Wednesday, 13 June 2018

42. Breast Cancer Good News!

Illustration: American Heart Association
The majority of patients with the most common type of breast cancer do not benefit from chemotherapy after surgery according to a comprehensive study.
A decade long multi-center study by the ECOG-ACRIN Research Group, involving 10,273 women with early-stage cancer at 1,182 treatment sites across USA, Australia, Canada, Ireland, New Zealand and Peru, showed conclusively that chemotherapy was unnecessary in 70% of cases.
The Stage-3 Trial findings were published in the New England Journal of Medicine last week following the trial leader’s presentation to the American Society of Clinical Oncology (ASCO) annual meeting.
Unlike many published clinical trial results which require many years of further study before findings are confirmed and validated, this trial’s results will have an immediate impact on global treatment practice for early-stage breast cancer.
Dr. Alistair Ring, a consultant oncologist at the Royal Marsden NHS Hospital, London, was upbeat about the potentially immediate impact on breast cancer treatment in the NHS. “I think this is a fundamental change in the way we treat women with early-stage breast cancer and will lead to a considerable number of women no longer needing to have chemotherapy.”
Up to 5,000 women in UK could now avoid the harrowing side effects from the toxic drugs used in chemotherapy, if this life-changing refinement of early-stage breast cancer treatment is followed across the NHS.
Until now, post-operative treatment included hormone therapy plus chemotherapy for women diagnosed with early-stage HR-positive, HER2-negative, axillary lymph node-negative breast cancer. This therapy combination was administered to these patients to inhibit cancer recurrence.  However the trial showed that invasive disease-free survival after treatment was almost statistically the same, whether patients had the combination therapy or hormone therapy alone.
There is an additional bonus this refined post-operative cancer treatment of hormone-only therapy will have for healthcare systems around the world: lower costs!
The NHS is struggling with the spiralling costs of cancer drugs used in chemotherapy. These drug costs inhibit the ability of an underfunded NHS to adequately invest in other cancer services.
Further Reading
Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer
TAILORx Trial result
Multi-national network of participating institutions.
Many breast cancer patients can safely skip chemotherapy, study finds.
Cancer drugs price rise ‘costing NHS millions’

Thursday, 7 June 2018

41. Immunotherapy future for breast and other cancers

ThUS National Cancer Institute’s, ((NCI),  development of a novel approach to immunotherapy, reported in the June issue of Nature Medicine, has been given wide coverage in the British press. It is an important step forward in our understanding of cancer mutation and treatment.
The complex trial approach was in fact a modified form of adoptive cell transfer, (ACT), which has already been effectively used in in skin cancer treatment trials.
The treatment trial on a patient with late-stage breast cancer led to the complete cancer regression in the patient who had been  unresponsive to all other treatments. All of the patient’s cancer, which had spread to other parts of her body, disappeared after the treatments and has not returned more than 22 months later.
This was an innovative experimental approach for one very lucky 52-year-old patient who had not responded to hormonal and chemotherapy, and whose condition had deteriorated to a point that she was planning her death after the cancer had spread to her lungs and liver.
Extensive and time-consuming multi-centre trials must now be undertaken to prove the treatment’s efficacy before it can be made routinely available to treat late-stage breast cancer patients.
“This is an illustrative case report that highlights, once again, the power of immunotherapy,” commented Tom Misteli, Director of NCI’s Centre of Cancer Research, (CCR) at Bethesda.  “If confirmed in a larger study, it promises to further extend the reach of this T-cell therapy to a broader spectrum of cancers.”
CCR’s Dr. Steven Rosenburg, the clinical trial leader, commented on the broad potential of this experimental trial approach: “Because this new approach to immunotherapy is dependent on mutations, not on cancer type, it is in a sense a blueprint we can use for the treatment of many types of cancer.”

Further Reading
Files 07.06.2018. Caring Cancer Trust

40. Blood tests show promise as early cancer screening process

Studies of a blood test for 10 different types of cancers show promise as an early cancer screening process before patients show symptoms, Dr Eric Klein from the Taussig Cancer Institute of Cleveland, USA, told members at the annual conference of the American Society of Clinical Oncologists, (ASCO), in Chicago last week.

