where it has been published online

Reference: DOI: 10.1200/JCO.2017.76.1825 Journal of Clinical Oncology – published online before print March 15, 2018

 

Unexpected weight loss associated with cancer in 10 cancer sites, finds new study

Oxford University | April 2018 | Weight loss is an important predictor of cancer

A team of scientists from  Oxford and Essex Universities conducted a systematic review and meta- analysis to examine all the literature on the association between weight loss and cancer in primary care. This robust study, the first of its kind in this area, demonstrates that unintentional weight loss is the second highest risk factor for colorectal, lung, pancreatic and renal cancers (via Oxford University).

Their analysis of 25 studies,  over 11.5 million patients  -predominantly in primary care 22 of the studies or 92% – used data coded by clinicians in primary care. Four-fifths of these data defined weight loss as a physician’s coding of the symptom; the remainder collected data directly.  An association was  identified with weight loss linked with 10 cancer sites: prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin’s lymphoma, ovarian, myeloma, renal tract, and biliary tree.
This also showed that people aged over 60 with unexpected weight loss have more than 3% chance of having cancer in one of the 10 cancer sites. In females in this age group, the average risk across all sites involved was estimated to be up to 6.7%, and in males up to 14.2%.

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The authors of the study conclude that a a primary care clinician’s decision to code for weight loss is highly predictive of cancer.
The article has been published in the British Journal of General Practice online ahead of print.

Cancers should be recategorised based on tumour types, not location, say American researchers

Liu, J.,  et al | 2018 | An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics | Cell | 73 | Vol. 2| P. 400-416| e11 | Doi: 10.1016/j.cell.2018.02.052. 

Researchers in the US argue that based on the findings of a study that looked at 33 cancer types in more than 10,000 patients, cancers should in future be categorised according to similarities in tumour types; rather than where they are first formed. The researchers suggest they could reclassified into clusters that shared molecules.

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Abstract

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.

Highlights:

  • Generation of TCGA Clinical Data Resource for 11,160 patients over 33 cancer types
  • Analysis of clinical outcome endpoints with usage recommendations for each cancer
  • Demonstration of data validity and utility for large-scale translational research

 

In the media: BBC News  Reclassify cancers to improve treatment, researchers say

The full article is available from The Cell 

Bowel Cancer Awareness Month

Bowel Cancer UK  |  Bowel Cancer Awareness Month 2018

April 2018 is bowel cancer  awareness month and Bowel Cancer UK has produced a range of resources to raise awareness. Their mission is to ensure that by 2050, no-one will die of bowel cancer.

Bowel cancer is the UK’s second biggest cancer killer however it shouldn’t be because it is treatable and curable especially if diagnosed early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer but this drops significantly as the disease develops. (Bowel Cancer UK)

Bowel Cancer
Image source: bowelcanceruk.org.uk

The resources including more information about the symptoms of bowel cancer are available at Bowel Cancer UK

 

The poster can be downloaded from Bowel Cancer UK here

 

Related:

NIHR | Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

 

In the media:

BBC News  | Ex-health secretary being treated for bowel cancer

 

Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

NIHR   | March 2018  |Three-month course of chemotherapy as effective as six months following surgery for bowel cancer

NIHR and MRC in partnership  have funded international clinical trial, which has evaluated the effectiveness of a three-month course of adjuvant oxaliplatin/fluoropyrimidine combination chemotherapy for colorectal cancer versus the standard six-month treatment regimen. The trial’s findings indicate that the shorter duration treatment leads to similar survival outcomes with better quality of life for patients and therefore might represent a new standard of care.

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The research team led by the Cancer Research UK Clinical Trials Unit in Glasgow, recruited more than  6,000 patients with high-risk stage II or stage III colorectal cancer from 244 centres across Europe, Australia and New Zealand. The participants in the trial  received either a three or six month course of chemotherapy and were followed up for a minimum of three years.

Three years later, 76.7% of patients who received treatment over three months were disease free compared to 77.1% of patients treated over six months. Patients treated over three months had fewer side effects and reported a better quality of life as well as reduced peripheral neuropathy.

Chief Investigator Dr Tim Iveson, Consultant Medical Oncologist at University Hospital Southampton NHS Foundation Trust and Honorary Associate Professor at the University of Southampton, said: “Bowel cancer is the fourth most common cancer in the UK with 41,000 new cases each year. Bowel cancer can be cured by surgery and chemotherapy. Approximately 2,500 patients per year currently receive up to six months of post-operative chemotherapy. Reducing chemotherapy duration to three months will save the NHS £5000 per patient – a total saving to the NHS of £12.5 million pounds per year.

