The long road to targeting the holy grail of the immune response

“This is not the cure to cancer. I think that’s very important to clarify. But I think it’s the beginning of the long road to better cancer immunotherapy.” 

Professor Sergio Quezada has long been studying the complex relationship between the immune system and cancer at University College London – a field of research that’s moving rapidly, and has already produced some stunning successes – drugs known as immunotherapies are now available for several types of cancer.

And Quezada’s fascination with the immune system has culminated in not only a potential new immunotherapy drug, but yet another paradigm shift in our understanding of how cancer immunotherapy works. 

The latest study to come out of Quezada’s Cancer Research UK-funded lab, published in Nature Cancer, outlines a new way to harness the immune system in favour of killing cancer cells. And it’s already led to early stage clinical trials.  

This story of discovery began many years ago, decades in fact. And as Quezada comments, it‘s just the beginning. 

Balancing T cells, a delicate dance  

The body’s immune system is tightly controlled. “When you think about the immune response to anything, you need to have stop and go signals,” explains Quezada 

Manipulating the balance between these stop and go signals to encourage a patient’s immune system to target their tumour has been a key focus of immunotherapy research, with most of the current immunotherapy focusing on so-called checkpoint signals, found on the surface of immune cells called T cells. 

But that’s not the only way to target the immune system. Quezada is interested in the delicate dance between two different types of T cells – ‘effector’ T cells, that help to destroy potential threats, and ‘regulatory’ T cells, which aim to keep our immune system in check.

“So whenever you have an inflammatory response, with immune cells going and trying to attack or destroy a tissue, that is followed immediately, or almost immediately, by regulatory T cells that are there to calm things down.” 

Regulatory T cells are vital to fine-tuning immune responses, but they’re also implicated in cancer. “In cancer, there are a good number of papers associating the presence of regulatory T cells to tumour progression and the poor survival of patients.” 

Quezada believes manipulating the balance between effector T cells and regulatory T cells could be a good strategy – one that could lead to a new generation of immunotherapy drugs.

Depleting regulatory T cells 

In order to produce an anti-cancer immune response in patients, researchers have been looking to build an immunotherapy drug that works by specifically reducing the number of regulatory T cells, without also affecting the crucial effector T cells.  

“If you were to take down the regulatory T cells, but also eliminate the effector T cells, you end up on a zero sum, you end up with no effect whatsoever. So you always want to play with that balance.”

If you are able to take out or partially take out the regulatory T cells from the equation, it’s like moving a rock up the mountain, were you will be able to push the boulder down and initiate a cascade of events that will end up in tumour rejection. So, for us, it’s one of the holy grails of immune regulation that if you target properly, you can get tumour control.

– Sergio Quezada

In order to target regulatory T cells without affecting the number of other T cells, scientists looked for specific feature on the surface of regulatory T cells that will help to distinguish them from other types. This would then allow them to design an antibody that attached to that it, labelling it for destruction by other parts of the immune system.

“That has been difficult for many years, and many, many investigators and companies have been looking for specific markers of regulatory T cells. One of them was shown decades ago, in the mid 90s. And that molecule is called CD25.

“Everybody said, ‘Oh, this is a great target, it’s preferentially expressed in regulatory T cells.’” At this point, it seemed they had hit the jackpot.

But despite ongoing attempts, when it came to making the perfect antibody that could target the CD25 receptor, and thus deplete regulatory T cells and allow an anti-tumour immune response, researchers were stumped. None of the CD25 antibodies they tested was effective against cancer.  

The excitement ground to a halt, and research into CD25 was largely put on the backburner. 

But this is a story of persistence and dedication. Quezada and his team continued to investigate CD25, going back to the basics of how antibodies and immune cells behave. And they’ve finally got to the bottom of this stubborn mystery.  

Finding the perfect match  

“The problem with all the experiments that have failed in the past is that the antibody that we’re using was the wrong antibody. The target was the correct, but the tool that we have all been using, it was absolutely wrong,” he says.

The problem stemmed from the fact that, as well as being present on regulatory T cells, CD25 is also found – in much lower amounts – on effector T cells too, where it forms part of an essential signalling process involving a messenger protein known as interleukin-2 (IL-2), which activates them and causes them to target cancer. 

Quezada and his team hypothesised that the CD25 antibodies didn’t work well because, although they were destroying regulatory T cells, they were also simultaneously blocking IL-2 signalling, deactivating the vital effector T cells and preventing them from targeting the cancer cells. 

The team at UCL set out to construct an antibody that still targets CD25 and destroys regulatory T cells. However, by sticking to a different part of the protein, it also manages to avoid blocking the all-important IL-2 signalling on effector T cells. 

As it turns out, their theory was correct. “We made the antibody, we tested it, and it worked. It worked fantastically,” Quezada exclaims. 

Not only did the antibody not interfere with effector T cells, Quezada says that it also creates a cascade of events that brings more cancer killing cells into the tumour, culminating in an even stronger anti-tumour response.  

And what’s more, their results suggest that it prevented the tumour becoming resistant to immunotherapy – something that can be a problem for patients treated with current drugs.

The story doesn’t end here 

So far, the results have been extremely promising, showing significantly improved long-term survival in mice with cancer. “A single dose of the antibody gave us near hundred percent complete responses in animal models.”  

After success in the lab, the antibody is currently in phase 1 clinical trials, testing the safety of the treatment in humans, following preclinical safety tests.

But Quezada emphasises how the story doesn’t end here. There’s still much more to learn about CD25, IL-2, and how it sets off a cascade of anti-cancer immunity.  

“Our role as scientists, especially as the laboratory that created the concept and the new antibody, is to dig deeper into the mechanism of response or resistance to this molecule in either mouse models or in clinical samples”. 

“The same is happening now with other immunotherapy drugs.  Some of these molecules are approved for cancer therapeutics, but we still don’t know the full mechanism of action of those drugs.” 

Ultimately, Quezada explains, if the new antibody proves to be safe and effective in clinical trials – and it’s a big ‘if’ – the drug could be used as part of combination approaches with existing therapies. But for now, Quezada and his team are eagerly awaiting the results of clinical trials that will put their new drug to the test in humans.  

“If the antibody does in humans what it does in mice, then this is really going to change the landscape.”  

Lilly 

from Cancer Research UK – Science blog https://ift.tt/3eJ1qe5

“This is not the cure to cancer. I think that’s very important to clarify. But I think it’s the beginning of the long road to better cancer immunotherapy.” 

Professor Sergio Quezada has long been studying the complex relationship between the immune system and cancer at University College London – a field of research that’s moving rapidly, and has already produced some stunning successes – drugs known as immunotherapies are now available for several types of cancer.

And Quezada’s fascination with the immune system has culminated in not only a potential new immunotherapy drug, but yet another paradigm shift in our understanding of how cancer immunotherapy works. 

The latest study to come out of Quezada’s Cancer Research UK-funded lab, published in Nature Cancer, outlines a new way to harness the immune system in favour of killing cancer cells. And it’s already led to early stage clinical trials.  

This story of discovery began many years ago, decades in fact. And as Quezada comments, it‘s just the beginning. 

Balancing T cells, a delicate dance  

The body’s immune system is tightly controlled. “When you think about the immune response to anything, you need to have stop and go signals,” explains Quezada 

Manipulating the balance between these stop and go signals to encourage a patient’s immune system to target their tumour has been a key focus of immunotherapy research, with most of the current immunotherapy focusing on so-called checkpoint signals, found on the surface of immune cells called T cells. 

But that’s not the only way to target the immune system. Quezada is interested in the delicate dance between two different types of T cells – ‘effector’ T cells, that help to destroy potential threats, and ‘regulatory’ T cells, which aim to keep our immune system in check.

“So whenever you have an inflammatory response, with immune cells going and trying to attack or destroy a tissue, that is followed immediately, or almost immediately, by regulatory T cells that are there to calm things down.” 

Regulatory T cells are vital to fine-tuning immune responses, but they’re also implicated in cancer. “In cancer, there are a good number of papers associating the presence of regulatory T cells to tumour progression and the poor survival of patients.” 

Quezada believes manipulating the balance between effector T cells and regulatory T cells could be a good strategy – one that could lead to a new generation of immunotherapy drugs.

