NICE recommends atezolizumab for treating people with triple negative breast cancer

Improved deal means new treatment for a type of advanced breast cancer can be recommended by NICE

Draft guidance published by NICE recommends atezolizumab for treating people with a type of breast cancer, called triple negative breast cancer, that has spread to other parts of the body.

The positive recommendation follows consultation on NICE’s previous draft guidance which did not recommend atezolizumab. The company has agreed to provide a larger discount to the list price of the drug following a deal with NHS England & NHS Improvement.

Around 2000 people in England have triple negative breast cancer, of whom around 600 people would be eligible for treatment with atezolizumab and nab-paclitaxel.

Full detail at National Institute for Health & Care Excellence

NICE draft guidance recommends new treatment option for people with early breast cancer

NICE  |  May 2020  | NICE draft guidance recommends new treatment option for people with early breast cancer

NICE published draft guidance which recommends trastuzumab emtansine (also called Kadcyla and made by Roche) as an option for some people with HER2-positive early breast cancer.

Around 7000 people diagnosed each year in England with early breast cancer have HER2-positive disease. HER2, which stands for human epidermal growth factor receptor 2, is a protein on the surface of cancer cells which makes them grow and divide.

Trastuzumab emtansine is a type of targeted cancer drug. Trastuzumab attaches to the HER2 receptor allowing the emtansine to go into the cancer cell where it becomes active and kills the cancer cell.

Clinical trial evidence shows that in people who still have some cancer cells remaining after chemotherapy to shrink their tumour and HER2-targeted treatment, trastuzumab emtansine increases the time people remain free of disease compared with trastuzumab alone. It is not known if trastuzumab emtansine increases the length of time people live because the final trial results are not yet available.

NICE NICE draft guidance recommends new treatment option for people with early breast cancer

Breast screening programme

Breast Screening Programme, England 2018-19 | NHS Digital |  30 January 2020

Women between the ages of 50 and 70 are invited for regular breast screening (every three years) under a national programme. Screening is intended to reduce mortality by detecting breast cancer at an early stage when there is a better chance of successful treatment.

This report presents information about the NHS Breast Screening Programme in England in 2018-19 and includes data on women invited for breast screening, coverage, uptake of invitations, outcomes of screening and cancers detected.

The publication also features an online interactive dashboard to complement the existing publication resources.

Full report: Breast Screening Programme England, 2018-19 | NHS Digital

Further detail at NHS Digital

International evaluation of an AI system for breast cancer screening

McKinney, S. M., et al. |2020| International evaluation of an AI system for breast cancer screening| Nature| 577|(7788)| P. 89-94.

An international team of researchers including experts from Imperial College London trained and tested an artificial intelligence (AI) system screening using a simulation of the double-reading process that is used in the UK.  29000 mammography images were used to demonstrate that the AI system was able to correctly identify cancers from the images with a similar degree of accuracy to expert radiologists, and holds the potential to assist clinical staff in practice. 

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The authors of the paper found that the computer algorithm (AI system) maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening (Source: Imperial College London). 

Full press release from Imperial College London Artificial intelligence could help to spot breast cancer

Screening mammography aims to identify breast cancer at earlier stages of the disease, when treatment can be more successful1. Despite the existence of screening programmes worldwide, the interpretation of mammograms is affected by high rates of false positives and false negatives2. Here we present an artificial intelligence (AI) system that is capable of surpassing human experts in breast cancer prediction. To assess its performance in the clinical setting, we curated a large representative dataset from the UK and a large enriched dataset from the USA. We show an absolute reduction of 5.7%and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. We provide evidence of the ability of the system to generalize from the UK to the USA. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. We ran a simulation in which the AI system participated in the double-reading process that is used in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening.

Paper: International evaluation of an AI system for breast cancer screening

In the news:

BBC |  AI ‘outperforms’ doctors diagnosing breast cancer

BMJ |  AI system outperforms radiologists in first reading of breast cancer screening, study claims

 

Blood test for breast cancer may be a step closer

NCRI Cancer Research Institute |nd | Clinical Utility of Autoantibodies in Early Detection of Breast Cancer

A team of researchers including experts from the University of Nottingham have developed a blood test which could detect breast cancer up to five years earlier before its clinical presentation. white-plastic-syringe-1164531.jpg

Abstract

Background

Autoantibodies against numbers of tumour-associated antigens (TAAs) were shown to be relevant tumor biomarkers and can be detected up to 5 years before the tumour is overt clinically. Early diagnosis of cancer is paramount to improved survival by enabling treatment prior to cancer spreading, when tumours should be both surgically removable and curable. The NHS in Scotland is currently carrying out a RCT (ECLS) involving 12,000 individuals at high risk of developing lung cancer being randomised to having (or not) an autoantibody ELISA blood test (EarlyCDT-Lung®) – followed by CT scans over 2 years follow-up in those individuals with a positive test – for early lung cancer detection.

We are aiming to develop a blood test enabling the early detection of breast cancer to significantly improve clinical outcome.

Method

In this pilot study, 180 breast cancer matched control samples were screened for the presence of autoantibodies against 67 TAAs which have already been shown to involve in breast cancer pathology. Optimised Protein microarray technology was applied for this study.

Results

The results confirmed our hypothesis that BC induce autoantibodies (AAbs) against different panels of specific tumour associated antigens (TAAs) used in the pilot study. The assay provided cancer/control discrimination through detection of AAbs against TAAs.

Conclusion

We identified antigen panels of sufficient sensitivity and specificity for early detection of BC based upon serum profiling of autoantibody response. This opens the possibility of a blood test for screening and detection of breast cancer.

The research has been recently presented at NCRI Cancer Conference, in Glasgow, Scotland on Sunday 3 November.

Read the story at Science Daily 

OnMedica Blood test for breast cancer may be a step closer

See also:

Nottingham Post Nottingham researchers develop blood test which could detect breast cancer much earlier

The Telegraph Simple blood test could spot breast cancer five years before any symptom

Record numbers beating breast cancer in the UK

More than 130,000 UK breast cancer deaths have been avoided in the last 30 years, according to new Cancer Research UK analysis to mark breast cancer awareness month

Breast cancer deaths in the UK hit a record high in 1989, when around 15,600 women lost their lives to the disease – but thanks to research developing new tests and better treatments, the death rate for women has since fallen by 44%.

This considerable drop is due to major advances in diagnosis and treatment. In the last three decades, we have seen improvements in surgical techniques and use of radiotherapy, new drugs being made available, and the impact of the national breast screening programme.

Full story at Cancer Research UK

See also: Breast cancer deaths almost halved since 1989, UK figures show | The Guardian

Breast cancer: Call for genetic screening for all

Study, published in JAMA Oncology looked at data on 11,800 women diagnosed with breast cancer in the UK, US and Australia, with findings suggesting that breast cancer genetic screening would save hundreds of lives each year | story via BBC News

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Offering every woman diagnosed with breast cancer genetic screening would save hundreds of lives each year, according to a new study published in JAMA Oncology.  Currently, only those with risk factors such as a close family history of breast cancer are offered the check. The analysis suggests one year’s testing could save 2,102 cases of breast and ovarian cancer and 633 lives in the UK.

The research says screening everyone would enable women to make informed treatment choices and allow family members to take preventative action. It would also be cost-effective for the NHS, they say.

Full story at BBC News

Full research paper: Sun L, Brentnall A, Patel S, et al. | A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer |  JAMA Oncology | Published online October 03, 2019