University of Edinburgh research: £6M boost to train doctors in cancer research

University of Edinburgh | May 2019 | £6M boost to train doctors in cancer research

Cancer Research UK has awarded more than £6 million to its research centres in Edinburgh and Glasgow to train early-career doctors to conduct medical research, known as clinician scientists.

Clinical Academic Training Programme will introduce new measures, including more flexible training options and improved mentorship and networking opportunities, It will better support women clinicians who want to get involved and stay in cancer research.

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In particular, the programme will offer a new type of qualification – known as an MB-PhD – which allows doctors to study for a PhD earlier in their medical training.

Traditionally, becoming a clinician scientist involves doctors taking time out of training to undertake a PhD before returning to complete their medical specialism.

Many doctors – particularly women – do not return to research after qualifying as consultants. As a result, the number of clinician scientists in Scotland is in decline, particularly in senior posts.

Now the joint Clinical Academic Training Programme will introduce new measures, including more flexible training options and improved mentorship and networking opportunities, It will better support women clinicians who want to get involved and stay in cancer research.

In particular, the programme will offer a new type of qualification – known as an MB-PhD – which allows doctors to study for a PhD earlier in their medical training (Source: University of Edinburgh).

News story £6M boost to train doctors in cancer research 

University of Nottingham Study: Drugs for invasive breast cancer ‘could treat earliest stages of the disease’

University of Nottingham | May 2019 | Drugs for invasive breast cancer ‘could treat earliest stages of the disease’

Experts from the University of Nottingham’s School of Medicine have undertaken research that has found drugs used to target HER2-positive invasive breast cancer may also be successful in treating women in the first stages of the disease.

The HER2 gene is already closely associated with aggressive, invasive breast cancer and is already treated using the drug trastuzumab, more commonly known as Herceptin.

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The Nottingham study looked at breast tissue from 776 women treated at Nottingham City Hospital between 1990 and 2012 for DCIS. It also collected information from 239 cases of DCIS and invasive breast cancer for comparison.

Following up on cases between two months and 20 years later, the team found that out of 308 patients treated with breast conserving surgery alone, the disease had reoccurred in 67 people (22 per cent). More than half of those (57 per cent) had gone on to develop aggressive, invasive breast cancer. Among the 93 cases treated with surgery and radiotherapy, the cancer came back in eight patients – two with invasive breast cancer and six with DCIS.

The researchers suggest that screening women with DCIS for HER2 may help to identify those at greater risk of developing more invasive forms of the disease.

Current treatments targeting HER2 could also potentially be extended to DCIS patients to reduce the chance of the cancer spreading and reduce the number of HER2-related deaths (Source: University of Nottingham).

Read the full, unabridged news story from the University of Nottingham

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 

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’ 

Can we cure cancer?

The Institute of Cancer Research | April 2019 | Can we cure cancer?

A new blog post on The Institute of Cancer Research outlines nine challenges that scientists say need to be overcome to potentially cure cancer at the recent conference The Challenges Preventing Cancer Cure at the Francis Crick Institute

The challenges are:

  • Analyse cancer in the fourth dimension
  • Account for cancer’s complexity in trial design
  • Accept that attempting ‘cure’ may not be best for everyone
  • Deliver longer-term benefits for drugs
  • Encourage more innovation
  • Develop better models of disease
  • Look for folk knowledge
  • Look at ‘full’ survival
  • Find advocates for ‘less glamourous’ disciplines

Further information from The Institute of Cancer Research

 

 

 

 

 

 

Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study

Tian, Y.  et al. | 2019|  Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study | 

The BMJ has published a cohort study that looked at relatives with colorectal cancer, unlike previous research this study also focused on second-degree relatives half siblings. The research identifies that second- degree relatives, for example half siblings, also had an association with colorectal cancer risk similar to that in first-degree relatives such as siblings or parents. 

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Abstract

Objective To explore the risk of colorectal cancer in family members of patients with colorectal cancer, with an emphasis on subtypes of second degree relatives, especially half siblings, which were lacking in the literature.

Design Ambidirectional cohort study.

Setting Nationwide Swedish Family Cancer Data (record linkage).

Participants All people residing in Sweden and born after 1931, with their biological parents, totalling more than 16 million individuals (follow-up: 1958-2015); of those with clear genealogy, 173 796 developed colorectal cancer.

Main outcome measures Lifetime (0-79 years) cumulative risk and standardised incidence ratio of colorectal cancer among first degree relatives and second degree relatives.

Results The overall lifetime cumulative risk of colorectal cancer in siblings of patients was 7%, which represents a 1.7-fold  (n=2089) increase over the risk in those without any family history of colorectal cancer. A similarly increased lifetime cumulative risk (6%) was found among half siblings. The risk in people with colorectal cancer in both a parent and a half sibling (n=32) was close to the risk in those with both an affected parent and an affected sibling (n=396). Family history of colorectal cancer in only one second degree relative other than a half sibling (without any affected first degree relatives), such as a grandparent, uncle, or aunt, showed minor association with the risk of colorectal cancer.

Conclusion Family history of colorectal cancer in half siblings is similarly associated with colorectal cancer risk to that in siblings. The increase in risk of colorectal cancer among people with one affected second degree relative was negligible, except for half siblings, but the risk was substantially increased for a combination of family history in one affected second degree relative and an affected first degree relative (or even another second degree relative). These evidence based findings provide novel information to help to identify people at high risk with a family history of colorectal cancer that can potentially be used for risk adapted screening.

Full abstract available from the BMJ

Read and download the full article online from the BMJ