Depleting regulatory T cells 

In order to produce an anti-cancer immune response in patients, researchers have been looking to build an immunotherapy drug that works by specifically reducing the number of regulatory T cells, without also affecting the crucial effector T cells.  

“If you were to take down the regulatory T cells, but also eliminate the effector T cells, you end up on a zero sum, you end up with no effect whatsoever. So you always want to play with that balance.”

If you are able to take out or partially take out the regulatory T cells from the equation, it’s like moving a rock up the mountain, were you will be able to push the boulder down and initiate a cascade of events that will end up in tumour rejection. So, for us, it’s one of the holy grails of immune regulation that if you target properly, you can get tumour control.

– Sergio Quezada

In order to target regulatory T cells without affecting the number of other T cells, scientists looked for specific feature on the surface of regulatory T cells that will help to distinguish them from other types. This would then allow them to design an antibody that attached to that it, labelling it for destruction by other parts of the immune system.

“That has been difficult for many years, and many, many investigators and companies have been looking for specific markers of regulatory T cells. One of them was shown decades ago, in the mid 90s. And that molecule is called CD25.

“Everybody said, ‘Oh, this is a great target, it’s preferentially expressed in regulatory T cells.’” At this point, it seemed they had hit the jackpot.

But despite ongoing attempts, when it came to making the perfect antibody that could target the CD25 receptor, and thus deplete regulatory T cells and allow an anti-tumour immune response, researchers were stumped. None of the CD25 antibodies they tested was effective against cancer.  

The excitement ground to a halt, and research into CD25 was largely put on the backburner. 

But this is a story of persistence and dedication. Quezada and his team continued to investigate CD25, going back to the basics of how antibodies and immune cells behave. And they’ve finally got to the bottom of this stubborn mystery.  

Finding the perfect match  

“The problem with all the experiments that have failed in the past is that the antibody that we’re using was the wrong antibody. The target was the correct, but the tool that we have all been using, it was absolutely wrong,” he says.

The problem stemmed from the fact that, as well as being present on regulatory T cells, CD25 is also found – in much lower amounts – on effector T cells too, where it forms part of an essential signalling process involving a messenger protein known as interleukin-2 (IL-2), which activates them and causes them to target cancer. 

Quezada and his team hypothesised that the CD25 antibodies didn’t work well because, although they were destroying regulatory T cells, they were also simultaneously blocking IL-2 signalling, deactivating the vital effector T cells and preventing them from targeting the cancer cells. 

The team at UCL set out to construct an antibody that still targets CD25 and destroys regulatory T cells. However, by sticking to a different part of the protein, it also manages to avoid blocking the all-important IL-2 signalling on effector T cells. 

As it turns out, their theory was correct. “We made the antibody, we tested it, and it worked. It worked fantastically,” Quezada exclaims. 

Not only did the antibody not interfere with effector T cells, Quezada says that it also creates a cascade of events that brings more cancer killing cells into the tumour, culminating in an even stronger anti-tumour response.  

And what’s more, their results suggest that it prevented the tumour becoming resistant to immunotherapy – something that can be a problem for patients treated with current drugs.

The story doesn’t end here 

So far, the results have been extremely promising, showing significantly improved long-term survival in mice with cancer. “A single dose of the antibody gave us near hundred percent complete responses in animal models.”  

After success in the lab, the antibody is currently in phase 1 clinical trials, testing the safety of the treatment in humans, following preclinical safety tests.

But Quezada emphasises how the story doesn’t end here. There’s still much more to learn about CD25, IL-2, and how it sets off a cascade of anti-cancer immunity.  

“Our role as scientists, especially as the laboratory that created the concept and the new antibody, is to dig deeper into the mechanism of response or resistance to this molecule in either mouse models or in clinical samples”. 

“The same is happening now with other immunotherapy drugs.  Some of these molecules are approved for cancer therapeutics, but we still don’t know the full mechanism of action of those drugs.” 

Ultimately, Quezada explains, if the new antibody proves to be safe and effective in clinical trials – and it’s a big ‘if’ – the drug could be used as part of combination approaches with existing therapies. But for now, Quezada and his team are eagerly awaiting the results of clinical trials that will put their new drug to the test in humans.  

“If the antibody does in humans what it does in mice, then this is really going to change the landscape.”  

Lilly 

from Cancer Research UK – Science blog https://ift.tt/3eJ1qe5

Learning the lessons of COVID-19: Protecting cancer services and research through the pandemic

It’s going to be a tough winter for all of us.

Cases of COVID-19 are rising in every part of the UK, and more extensive measures to control the spread of the virus are being put in place.

Cancer patients – and those who think they might have cancer – have already faced huge challenges this year, with many worried about coming forward to their GP or going into hospital to get tests because of the risk of getting COVID-19. And, with a huge backlog of patients still waiting for screening, diagnostic tests and treatments, we fear that there will be a negative impact on cancer survival.

That’s why, today, Cancer Research UK along with 50 leaders from across the NHS and cancer community have written to the Prime Minister and First Ministers in Scotland and Wales, and First and Deputy First Ministers of Northern Ireland. The letter calls on them to stand by their commitments to improving cancer survival and make sure that everyone can still receive cancer diagnosis, treatment and care throughout the COVID-19 crisis.

Here, we set out where cancer services are today and the lessons we’ve learned from the first wave of COVID-19 – lessons that must be remembered and acted on as cases of COVID-19 rise again.

Where are we now?

It’s been almost 8 months since the first UK-wide lockdown, and we have a much clearer understanding of the impact the pandemic has had on cancer care.

The impact was felt right across the cancer pathway, with over 3 million people across the UK not able to go for cancer screening and thousands fewer people referred for tests for suspected cancer compared to normal.

Over 30,000 fewer people started their treatment than the same time last year too, and most cancer clinical trials were disrupted.

Because of the hard work of our amazing NHS staff, cancer services are getting back up and running and the situation is improving. The numbers of people being urgently referred for suspected cancer are almost back to the levels seen at the same time last year. It’s a positive sign that initiatives like the ‘Help Us Help You’ campaign by the NHS in England are working to encourage patients to see their GP if they’ve noticed anything unusual.

But challenges still exist. For some cancer types, such as lung cancer or urological cancers, referral numbers are still well below where they were last year. While trials are getting back up and running, this is happening slower than we would like. And even with increasing activity, there’s still huge numbers of people waiting for screening, diagnosis and treatment.

So it’s vital that cancer services and clinical trials can continue to recover and not go backwards again as COVID-19 cases rise again.

Protecting cancer services and research in future waves

There are already worrying signs that the NHS is beginning to feel the strain of the second wave. Governments across the UK have made it clear that health services will remain open, so they must ensure in coming months that there’s no further delays to essential cancer diagnosis, treatment and clinical trials.

Making sure the lessons learned in the summer are acted on will be vital.

First, we must ensure people feel confident to see their GP if they notice symptoms. And if those symptoms might be linked to cancer, that they get diagnostic tests quickly and safely. Many people heeded the advice to stay home and protect the NHS in the first wave. But the health system is there for everyone, including people who suspect they have cancer. Public campaigns like ‘Help Us to Help You’, and similar efforts in the devolved nations, must continue.

Second, we know that some cancer patients are at higher risk of complications if they catch COVID-19. So it’s critical that hospitals can provide cancer care in safe environments, including ‘COVID-protected’ spaces. A recent study showed that cancer patients who have surgery in ‘COVID-protected’ safe spaces have better outcomes, emphasising how important it is to get this right. This model has been set up all over the country and must be maintained.

Third, COVID-19 is tricky, as some people can be asymptomatic or infectious before they have symptoms. So, creating ‘COVID-protected’ spaces rely on a range of things to ensure they really are safe from COVID-19. Regularly testing all patient-facing staff often and quickly – whether they have symptoms or not – is a vital part of this, but it’s not clear that this is happening routinely across health systems yet.

Healthcare staff sickness – including in primary care – is rising because of burnout, having to self-isolate or catching COVID-19, exacerbating staff shortages that existed long before the pandemic. Ramping up testing is vital.