Dr Iveson added: “The impact on patients is important, as by having a shorter course of chemotherapy patients have fewer side effects.  Based on these results, three months of post-operative chemotherapy should be considered as the new standard care for many patients with bowel cancer.”

The full unedited news item is available from NIHR  here

Summary

Background

6 months of oxaliplatin-containing chemotherapy is usually given as adjuvant treatment for stage 3 colorectal cancer. We investigated whether 3 months of oxaliplatin-containing chemotherapy would be non-inferior to the usual 6 months of treatment.

Methods

The SCOT study was an international, randomised, phase 3, non-inferiority trial done at 244 centres. Patients aged 18 years or older with high-risk stage II and stage III colorectal cancer underwent central randomisation with minimisation for centre, choice of regimen, sex, disease site, N stage, T stage, and the starting dose of capecitabine. Patients were assigned (1:1) to receive 3 months or 6 months of adjuvant oxaliplatin-containing chemotherapy. The chemotherapy regimens could consist of CAPOX (capecitabine and oxaliplatin) or FOLFOX (bolus and infused fluorouracil with oxaliplatin). The regimen was selected before randomisation in accordance with choices of the patient and treating physician. The primary study endpoint was disease-free survival and the non-inferiority margin was a hazard ratio of 1·13. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who started study treatment. This trial is registered with ISRCTN, number ISRCTN59757862, and follow-up is continuing.

Findings

6088 patients underwent randomisation between March 27, 2008, and Nov 29, 2013. The intended treatment was FOLFOX in 1981 patients and CAPOX in 4107 patients. 3044 patients were assigned to 3 month group and 3044 were assigned to 6 month group. Nine patients in the 3 month group and 14 patients in the 6 month group did not consent for their data to be used, leaving 3035 patients in the 3 month group and 3030 patients in the 6 month group for the intention-to-treat analyses. At the cutoff date for analysis, there had been 1482 disease-free survival events, with 740 in the 3 month group and 742 in the 6 month group. 3 year disease-free survival was 76·7% (95% CI 75·1–78·2) for the 3 month group and 77·1% (75·6–78·6) for the 6 month group, giving a hazard ratio of 1·006 (0·909–1·114, test for non-inferiority p equal to 0·012), significantly below the non-inferiority margin. Peripheral neuropathy of grade 2 or worse was more common in the 6 month group (237 [58%] of 409 patients for the subset with safety data) than in the 3 month group (103 [25%] of 420) and was long-lasting and associated with worse quality of life. 1098 serious adverse events were reported (492 reports in the 3 month group and 606 reports in the 6 month group) and 32 treatment-related deaths occurred (16 in each group).

Interpretation

In the whole study population, 3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care.

Funding

Medical Research Council, Swedish Cancer Society, NETSCC, and Cancer Research UK.

 

Full reference:
Iveson, T. J., et al  |    2018  | 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial The Lancet Oncology  |  Vol. 19  | 4 | P.562–78

The full article can be read in The Lancet here

NHS England: ‘One stop shop’ marks a ‘step change’ in the identification, diagnosis and treatment of cancer

NHS England  | New ‘one stop shops’ for cancer to speed up diagnosis and save lives  |

Rapid diagnostic and assessment centres are being piloted in ten areas as part of NHS England’s drive to catch cancer early and speed up diagnosis for people with cancer.  These pilots form the Accelerate, Co-ordinate and Evaluate (ACE 2) Early Diagnosis Programme, a joint initiative by NHS England, Cancer Research UK and Macmillan.   These new centres are part of NHS’s plan to meet the new faster diagnosis standard, where patients with suspected cancer should receive a diagnosis or the all clear within 28-days.   Those diagnosed, with cancer can be referred on to specialists,  those with benign conditions will be directed to appropriate treatment and receive tailored advice about prevention. It is anticipated that if the pilot is successful the programme will be rolled out across England.

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While these pilots  are the first multidisciplinary diagnostic centres in England, the concept comes from Denmark, where it was developed in response to patients presenting with vague symptoms being referred for multiple tests, when they required an urgent diagnosis.
All of the centres have the same purpose – to diagnose cancers early in people who do not have ‘alarm symptoms’ for a specific type of cancer, but each of will operate in a different way to address the needs of their local communities. The ten centres are located at:

  • North Middlesex University Hospital,
  • University College London Hospital,
  • Southend University Hospital,
  • Queens Hospital
  • Royal Free Hospital
  • St James University Hospital
  • Airedale General Hospital
  • University Hospital South Manchester
  • Royal Oldham Hospital
  • Churchill Hospital

The full post and further details of the programme can be found at NHS England 

In the media: BBC News  ‘One-stop shops’ set to speed up cancer diagnosis