The blood test, called a liquid biopsy, screens for cancer by detecting tiny bits of DNA released by cancer cells into blood. The liquid biopsy technology was initially used to monitor patients after they receive treatment for an advanced cancer to evaluate their treatment’s progress or detect a recurrence through increased cancer cell DNA.

In recently completed studies of blood biopsy tests at Dr Klein’s Cleveland Centre and at Stanford University, clinicians scrutinised the cases of more than 1,600 people, 749 of whom were cancer-free at the time of the study, and 878 of whom had been newly diagnosed with a cancer. Liquid biopsies correctly found cancer cell DNA in 80% of the 878 patients in tests for pancreatic, ovarian, liver and gallbladder cancers. The tests were less accurate with lymphoma, myeloma, bowel, lung, head and neck cancers with a low correct diagnosis ranging from only 56% to 77%.
Although promising, there is obviously a long way to go in research to achieve the desired positive or negative predictive values with liquid biopsies before we can safely implement such tests in any national screening programme. To illustrate, globally ovarian cancer has an annual incidence of approximately 12 cases per annum per 100,000 women. If the new test has only an 80% chance of detecting this disease, this would translate to a failure (false negative) to detect 1 in 5 of these cancers. Furthermore, if the test has a false positive rate of just 1%, this would mean incorrectly diagnosing 1000 women as cancer positive in order to detect less than 12 actual cancers.

So there is obviously considerably more research needed to clinically develop blood tests to a point where they can accurately detect a cancer. However, following on-going studies presented by Dr Vogelstein of John Hopkins School of Medicine to the conference in 2017, and by Dr Klein last week, further research could ultimately lead to the availability of an accurate universal blood test screening for cancer, enabling doctors to accurately detect a cancer in patients at what is presently an undetectable early stage.

“This is potentially the Holy Grail of cancer research, to find cancers that are currently hard to cure at an earlier stage when they are easier to cure,” said Dr Klein, lead author of the Taussig Centre study. “Potentially this test could be used for everybody. It is several steps away and more research is needed, but it could be given to healthy adults of a certain age, such as those over 40, to see if they have early signs of cancer. We hope this test could save many lives.”

As Dr Bert Vogelstein of John Hopkins Kimmel Cancer Centre pointed out at last years ASCO conference: “It’s fair to say that if you could detect all cancers while they are still localised, you could diminish cancer deaths by 90%.”

Studies at John Hopkins have indicated that while cancers of liver, stomach, pancreatic, ovarian, oesophagus, colon, lung and breast can be detected from cancer tumour DNA in the blood, not all tumour types can be accurately detected in this way. Their studies continue with gene-based cancer tests that work using bodily fluids and secretions as well as blood.

An accurate liquid biopsy cancer screening in the UK and consequent early treatment for cancer positives would save thousands of lives and millions of pounds. But the NHS is presently overwhelmed, understaffed and underfunded and, thanks to the ever-growing pressure of rising demand, it is not coping with acute cases, let alone belated or cancelled treatment and diagnostic procedures. And this does not include the potential cost of funding and operating universal blood tests for those people who don’t actually realise that they are sickening with a previously undetected cancer.

Perhaps, by the time accurate liquid biopsy tests envisaged by Drs Vogelstein and Klein have been perfected for cancer detection, we shall have an adequately funded and fully staffed NHS that can make them universally available to those over 40.

Extensive time-consuming clinical research into liquid biopsies is underway in USA and the University of Manchester’s Research Centre in UK to find that Holy Grail of accurate comprehensive early stage cancer detection by means other than X-rays, colonoscopy or pap smears. However Press headlines about cancer detection progress rarely mention the research timescales and cost. These studies take considerable time and money, as will the additional multi-centre research over the next five or ten years to evaluate and confirm a genetic blood test as fit for purpose, before any universal screening test can be implemented.
We need to keep funding this exciting research to advance the science of liquid biopsies. The research has come a long way in the past five years, but we still have a long way to go.
Further Reading
Filed 006.2018. Caring Cancer Trust