Fourth, even with all of this, the number of patients with COVID-19 and other diseases may outstrip capacity in the NHS to provide safe care. The use of the independent sector has been a positive development to keep care running when this happens, so it’s important the NHS can continue to tap into this resource.

While this may all sound challenging, there have been some positive developments in this crisis. Innovative diagnostics and treatments are being fast-tracked into the system, and new ways of working embedded that could help services in the long run.

Investing for the future of cancer care

Unfortunately, many of the challenges that cancer services are experiencing are not new. Workforce and equipment shortages, particularly for diagnosing cancer, were holding back cancer services long before the pandemic.

Cancer services need governments’ help to address deep seated challenges so they can come out of this crisis in a stronger position.

Put simply, we need more staff, and for them to be fully equipped. Without this, the health services’ ability to recover from the pandemic will be hampered and it won’t be possible to meet the government’s ambitions to improve cancer survival in the long term.

The UK Government’s spending review is an opportunity to show their commitment to the NHS by giving them the investment needed to provide the best cancer care. With any extra funding, it’s vital devolved governments to do the same for health systems across the UK.

The spending review is also a crucial moment for Government to protect the role of life-saving research funded by medical research charities, who have been massively hit by COVID-19, with a Life Sciences – Charity Partnership Fund.

Time to act

The impact of COVID-19 on people affected by cancer has already been devastating, and we can’t let things get worse again.

Cancer services need support now. Lessons learned earlier this year need to be put in place to minimise any future impacts of COVID-19. And cancer services must get the investment they need to continue to improve cancer outcomes.

Now is the time for governments across the UK to act.

Matt Sample is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2IjgwLu

It’s going to be a tough winter for all of us.

Cases of COVID-19 are rising in every part of the UK, and more extensive measures to control the spread of the virus are being put in place.

Cancer patients – and those who think they might have cancer – have already faced huge challenges this year, with many worried about coming forward to their GP or going into hospital to get tests because of the risk of getting COVID-19. And, with a huge backlog of patients still waiting for screening, diagnostic tests and treatments, we fear that there will be a negative impact on cancer survival.

That’s why, today, Cancer Research UK along with 50 leaders from across the NHS and cancer community have written to the Prime Minister and First Ministers in Scotland and Wales, and First and Deputy First Ministers of Northern Ireland. The letter calls on them to stand by their commitments to improving cancer survival and make sure that everyone can still receive cancer diagnosis, treatment and care throughout the COVID-19 crisis.

Here, we set out where cancer services are today and the lessons we’ve learned from the first wave of COVID-19 – lessons that must be remembered and acted on as cases of COVID-19 rise again.

Where are we now?

It’s been almost 8 months since the first UK-wide lockdown, and we have a much clearer understanding of the impact the pandemic has had on cancer care.

The impact was felt right across the cancer pathway, with over 3 million people across the UK not able to go for cancer screening and thousands fewer people referred for tests for suspected cancer compared to normal.

Over 30,000 fewer people started their treatment than the same time last year too, and most cancer clinical trials were disrupted.

Because of the hard work of our amazing NHS staff, cancer services are getting back up and running and the situation is improving. The numbers of people being urgently referred for suspected cancer are almost back to the levels seen at the same time last year. It’s a positive sign that initiatives like the ‘Help Us Help You’ campaign by the NHS in England are working to encourage patients to see their GP if they’ve noticed anything unusual.

But challenges still exist. For some cancer types, such as lung cancer or urological cancers, referral numbers are still well below where they were last year. While trials are getting back up and running, this is happening slower than we would like. And even with increasing activity, there’s still huge numbers of people waiting for screening, diagnosis and treatment.

So it’s vital that cancer services and clinical trials can continue to recover and not go backwards again as COVID-19 cases rise again.

Protecting cancer services and research in future waves

There are already worrying signs that the NHS is beginning to feel the strain of the second wave. Governments across the UK have made it clear that health services will remain open, so they must ensure in coming months that there’s no further delays to essential cancer diagnosis, treatment and clinical trials.

Making sure the lessons learned in the summer are acted on will be vital.

First, we must ensure people feel confident to see their GP if they notice symptoms. And if those symptoms might be linked to cancer, that they get diagnostic tests quickly and safely. Many people heeded the advice to stay home and protect the NHS in the first wave. But the health system is there for everyone, including people who suspect they have cancer. Public campaigns like ‘Help Us to Help You’, and similar efforts in the devolved nations, must continue.

Second, we know that some cancer patients are at higher risk of complications if they catch COVID-19. So it’s critical that hospitals can provide cancer care in safe environments, including ‘COVID-protected’ spaces. A recent study showed that cancer patients who have surgery in ‘COVID-protected’ safe spaces have better outcomes, emphasising how important it is to get this right. This model has been set up all over the country and must be maintained.

Third, COVID-19 is tricky, as some people can be asymptomatic or infectious before they have symptoms. So, creating ‘COVID-protected’ spaces rely on a range of things to ensure they really are safe from COVID-19. Regularly testing all patient-facing staff often and quickly – whether they have symptoms or not – is a vital part of this, but it’s not clear that this is happening routinely across health systems yet.

Healthcare staff sickness – including in primary care – is rising because of burnout, having to self-isolate or catching COVID-19, exacerbating staff shortages that existed long before the pandemic. Ramping up testing is vital.

Fourth, even with all of this, the number of patients with COVID-19 and other diseases may outstrip capacity in the NHS to provide safe care. The use of the independent sector has been a positive development to keep care running when this happens, so it’s important the NHS can continue to tap into this resource.

While this may all sound challenging, there have been some positive developments in this crisis. Innovative diagnostics and treatments are being fast-tracked into the system, and new ways of working embedded that could help services in the long run.

Investing for the future of cancer care

Unfortunately, many of the challenges that cancer services are experiencing are not new. Workforce and equipment shortages, particularly for diagnosing cancer, were holding back cancer services long before the pandemic.

Cancer services need governments’ help to address deep seated challenges so they can come out of this crisis in a stronger position.

Put simply, we need more staff, and for them to be fully equipped. Without this, the health services’ ability to recover from the pandemic will be hampered and it won’t be possible to meet the government’s ambitions to improve cancer survival in the long term.

The UK Government’s spending review is an opportunity to show their commitment to the NHS by giving them the investment needed to provide the best cancer care. With any extra funding, it’s vital devolved governments to do the same for health systems across the UK.

The spending review is also a crucial moment for Government to protect the role of life-saving research funded by medical research charities, who have been massively hit by COVID-19, with a Life Sciences – Charity Partnership Fund.

Time to act

The impact of COVID-19 on people affected by cancer has already been devastating, and we can’t let things get worse again.

Cancer services need support now. Lessons learned earlier this year need to be put in place to minimise any future impacts of COVID-19. And cancer services must get the investment they need to continue to improve cancer outcomes.

Now is the time for governments across the UK to act.

Matt Sample is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2IjgwLu

What’s happened to cancer clinical trials during the COVID-19 pandemic?

Clinical trials are an essential part of cancer research and care, with around 1 in 6 people with cancer taking part in research to access new methods of care and help improve the care received by future patients.

But like cancer services, such as screening and diagnosis, the COVID-19 pandemic has heavily disrupted cancer research. Because clinical trials are often based in hospitals, the risk of COVID-19 infection forced many researchers to pause recruitment in order to keep patients safe.

This didn’t happen to all cancer studies, as some trials were able to keep running during lockdown, but most were disrupted.

Thankfully, the situation is starting to improve, with a growing number of paused trials now restarting recruitment in some of their study sites. However, a second wave of COVID-19 risks disrupting cancer research again and reversing progress towards recovery.

To prevent this, we need to avoid another national pause on clinical trials and support restarted trials to continue running during future waves of COVID-19. We also need Government support to protect the UK’s science base’s ability to deliver life-saving research in the future.

Here’s what happened to clinical trials so far.

How did COVID-19 affect cancer research and trials?

COVID-19 forced most clinical trials in the UK to stop recruiting patients, including 95% of our cancer trials. The pandemic caused this disruption because:

1. Researchers needed to minimise the number of patients visiting hospitals, as these visits risked infecting their patients with COVID-19.
2. Some clinical staff usually dedicated to research needed to support frontline services as part of the NHS’s response to COVID-19.

