34. Genomic Differences between Childhood and Adult Cancers

A recent pan-cancer study in USA published in Nature, 28 February, has found that several cancer types are genetically different in children and adults.

The paediatric study, led by Jinghui Zhang, Ph.D., at St. Jude Children's Research Hospital, Memphis, analysed samples from nearly 1,700 patients, aged 20 or younger, looking at all non-inherited, or somatic, genetic alterations. Adult patients in the TARGET study elsewhere in USA had common childhood cancers, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), neuroblastoma, Wilms tumour, and osteosarcoma.

The researchers identified 142 altered genes that drive the development of these cancers (driver mutations), of which only 45% are found in adult cancers.

The findings reinforce the growing belief that drugs developed and approved to treat cancers in adults may not always be effective or appropriate for children with the same cancer types, emphasising the need for paediatric cancer-specific development of precision therapies.

Further Reading

Nature, International Journal of Science.

Filed 24 April, Caring Cancer Trust.

33. Childhood Leukaemia Targeted Therapy Trialsdrug trial success

Photo: Rosewell Park Cancer Center, Buffalo, NY.

Stage 3 trials of an experimental targeted cancer drug produced by AstraZeneca that includes a bacterial toxin shows promise in treating the most common cancer in children, B-cell acute lymphoblastic leukaemia (ALL). However, therapeutic benefits in the trial appear to be limited, because trial patients are quickly developing therapeutic resistance to the drug and relapse.

A US trial however has shown that resistance to the targeted toxin-based therapy can possibly be overcome by combining it with another leukaemia drug, (Moxe), thus increasing its efficacy in patients with relapsed and chemotherapy-resistant (refractory) ALL.

Elsewhere Pilot phase 2 trials involving 154 children’s hospitals across USA are underway to test combination treatment for ALL, its infant tolerability and long-term event-free infant survival. The trials use a cocktail of targeted chemotherapy drugs that work in three different ways to stop cancer cell growth; by killing the cells, by stopping them from dividing, or by stopping them from spreading.

There is still a long way to go before the long-term efficacy of targeted drug combinations are proven, accepted and licensed by the FDA in USA and the NHS in UK for treating infant leukaemia.  Research clinicians however are showing significant progress in harnessing the body’s own defence system by using modified T-cell based therapy to attack and kill cancer cells in both ALL and other cancers; a radically different approach to previous conventional chemotherapy treatments.

Genetically modified so-called chimeric antigen receptor (CAR) T-cells are showing remarkable efficacy for the treatment of chemotherapy resistant relapsed B-cell ALL, and other cancers, although tumour cells still adapt to evade even this new type of treatment.  It is hoped that selecting the right combination of therapies will limit the ability of cancer cells to escape such combinatorial approaches to treatment.

Filed March, 2018, Caring Cancer Trust.

32. NHS RAPID pathway to prostate cancer diagnosis

A new pilot high-speed path to treatment for prostate cancer that can significantly cut diagnosis time was presented at the European Association of Urology Conference in Copenhagen in March by Professor Hashim Ahmed, Chair of Urology at Imperial College London.

The procedure can cut waiting time for detection in the UK from an average 56 days to 17 days after referral from GP. As the difference between early and late detection of the disease is a matter of life and death, this new rapid procedure could save many lives if rolled out by the NHS across the country in the 2020s, following clinical trials.

The new world-leading (magnetic resonance imaging (MRI) procedure, is completed in one day rather than several. It was successfully piloted at London’s Imperial College Charing Cross Hospital and Epsom Hospital in 2017. Some 4 in 10 patients are cleared immediately after their MRI scan and the rest have a precision biopsy using fusion technology later that same day.

Professor Hashim Ahmed to led the treatment trial said: “The NHS has led the research that underpins this RAPID pathway to improve the diagnosis of prostate cancer. The NHS is now leading the way in ensuring all men get to benefit from this innovation. Fast access to high quality prostate MRI allows many men to avoid invasive biopsies as well as allowing precision biopsy in those men requiring it to find high risk tumours much earlier.” access to high quality prostate MRI allows many men to avoid invasive biopsies as well as allowing precision biopsy in those men requiring it to find high risk tumour much earlier,”

Prostate cancer is now the second biggest killer for men after lung cancer. It kills over 10,000 men in UK, 28,000 in USA and 4,000 in Canada each year.

Filed 22 March 2018 Caring Cancer Trust