Gene test could guide use of cancer chemotherapy

Nature 2023

A gene test already used routinely in the NHS can guide use of chemotherapy in people with bowel cancer by predicting whether or not they will benefit.

The test could allow doctors to select patients whose cancers are likely to be sensitive to chemotherapy – and spare others who will not respond from unnecessary toxicity and debilitating side effects.

Scientists hope their findings, published in Nature Medicine, will enable the first routine use of a genetic test to predict how patients’ cancers will respond to chemotherapy in bowel cancer.

The gene test is already used as part of standard of care in the UK and worldwide to predict patients’ responses to other targeted cancer drugs, meaning doctors could apply it to guide chemotherapy straight away.

The research was a joint effort between scientists from The Institute of Cancer Research, London, Imperial College London and the Netherlands Cancer Institute. It was funded by The Institute of Cancer Research (ICR), Imperial and the Oncode Institute.

Background Reserach – van de Haar, J., Ma, X., Ooft, S.N. et al. Codon-specific KRAS mutations predict survival benefit of trifluridine/tipiracil in metastatic colorectal cancer. Nat Med (2023). https://doi.org/10.1038/s41591-023-02240-8

Case study: Artificial intelligence helping to speed up skin cancer diagnosis in Leicester, Leicestershire, and Rutland integrated care system

NHS England – 27 February

Dermatology services in Leicester, Leicestershire, and Rutland integrated care system (ICS) are embracing digital innovation so that patients with suspected skin cancer can be seen more quickly.

Further information – Artificial intelligence helping to speed up skin cancer diagnosis in Leicester, Leicestershire, and Rutland integrated care system

Early-onset cancer: why are more young adults being diagnosed?

Cancer Research UK – January 2023

We monitor cancer statistics to better understand the disease. They show us the progress we’ve made to help more people survive cancer, and they help us focus our work to keep that progress going.

But progress isn’t always linear. Sometimes the statistics reveal unexpected challenges, like the rising number of cancer cases in younger adults.

Between the early 1990s and 2018, cancer incidence rates in 25 to 49-year-olds in the UK increased by 22%. That’s a bigger percentage change than in any other age group – more than twice the 9% increase in over-75s.

As striking as those numbers are, we need to be clear: these ‘early-onset’ cancers are still uncommon. Around 90% of all cancers affect people over the age of 50. In fact, 50% affect the over-75s, even though that’s quite a small part of the overall population.

So, in younger adults, this is only a slight increase in the number of cases, and from a low starting point. But the trend is important. The evidence suggests that more adults under 50 may be getting cancer than ever before.

Further information – Early-onset cancer: why are more young adults being diagnosed?

Ugai, T., Sasamoto, N., Lee, HY. et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol 19, 656–673 (2022). https://doi.org/10.1038/s41571-022-00672-8

Cancer incidence by age – Cancer Research UK

Urgent, Coordinated Global Action on Lung Cancer

Lung Ambition Alliance 2022

This report by the Lung Cancer Collaboration, formed by the Lung Ambition Alliance in partnership
with the World Economic Forum, supplements the WHO guidance by providing simple, clear
recommendations on how, in addition to tobacco control measures, governments can improve
the chances of lung cancer survival through the inclusion of basic and high-impact lung cancer
diagnosis and treatment services in their national cancer control plans. Given the clear economic
benefits, governments should also commit the necessary funding and resources to unlock these
human and financial benefits.

Read the Report – Urgent, Coordinated Global Action on Lung Cancer

Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites

BMJ Open – 2023

Cancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality of cancer stage and ethnicity data has improved markedly over recent years in England, allowing for comparison of stage distributions at diagnosis between ethnic groups. This study aimed to assess relationships between ethnic group and two outcomes: unknown stage cancer and late stage (stages 3 and 4) cancer, after adjustment for confounders.

Further information – Fry A, White B, Nagarwalla D, et al Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites BMJ Open 2023;13:e062079. doi: 10.1136/bmjopen-2022-062079

The ecDNA story – catching the mastermind behind cancer evolution

Cancer Research UK – 20th February 2023

Some cancers can adapt to resist effective treatments in a week. The same slow story of step-by-step genetic mutations can’t explain both things. For a long time, then, we’ve needed a new model. The fastest evolving cancers are often the ones with the lowest survival.

Now, thanks to Dr Paul Mischel, we have that model. His research has shown that cancers commonly use runaway circles of DNA called ‘extrachromosomal DNA’ (ecDNA) to evolve as quickly as possible. Since his discovery, our progress against it has started speeding up too.

Further information – The ecDNA story – catching the mastermind behind cancer evolution

Cancer statistics for England

House of Commons Library – 7 February 2023

Cancer is the cause of just over a quarter of all deaths in England in a typical year. In 2021, 134,802 people died from cancer in England. This paper provides statistics on new cancer diagnoses, deaths, and survival
rates in England.

Read the Data – Cancer statistics for England

Feeling the pull: Using magnetic drug targeting to improve chemotherapy in brain tumours

Cancer Research UK – 16th February 2023

They designed a device for mice with brain tumours using magnets called neodymium magnets. These magnets were stronger than the ones used in previous trials, but much smaller and more portable than MRI magnets.

They built these magnets into a kind of helmet, which kept it in the correct position for the course of the treatment and encased them in a way that created a more focussed and stable magnetic field.

They then intravenously administered MNPs made of iron oxide to the mice and put these helmets on them for 30 minutes. After that time, they found that not only had the MNPs made it into the brain successfully, but they were also concentrated in the tumour. That meant the magnet was doing its job.

The results showed that the magnetised temozolomide significantly reduced the size of the mice’s tumours and extended their survival. Importantly, these mice survived for longer than those who had temozolomide by itself, showing that the magnet made the same dose of drug more effective against the tumour.

What’s more, they didn’t find any MNPs in the liver, spleen or lungs of any of the mice, which tells us that the body can safely break them down and excrete them without any damage to other organs.

Further information – Feeling the pull: Using magnetic drug targeting to improve chemotherapy in brain tumours

Proposal to scrap England’s long term plan for cancer

BMJ – Published 15 February 2023

BMJ editorial considers government’s announcement that cancer would no longer have a dedicated plan, but instead would be rolled into a chronic disease strategy, to be a catastrophic decision, jettisoning decades of global consensus that cancer plans are vital.

Further information – Proposal to scrap England’s long term plan for cancer

Starving cancer into submission

Cancer Research UK – January 30, 2023

Starving cancer cells of specific nutrients can slow tumour growth and sharpen the effects of chemotherapy and radiotherapy – now, startup Faeth Therapeutics is creating precision diets which can enhance cancer treatments. We spoke with Professor Oliver Maddocks to find out how the startup came about, and how hacking cancer metabolism with diet could help cancer treatments work better.

Further information – Starving cancer into submission