Although COVID-19 has disrupted research into all types of cancer, the pandemic’s impact has varied between cancer types. For example, research into cancers affecting children and young people was less disrupted by COVID-19. One reason for this is that children – including children with cancer – are at a lower risk of developing severe COVID-19 symptoms than adults, so some studies could safely continue recruiting patients during lockdown.

COVID-19’s impact extends beyond disrupting today’s cancer trials – it also threatens tomorrow’s cancer research.

Due to COVID-19, we expect to lose 30% (£160m) of our income this year. This has prevented us from funding new trials this year because we’ve had to focus our finite funding on supporting the restart of existing cancer trials. For comparison, we usually fund around 10 new trials each year, in addition to funding trials already underway.

The pandemic’s financial impact means we won’t be able to fund as many cancer studies in the future, as we expect our income to take several years to recover. To avoid this outcome, we’re seeking support from the Government.

What’s happening to clinical trials now?

The good news is that progress is being made to restart paused clinical trials. Since May, the number of patients being recruited to clinical trials has increased, although the speed of recovery has varied between regions and cancer types.

For example, the percentage of non-commercial (e.g. charity-funded) clinical trials that are open to recruitment has risen from 12% in mid-April to 40% in early-September. And of the non-commercial trials open to recruitment, 42% have recruited a patient since 1 June.

While these figures are heading in the right direction, the recovery of recruitment to clinical trials has been slower than we hoped, largely due to a lack of capacity in hospitals across a range of services.

Even before the pandemic, there was not enough capacity in the system in several key functions, and COVID-19 has introduced many additional barriers:

1. COVID-19 has increased pressure on the NHS and significantly reduced the capacity of services that cancer trials need to properly function, such as radiology and pharmacy.
2. This services shortage has also created a backlog of cancer patients waiting for tests and treatments. Reducing this backlog remains an urgent priority and it’s important that the recovery of research is seen as integral to this process, rather than as an ‘add-on’.
3. Research into COVID-19, though necessary, is being over-prioritised by some local decision makers, making it harder for non-COVID clinical trials to access essential resources.
4. Patients may be reluctant to come into hospital due to fear of infection.

These barriers will become more challenging as cases of COVID-19 continue to rise once again. It’s vital that we ensure that the trials that have maintained or restarted recruitment can continue to recruit during future waves of the epidemic.

“We’re going over and above to ensure patient safety”

Ben Hood is a Cancer Research UK-funded clinical research nurse based in Newcastle. Hood works on an early phase cancer research unit, which runs a lot of early stage clinical trials.

“We see a lot of patients who might not have another treatment option. One of the biggest impacts of the pandemic was that patients in many cases weren’t allowed to have family members come on the unit when they were receiving treatment or having initial discussions about taking part in research, which could be quite distressing.”

The other big concern during the first wave was getting COVID-19. “There was quite a lot of anxiety from patients about being in a hospital setting in general.” Hood says the clinical nursing team worked overtime to keep in touch with patients and families and talk through their concerns.

“Where possible, we changed things so treatments could be delivered to patients’ homes, using courier services and we linked up a lot more with primary care – local GP practices and district nurses.” Hood says they’ve also evolved how they’re consenting people into clinical trials, to reduce trips to the hospital.

“Even though the world has turned on its head, within our unit and other experimental cancer centres, everybody has gone over and above to ensure that patient safety is the top priority during this time.”

And although coronavirus cases are on the rise again the UK, Hood feels the unit is in a strong position. “During the first wave nobody knew what to expect. But we’re definitely a lot more prepared for the second wave – we’re aware of the risk factors and the precautions we need to take to ensure patient safety.”

How do we move forward?

With 8 months’ experience dealing with COVID-19, the NHS is in a better position to balance the demands of the pandemic with meeting the needs of cancer patients.

Hospitals have taken steps to allow patients to be treated as safely as possible. It’s vitally important that patients go for treatment, and if anyone is worried about symptoms that you go to your GP. You may have to wait a bit longer than usual, but you will get the help you need.

Restoring and maintaining access to cancer services must remain the priority, and this should include keeping cancer trials open during future waves of COVID-19. That’s why we’ve revised our policy on redeploying Cancer Research UK-funded researchers, which sets out that:

• There should be no national pause on recruitment to clinical trials during future waves of COVID-19. Trials should be paused locally in response to exceptional strain on hospitals.
• All Cancer Research UK-funded staff and facilities redeployed during the first wave should be restored to cancer research.
• Redeployment of Cancer Research UK-funded staff should only be considered in exceptional circumstances, and only to support frontline cancer services.

Cancer isn’t going away, so we really need to continue to offer early phase research clinical trials, because otherwise some people won’t have any treatment options. We shouldn’t give up on these patients.

– Ben Hood, research nurse.

We also need to protect our ability to deliver life-saving research in the future. As mentioned earlier, COVID-19 has significantly reduced the incomes of research funders like Cancer Research UK, meaning less money will be available to fund future clinical trials.

To avoid this, we’re asking the UK Government to commit to a Life Sciences-Charity Partnership Fund that will fill this funding shortfall and protect our ability to deliver life-saving research.

Oliver Buckley-Mellor is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2TOYzH2

Clinical trials are an essential part of cancer research and care, with around 1 in 6 people with cancer taking part in research to access new methods of care and help improve the care received by future patients.

But like cancer services, such as screening and diagnosis, the COVID-19 pandemic has heavily disrupted cancer research. Because clinical trials are often based in hospitals, the risk of COVID-19 infection forced many researchers to pause recruitment in order to keep patients safe.

This didn’t happen to all cancer studies, as some trials were able to keep running during lockdown, but most were disrupted.

Thankfully, the situation is starting to improve, with a growing number of paused trials now restarting recruitment in some of their study sites. However, a second wave of COVID-19 risks disrupting cancer research again and reversing progress towards recovery.

To prevent this, we need to avoid another national pause on clinical trials and support restarted trials to continue running during future waves of COVID-19. We also need Government support to protect the UK’s science base’s ability to deliver life-saving research in the future.

Here’s what happened to clinical trials so far.

How did COVID-19 affect cancer research and trials?

COVID-19 forced most clinical trials in the UK to stop recruiting patients, including 95% of our cancer trials. The pandemic caused this disruption because:

1. Researchers needed to minimise the number of patients visiting hospitals, as these visits risked infecting their patients with COVID-19.
2. Some clinical staff usually dedicated to research needed to support frontline services as part of the NHS’s response to COVID-19.

Although COVID-19 has disrupted research into all types of cancer, the pandemic’s impact has varied between cancer types. For example, research into cancers affecting children and young people was less disrupted by COVID-19. One reason for this is that children – including children with cancer – are at a lower risk of developing severe COVID-19 symptoms than adults, so some studies could safely continue recruiting patients during lockdown.

COVID-19’s impact extends beyond disrupting today’s cancer trials – it also threatens tomorrow’s cancer research.

Due to COVID-19, we expect to lose 30% (£160m) of our income this year. This has prevented us from funding new trials this year because we’ve had to focus our finite funding on supporting the restart of existing cancer trials. For comparison, we usually fund around 10 new trials each year, in addition to funding trials already underway.

The pandemic’s financial impact means we won’t be able to fund as many cancer studies in the future, as we expect our income to take several years to recover. To avoid this outcome, we’re seeking support from the Government.

What’s happening to clinical trials now?

The good news is that progress is being made to restart paused clinical trials. Since May, the number of patients being recruited to clinical trials has increased, although the speed of recovery has varied between regions and cancer types.

For example, the percentage of non-commercial (e.g. charity-funded) clinical trials that are open to recruitment has risen from 12% in mid-April to 40% in early-September. And of the non-commercial trials open to recruitment, 42% have recruited a patient since 1 June.

While these figures are heading in the right direction, the recovery of recruitment to clinical trials has been slower than we hoped, largely due to a lack of capacity in hospitals across a range of services.

Even before the pandemic, there was not enough capacity in the system in several key functions, and COVID-19 has introduced many additional barriers:

1. COVID-19 has increased pressure on the NHS and significantly reduced the capacity of services that cancer trials need to properly function, such as radiology and pharmacy.
2. This services shortage has also created a backlog of cancer patients waiting for tests and treatments. Reducing this backlog remains an urgent priority and it’s important that the recovery of research is seen as integral to this process, rather than as an ‘add-on’.
3. Research into COVID-19, though necessary, is being over-prioritised by some local decision makers, making it harder for non-COVID clinical trials to access essential resources.
4. Patients may be reluctant to come into hospital due to fear of infection.

These barriers will become more challenging as cases of COVID-19 continue to rise once again. It’s vital that we ensure that the trials that have maintained or restarted recruitment can continue to recruit during future waves of the epidemic.

“We’re going over and above to ensure patient safety”

Ben Hood is a Cancer Research UK-funded clinical research nurse based in Newcastle. Hood works on an early phase cancer research unit, which runs a lot of early stage clinical trials.

“We see a lot of patients who might not have another treatment option. One of the biggest impacts of the pandemic was that patients in many cases weren’t allowed to have family members come on the unit when they were receiving treatment or having initial discussions about taking part in research, which could be quite distressing.”

The other big concern during the first wave was getting COVID-19. “There was quite a lot of anxiety from patients about being in a hospital setting in general.” Hood says the clinical nursing team worked overtime to keep in touch with patients and families and talk through their concerns.

“Where possible, we changed things so treatments could be delivered to patients’ homes, using courier services and we linked up a lot more with primary care – local GP practices and district nurses.” Hood says they’ve also evolved how they’re consenting people into clinical trials, to reduce trips to the hospital.

“Even though the world has turned on its head, within our unit and other experimental cancer centres, everybody has gone over and above to ensure that patient safety is the top priority during this time.”

And although coronavirus cases are on the rise again the UK, Hood feels the unit is in a strong position. “During the first wave nobody knew what to expect. But we’re definitely a lot more prepared for the second wave – we’re aware of the risk factors and the precautions we need to take to ensure patient safety.”

How do we move forward?

With 8 months’ experience dealing with COVID-19, the NHS is in a better position to balance the demands of the pandemic with meeting the needs of cancer patients.

Hospitals have taken steps to allow patients to be treated as safely as possible. It’s vitally important that patients go for treatment, and if anyone is worried about symptoms that you go to your GP. You may have to wait a bit longer than usual, but you will get the help you need.

Restoring and maintaining access to cancer services must remain the priority, and this should include keeping cancer trials open during future waves of COVID-19. That’s why we’ve revised our policy on redeploying Cancer Research UK-funded researchers, which sets out that:

• There should be no national pause on recruitment to clinical trials during future waves of COVID-19. Trials should be paused locally in response to exceptional strain on hospitals.
• All Cancer Research UK-funded staff and facilities redeployed during the first wave should be restored to cancer research.
• Redeployment of Cancer Research UK-funded staff should only be considered in exceptional circumstances, and only to support frontline cancer services.

Cancer isn’t going away, so we really need to continue to offer early phase research clinical trials, because otherwise some people won’t have any treatment options. We shouldn’t give up on these patients.

– Ben Hood, research nurse.

We also need to protect our ability to deliver life-saving research in the future. As mentioned earlier, COVID-19 has significantly reduced the incomes of research funders like Cancer Research UK, meaning less money will be available to fund future clinical trials.

To avoid this, we’re asking the UK Government to commit to a Life Sciences-Charity Partnership Fund that will fill this funding shortfall and protect our ability to deliver life-saving research.

Oliver Buckley-Mellor is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2TOYzH2

News digest – ovarian cancer blood test, statins, spending review and head and neck cancer immunotherapy

Ovarian cancer blood test ‘better than previously thought’  

A new investigation into an existing blood test to detect ovarian cancer has uncovered better-than-expected capabilities. Co-funded by Cancer Research UK, researchers at the Universities of Cambridge, Manchester and Exeter found the CA125 test could be more predictive than originally thought and may even pick up other forms of cancer. Our blog post and BBC Radio 4 have more  

Time to invest in cancer care’s future 

Now is the time for Chancellor Rishi Sunak and the UK Government to invest in the future of  cancer research, services and care, writes Matt Sample, policy advisor at Cancer Research UK in his latest blog post. The upcoming spending review presents an opportunity for a ‘cancer reset’, with the country facing an “immense challenge” that must be faced head on.

Head and neck cancer drug gets approval for NHS use  

The immunotherapy drug pembrolizumab (Keytruda) has been approved for use on the NHS in England as an option for some adults with head and neck cancer. In green-lighting the treatment, the National Institute of Health and Care Excellence said around 950 people whose cancer has either spread or returned could benefit. Pembrolizumab was initially rejected in January, but additional data helped NICE to fully evaluate its benefits, as detailed in our report. 

Immunotherapy – longer term side effects are emerging 

A new piece in the Daily Mail takes a look at type of immunotherapy drugs called monoclonal antibodies which started to come to prominence for cancer around 9 years ago. At a cost of around £100,000 per patient a year (and with potentially severe side-effects including rheumatoid arthritis) the article looks at the risks and benefits of these immune-boosting treatments. 

New evidence suggests statin’s cancer benefits  

Statins – drugs that lower cholesterol and improve heart health – may also have a positive impact  on cancer survival, according to new research. Researchers tracked statin use in women with newly diagnosed melanoma, breast and bowel cancer and found a link between adherence to statins and cancer mortality. While the study points to some potential benefits of statins, researchers cautioned that they cannot definitely say that statins were responsible for this effect and the results must be confirmed with clinical trials. The New York Times has the full story. 

Diet advice could be helpful for bowel cancer patients 

As many as 69% of people living with bowel, colon and rectal cancer received no advice or support on diet from their healthcare team at any stage of their care, new research from the University of Sheffield has found. With around 268,000 people in the UK living with bowel cancer, Lauren Wiggins at Bowel Cancer UK says the conversation around diet and cancer must be changed. Raconteur has more.

And finally… 

As many as 50,000 people in the UK are living with undiagnosed cancer as a result of the disruption caused by coronavirus, according to new figures from Macmillan Cancer Support. We’ve blogged before about how coronavirus has affected cancer services. 

And in more coronavirus news, the UK could be set to lose up to £7.8 billion in lifesaving investment over the next seven years as a result of the pandemic. Our news report has the story. 

Jake Richards is a writer for PA Media Group

from Cancer Research UK – Science blog https://ift.tt/35Oztxz

Ovarian cancer blood test ‘better than previously thought’  

A new investigation into an existing blood test to detect ovarian cancer has uncovered better-than-expected capabilities. Co-funded by Cancer Research UK, researchers at the Universities of Cambridge, Manchester and Exeter found the CA125 test could be more predictive than originally thought and may even pick up other forms of cancer. Our blog post and BBC Radio 4 have more  

Time to invest in cancer care’s future 

Now is the time for Chancellor Rishi Sunak and the UK Government to invest in the future of  cancer research, services and care, writes Matt Sample, policy advisor at Cancer Research UK in his latest blog post. The upcoming spending review presents an opportunity for a ‘cancer reset’, with the country facing an “immense challenge” that must be faced head on.

Head and neck cancer drug gets approval for NHS use  

The immunotherapy drug pembrolizumab (Keytruda) has been approved for use on the NHS in England as an option for some adults with head and neck cancer. In green-lighting the treatment, the National Institute of Health and Care Excellence said around 950 people whose cancer has either spread or returned could benefit. Pembrolizumab was initially rejected in January, but additional data helped NICE to fully evaluate its benefits, as detailed in our report. 

Immunotherapy – longer term side effects are emerging 

A new piece in the Daily Mail takes a look at type of immunotherapy drugs called monoclonal antibodies which started to come to prominence for cancer around 9 years ago. At a cost of around £100,000 per patient a year (and with potentially severe side-effects including rheumatoid arthritis) the article looks at the risks and benefits of these immune-boosting treatments. 

New evidence suggests statin’s cancer benefits  

Statins – drugs that lower cholesterol and improve heart health – may also have a positive impact  on cancer survival, according to new research. Researchers tracked statin use in women with newly diagnosed melanoma, breast and bowel cancer and found a link between adherence to statins and cancer mortality. While the study points to some potential benefits of statins, researchers cautioned that they cannot definitely say that statins were responsible for this effect and the results must be confirmed with clinical trials. The New York Times has the full story. 

Diet advice could be helpful for bowel cancer patients 

As many as 69% of people living with bowel, colon and rectal cancer received no advice or support on diet from their healthcare team at any stage of their care, new research from the University of Sheffield has found. With around 268,000 people in the UK living with bowel cancer, Lauren Wiggins at Bowel Cancer UK says the conversation around diet and cancer must be changed. Raconteur has more.

And finally… 

As many as 50,000 people in the UK are living with undiagnosed cancer as a result of the disruption caused by coronavirus, according to new figures from Macmillan Cancer Support. We’ve blogged before about how coronavirus has affected cancer services. 

And in more coronavirus news, the UK could be set to lose up to £7.8 billion in lifesaving investment over the next seven years as a result of the pandemic. Our news report has the story. 

Jake Richards is a writer for PA Media Group

from Cancer Research UK – Science blog https://ift.tt/35Oztxz

An existing blood test for ovarian cancer has been re-evaluated. The results are in.

Ovarian cancer is the sixth most common cancer in women in the UK, with about 7,400 new cases every year. This number equates to approximately 20 diagnoses a day.

Early diagnosis is key to successfully treating cancer, and ovarian cancer is no exception. But as seen frequently with many different cancer types, there are a number of obstacles we need to tackle for early diagnosis to become a reality.

The answer for ovarian cancer could involve a blood test.

We often hear about blood tests when it comes to detecting cancer. And while many are still in the early phases of development, cancer blood tests do exist, and some are even currently being used in GP practices.

A team of researchers, based at the Universities of Cambridge, Manchester and Exeter and funded by Cancer Research UK and NIHR, have been investigating a blood test for ovarian cancer – CA125 – that’s already out there. Their research, published this week in PLOS Medicine, found it is far more predictive than we originally thought and could potentially pick up other forms of cancer.

The importance of early diagnosis

Like many other cancers, survival of ovarian cancer depends on the stage at which the cancer has been diagnosed.

Put simply – the earlier the better.

The differences in survival between an early stage and late stage diagnosis are significant. 93% of people diagnosed with ovarian cancer diagnosed at the earliest stage (stage 1) survive their disease for 5 years or more, compared to just 13% of those diagnosed at the latest stage (stage 4).

Sadly, ovarian cancer is often diagnosed late. The majority of women will be diagnosed when they notice symptoms, typically when they visit the GP. And while symptoms can occur at every stage of the disease, the symptoms are non-specific, such as abdominal pain and bloating, and can be hard to pinpoint.

Why investigate a test that we already have?

The CA125 test is a blood test used around the world, including in the UK, to help identify ovarian cancer in women who are already presenting with symptoms. Those who have above a certain level of CA125 in their blood are advised to follow on with further tests, such as an ultrasound.

How does the CA125 test work?

• CA125 is a protein often found on the surface of ovarian cancer cells and in some normal tissues. Women with ovarian cancer often have a high level of this protein in their blood.
• A high level of CA125 in your blood could be a sign of ovarian cancer. It can also be a result of other conditions such as endometriosis, fibroids and even pregnancy.
• If a test shows you have high levels of CA125, you may be referred for a scan to check for possible causes.

Back in 2011, the National Institute for Health and Care Excellence (NICE) recommended that women with symptoms of possible ovarian cancer be tested for CA125 in a primary care setting, typically at your GP surgery.

While the CA125 test has been studied in women in secondary care, for example, women with pelvic masses in a hospital setting, the test hadn’t been evaluated for women who had seen their GP with symptoms that could be ovarian cancer.

The research team, working as part of the CanTest collaborative, set to fill in this missing data.

“There’s around 7,000 women diagnosed with ovarian cancer in the UK each year. Picking up the disease early is really important because we’re more likely to be able to treat and cure the disease effectively if we do that…..”

“The CA125 blood test has been around and available to GPs for a while. But it’s never actually been evaluated in primary care,” explains Dr Garth Funston, from the University of Cambridge, who led the study.

“Tests perform differently depending on how you use them and who you use them in. So to really understand how this test performs, we needed to study it in the population in which it was used.”

Funston says that before this study, doctors relied on evidence and results from research conducted in other settings. “This study shows that it is a really useful test in helping to work out who to refer on for further investigation.”

The results are in

The study looked at 50,000 women who had seen their GP and took the CA125 test between 2011 and 2014.

This research found that 10% of women with higher levels of the protein biomarker were diagnosed with ovarian cancer, making an abnormal test 12 times more predictive than previous estimates had suggested.

What’s more, this study showed for the first time that an abnormal CA125 result in primary care was not only associated with ovarian cancer – over 350 women with high protein levels had the disease – it also found more than 380 women with an abnormal CA125 result had another type of cancer such as pancreatic, lung or bowel cancer. These results reflect how important it is that GPs remain alert to the risk of other cancer types when carrying out specific triage tests.

Age was a big factor that affected the results. The proportion of women with an abnormal test who had any cancer, was much higher in women aged 50 or over (33%) compared to women younger than 50 (6%).

“One of the most exciting things from this research is that we’ve been able to develop models which give the individualised risk or probability of a woman having cancer, based on their CA125 test level and their age,” Funston comments.

“We think this will be really useful in helping women and GPs make decisions about the need for further testing and referral,” he adds.

This research demonstrates a readily available and tangible test that can be used more often by GPs to give people more time with their loved ones.

Significant investment in diagnostic equipment and technology, along with NHS staff is urgently needed to diagnose more cancers at an earlier stage and save lives. Through the right investments and policies, the UK has the potential to become a world leader in the early detection and diagnosis of cancer.

– Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis.

What does this mean for patients?

The team at Cambridge hope that this new, added insight on the performance of the CA125 test will help aid the diagnosis pathway for ovarian cancer.

Fiona Barve is a science teacher who lives near Cambridge. She was diagnosed with ovarian cancer in 2017 after visiting her doctor with stomach pains.

“I hadn’t heard of the CA125 blood test before my GP suggested that I take one. Although I was diagnosed at a late stage, the test helped identify the problem – I didn’t even know this test existed before. I’d like to see a day when tests like this are routinely used to help more people have their cancer diagnosed early,” she says. “I was fortunate my surgery, which I received within four weeks of being diagnosed and chemotherapy worked for me. Now I feel lucky to be around.”

Fiona has been cancer free since April 2019 and leads a fit and active life, working as a science teacher at her local school three days a week. She is monitored every 3 months by her consultant Professor James Brenton, a process which includes having regular CA125 tests.

Although the CA125 test is already being used in GP surgeries, this new data provides a great opportunity to encourage the use of the CA125 test as an effective triage tool.

“It would be fantastic to see the models we’ve developed integrated into the GP practice to help guide decisions about which patients need to be referred urgently for further investigation and which patients can be reassured. So I’d really like to see the models implemented and used,” Funston concludes.

Lilly

from Cancer Research UK – Science blog https://ift.tt/3oCnL1K

Ovarian cancer is the sixth most common cancer in women in the UK, with about 7,400 new cases every year. This number equates to approximately 20 diagnoses a day.

Early diagnosis is key to successfully treating cancer, and ovarian cancer is no exception. But as seen frequently with many different cancer types, there are a number of obstacles we need to tackle for early diagnosis to become a reality.

The answer for ovarian cancer could involve a blood test.

We often hear about blood tests when it comes to detecting cancer. And while many are still in the early phases of development, cancer blood tests do exist, and some are even currently being used in GP practices.

A team of researchers, based at the Universities of Cambridge, Manchester and Exeter and funded by Cancer Research UK and NIHR, have been investigating a blood test for ovarian cancer – CA125 – that’s already out there. Their research, published this week in PLOS Medicine, found it is far more predictive than we originally thought and could potentially pick up other forms of cancer.

The importance of early diagnosis

Like many other cancers, survival of ovarian cancer depends on the stage at which the cancer has been diagnosed.

Put simply – the earlier the better.

The differences in survival between an early stage and late stage diagnosis are significant. 93% of people diagnosed with ovarian cancer diagnosed at the earliest stage (stage 1) survive their disease for 5 years or more, compared to just 13% of those diagnosed at the latest stage (stage 4).

Sadly, ovarian cancer is often diagnosed late. The majority of women will be diagnosed when they notice symptoms, typically when they visit the GP. And while symptoms can occur at every stage of the disease, the symptoms are non-specific, such as abdominal pain and bloating, and can be hard to pinpoint.

Why investigate a test that we already have?

The CA125 test is a blood test used around the world, including in the UK, to help identify ovarian cancer in women who are already presenting with symptoms. Those who have above a certain level of CA125 in their blood are advised to follow on with further tests, such as an ultrasound.

How does the CA125 test work?

• CA125 is a protein often found on the surface of ovarian cancer cells and in some normal tissues. Women with ovarian cancer often have a high level of this protein in their blood.
• A high level of CA125 in your blood could be a sign of ovarian cancer. It can also be a result of other conditions such as endometriosis, fibroids and even pregnancy.
• If a test shows you have high levels of CA125, you may be referred for a scan to check for possible causes.

Back in 2011, the National Institute for Health and Care Excellence (NICE) recommended that women with symptoms of possible ovarian cancer be tested for CA125 in a primary care setting, typically at your GP surgery.

While the CA125 test has been studied in women in secondary care, for example, women with pelvic masses in a hospital setting, the test hadn’t been evaluated for women who had seen their GP with symptoms that could be ovarian cancer.

The research team, working as part of the CanTest collaborative, set to fill in this missing data.

“There’s around 7,000 women diagnosed with ovarian cancer in the UK each year. Picking up the disease early is really important because we’re more likely to be able to treat and cure the disease effectively if we do that…..”

“The CA125 blood test has been around and available to GPs for a while. But it’s never actually been evaluated in primary care,” explains Dr Garth Funston, from the University of Cambridge, who led the study.

“Tests perform differently depending on how you use them and who you use them in. So to really understand how this test performs, we needed to study it in the population in which it was used.”

Funston says that before this study, doctors relied on evidence and results from research conducted in other settings. “This study shows that it is a really useful test in helping to work out who to refer on for further investigation.”

The results are in

The study looked at 50,000 women who had seen their GP and took the CA125 test between 2011 and 2014.

This research found that 10% of women with higher levels of the protein biomarker were diagnosed with ovarian cancer, making an abnormal test 12 times more predictive than previous estimates had suggested.

What’s more, this study showed for the first time that an abnormal CA125 result in primary care was not only associated with ovarian cancer – over 350 women with high protein levels had the disease – it also found more than 380 women with an abnormal CA125 result had another type of cancer such as pancreatic, lung or bowel cancer. These results reflect how important it is that GPs remain alert to the risk of other cancer types when carrying out specific triage tests.

Age was a big factor that affected the results. The proportion of women with an abnormal test who had any cancer, was much higher in women aged 50 or over (33%) compared to women younger than 50 (6%).

“One of the most exciting things from this research is that we’ve been able to develop models which give the individualised risk or probability of a woman having cancer, based on their CA125 test level and their age,” Funston comments.

“We think this will be really useful in helping women and GPs make decisions about the need for further testing and referral,” he adds.

This research demonstrates a readily available and tangible test that can be used more often by GPs to give people more time with their loved ones.

Significant investment in diagnostic equipment and technology, along with NHS staff is urgently needed to diagnose more cancers at an earlier stage and save lives. Through the right investments and policies, the UK has the potential to become a world leader in the early detection and diagnosis of cancer.

– Dr Jodie Moffat, Cancer Research UK’s head of early diagnosis.

What does this mean for patients?

The team at Cambridge hope that this new, added insight on the performance of the CA125 test will help aid the diagnosis pathway for ovarian cancer.

Fiona Barve is a science teacher who lives near Cambridge. She was diagnosed with ovarian cancer in 2017 after visiting her doctor with stomach pains.

“I hadn’t heard of the CA125 blood test before my GP suggested that I take one. Although I was diagnosed at a late stage, the test helped identify the problem – I didn’t even know this test existed before. I’d like to see a day when tests like this are routinely used to help more people have their cancer diagnosed early,” she says. “I was fortunate my surgery, which I received within four weeks of being diagnosed and chemotherapy worked for me. Now I feel lucky to be around.”

Fiona has been cancer free since April 2019 and leads a fit and active life, working as a science teacher at her local school three days a week. She is monitored every 3 months by her consultant Professor James Brenton, a process which includes having regular CA125 tests.

Although the CA125 test is already being used in GP surgeries, this new data provides a great opportunity to encourage the use of the CA125 test as an effective triage tool.

“It would be fantastic to see the models we’ve developed integrated into the GP practice to help guide decisions about which patients need to be referred urgently for further investigation and which patients can be reassured. So I’d really like to see the models implemented and used,” Funston concludes.

Lilly

from Cancer Research UK – Science blog https://ift.tt/3oCnL1K

The UK Government’s spending review: Time to invest in the future of cancer care

This autumn, the chancellor Rishi Sunak will go to Parliament and set out the UK Government’s spending priorities in the Comprehensive Spending Review (CSR).

It will be a big moment for the whole of the UK, detailing what the coming years of UK Government spending will look like across the board. And it will be pivotal for the future direction of the NHS, research and cancer care.

The challenge ahead is immense, but must be faced head on.

The last big spending review was in 2015, followed by smaller one-year plans that haven’t tackled the fundamental challenges facing cancer services.

Since then, cancer waiting times have worsened and people with cancer in the UK still face lower survival rates than similar countries around the world.

In the 2019 General Election, the Conservatives committed to increase cancer survival rates and boost early cancer diagnosis. NHS England has a more specific ambition – to see 3 in 4 cancers diagnosed at an early stage by 2028.

Sadly, we weren’t on track to meet these ambitions even before COVID-19. And the pandemic has only increased the pressure on cancer services and made it even more vital to accelerate progress now, to make sure that people with cancer can get the diagnosis and treatment they deserve, today and in the future.

To get on track, the UK Government needs to use the CSR to invest in key areas we know will make the most difference for cancer patients, by:

• Giving our NHS the investment it needs to recruit and train enough staff to diagnose and treat every cancer patient and relieve growing pressures on cancer services
• Invest in more diagnostic equipment, so that Government can deliver on its commitment to diagnose more cancers earlier
• Help medical research charities protect their life-saving research from the impact of COVID-19 with a Life Sciences Charity Partnership Fund

Here’s why these areas are so important.

Growing the cancer workforce to meet demand

A leap forward in our ability to diagnose cancer at an early stage is critical to improving survival. People diagnosed at the earliest stages of cancer have the best chances of accessing curative treatment, which dramatically improves their chances of long-term survival.

Put simply, early diagnosis saves lives.

But in the UK, we only diagnose just over half of patients at an early stage, and right now we’re way off track to meet NHS England’s ambition to diagnose 3 in 4 cancers at an early stage by 2028.

Copy this link and share our graphic. Credit: Cancer Research UK

This means there’s still a lot of progress we need to make.

And crucial to making this progress will be investing to recruit and train more staff to diagnose, treat and care for people with cancer. Last week, we published new estimates for how many more staff the NHS in England will need to diagnose and treat cancer in the next 10 years.

Health Education England (HEE) – the organisation responsible for workforce planning and training – estimates that we need 45% growth in the number of staff in 7 roles key to diagnosing and treating cancer to meet cancer ambitions.

Copy this link and share our graphic. Credit: Cancer Research UK

To see that growth and make sure the NHS has the cancer workforce it needs, we estimate that HEE will need at least £142 million but possibly as much as £260 million more than it already invests over the next 3-5 years.

This investment would not only help to ‘future-proof’ cancer care, but because many of these professions work on other conditions too, the whole NHS would benefit.

Giving the NHS the kit it needs to diagnose and treat cancer patients

In early October, NHS England published a review of diagnostic services. The report made clear that without a major expansion and reform of how we diagnose diseases like cancer, efforts to improve cancer outcomes would be put at risk.

The UK is well behind other similar countries when it comes to how much diagnostic kit we have. For example, we have the lowest number of CT scanners – vital for diagnosing many cancers as well as other conditions – per million people compared to 23 major economies.

The impact of COVID-19 has only made the challenges greater, with diagnostic services hit hard and important new infection control measures making it difficult to see the same number of patients as before.

NHS England’s review suggested setting up new ‘Community Diagnostic Hubs’, a great idea that could not only be implemented in a COVID-19 safe way, but could also build on current work to create ‘one stop shops’ for cancer patients to get all of their diagnostic tests at once.

To make these changes, be it having enough equipment or implementing new models for diagnostic services, we’ll need Government to significantly invest.

Invest to protect life-saving research

Medical research charities like Cancer Research UK invest around £1.9 billion a year into life-saving research, playing a vital part in improving outcomes for people with cancer and a range of other diseases. Just in the case of cancer, charities fund half of all publicly funded cancer research.

But the impact of COVID-19 has been devastating. The Association of Medical Research Charities (AMRC) estimates that this year alone, medical research charities will spend between £252 to £368 million less on research.

The picture is just as bleak for cancer research.

New figures from the National Institute of Cancer Research estimate charities will spend £167 million less on cancer research this year due to the financial impact of COVID-19. In our case, a 30% reduction in fundraising income this year has meant we’ve already been forced to cut £44 million of planned research. In the very worst case, we could have to cut our spending on research by £150 million a year by 2024.

Our vision for beating cancer is underpinned by funding life-saving research into the causes and treatment of every type of cancer. And the reality is that, without Government support, our shortfall in income, will set our research back by years, with fewer scientists supported and fewer clinical trials being funded.

That’s why, along with the AMRC and other members, we’re calling on the Government to set up a 3-year Life Sciences-Charity Partnership Fund. The Fund would protect medical research charities through the worst of the impact of COVID-19 by investing at least £310 million in the first year to maintain ongoing research projects. The investment would then gradually reduce as charities strive to recover and build back stronger in later years.

A ‘cancer reset’

The Comprehensive Spending Review is an opportunity for a ‘cancer reset’.

An opportunity for the Government to make good on its 2019 manifesto commitments, and to give each part of the UK the funding they need to improve cancer outcomes.

An opportunity to give the health system the people and the kit it needs to reduce the heartbreak of lengthening cancer waiting times and growing demand for cancer diagnosis and treatment.

An opportunity to drive investment in future medical breakthroughs.

Now it’s up to Rishi Sunak and the Government to seize this opportunity to deliver for people with cancer and invest to dramatically improve cancer survival across the UK.

Matt Sample is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2H87PDB

This autumn, the chancellor Rishi Sunak will go to Parliament and set out the UK Government’s spending priorities in the Comprehensive Spending Review (CSR).

It will be a big moment for the whole of the UK, detailing what the coming years of UK Government spending will look like across the board. And it will be pivotal for the future direction of the NHS, research and cancer care.

The challenge ahead is immense, but must be faced head on.

The last big spending review was in 2015, followed by smaller one-year plans that haven’t tackled the fundamental challenges facing cancer services.

Since then, cancer waiting times have worsened and people with cancer in the UK still face lower survival rates than similar countries around the world.

In the 2019 General Election, the Conservatives committed to increase cancer survival rates and boost early cancer diagnosis. NHS England has a more specific ambition – to see 3 in 4 cancers diagnosed at an early stage by 2028.

Sadly, we weren’t on track to meet these ambitions even before COVID-19. And the pandemic has only increased the pressure on cancer services and made it even more vital to accelerate progress now, to make sure that people with cancer can get the diagnosis and treatment they deserve, today and in the future.

To get on track, the UK Government needs to use the CSR to invest in key areas we know will make the most difference for cancer patients, by:

• Giving our NHS the investment it needs to recruit and train enough staff to diagnose and treat every cancer patient and relieve growing pressures on cancer services
• Invest in more diagnostic equipment, so that Government can deliver on its commitment to diagnose more cancers earlier
• Help medical research charities protect their life-saving research from the impact of COVID-19 with a Life Sciences Charity Partnership Fund

Here’s why these areas are so important.

Growing the cancer workforce to meet demand

A leap forward in our ability to diagnose cancer at an early stage is critical to improving survival. People diagnosed at the earliest stages of cancer have the best chances of accessing curative treatment, which dramatically improves their chances of long-term survival.

Put simply, early diagnosis saves lives.

But in the UK, we only diagnose just over half of patients at an early stage, and right now we’re way off track to meet NHS England’s ambition to diagnose 3 in 4 cancers at an early stage by 2028.

Copy this link and share our graphic. Credit: Cancer Research UK

This means there’s still a lot of progress we need to make.

And crucial to making this progress will be investing to recruit and train more staff to diagnose, treat and care for people with cancer. Last week, we published new estimates for how many more staff the NHS in England will need to diagnose and treat cancer in the next 10 years.

Health Education England (HEE) – the organisation responsible for workforce planning and training – estimates that we need 45% growth in the number of staff in 7 roles key to diagnosing and treating cancer to meet cancer ambitions.

Copy this link and share our graphic. Credit: Cancer Research UK

To see that growth and make sure the NHS has the cancer workforce it needs, we estimate that HEE will need at least £142 million but possibly as much as £260 million more than it already invests over the next 3-5 years.

This investment would not only help to ‘future-proof’ cancer care, but because many of these professions work on other conditions too, the whole NHS would benefit.

Giving the NHS the kit it needs to diagnose and treat cancer patients

In early October, NHS England published a review of diagnostic services. The report made clear that without a major expansion and reform of how we diagnose diseases like cancer, efforts to improve cancer outcomes would be put at risk.

The UK is well behind other similar countries when it comes to how much diagnostic kit we have. For example, we have the lowest number of CT scanners – vital for diagnosing many cancers as well as other conditions – per million people compared to 23 major economies.

The impact of COVID-19 has only made the challenges greater, with diagnostic services hit hard and important new infection control measures making it difficult to see the same number of patients as before.

NHS England’s review suggested setting up new ‘Community Diagnostic Hubs’, a great idea that could not only be implemented in a COVID-19 safe way, but could also build on current work to create ‘one stop shops’ for cancer patients to get all of their diagnostic tests at once.

To make these changes, be it having enough equipment or implementing new models for diagnostic services, we’ll need Government to significantly invest.

Invest to protect life-saving research

Medical research charities like Cancer Research UK invest around £1.9 billion a year into life-saving research, playing a vital part in improving outcomes for people with cancer and a range of other diseases. Just in the case of cancer, charities fund half of all publicly funded cancer research.

But the impact of COVID-19 has been devastating. The Association of Medical Research Charities (AMRC) estimates that this year alone, medical research charities will spend between £252 to £368 million less on research.

The picture is just as bleak for cancer research.

New figures from the National Institute of Cancer Research estimate charities will spend £167 million less on cancer research this year due to the financial impact of COVID-19. In our case, a 30% reduction in fundraising income this year has meant we’ve already been forced to cut £44 million of planned research. In the very worst case, we could have to cut our spending on research by £150 million a year by 2024.

Our vision for beating cancer is underpinned by funding life-saving research into the causes and treatment of every type of cancer. And the reality is that, without Government support, our shortfall in income, will set our research back by years, with fewer scientists supported and fewer clinical trials being funded.

That’s why, along with the AMRC and other members, we’re calling on the Government to set up a 3-year Life Sciences-Charity Partnership Fund. The Fund would protect medical research charities through the worst of the impact of COVID-19 by investing at least £310 million in the first year to maintain ongoing research projects. The investment would then gradually reduce as charities strive to recover and build back stronger in later years.

A ‘cancer reset’

The Comprehensive Spending Review is an opportunity for a ‘cancer reset’.

An opportunity for the Government to make good on its 2019 manifesto commitments, and to give each part of the UK the funding they need to improve cancer outcomes.

An opportunity to give the health system the people and the kit it needs to reduce the heartbreak of lengthening cancer waiting times and growing demand for cancer diagnosis and treatment.

An opportunity to drive investment in future medical breakthroughs.

Now it’s up to Rishi Sunak and the Government to seize this opportunity to deliver for people with cancer and invest to dramatically improve cancer survival across the UK.

Matt Sample is a policy advisor at Cancer Research UK

from Cancer Research UK – Science blog https://ift.tt/2H87PDB