CANCER The revolution and how YOU can benefit
A test that could mean no more chemo. A drug that offers men a vital lifeline. And an end to unnecessary surgery. We reveal all about...
CANCER experts from around the world unveiled a raft of discoveries last week that will, they hope, transform treatment for millions of patients. Thousands of specialists got together at the American Society of Clinical Oncology’s annual meeting in Chicago to share the latest gamechanging research findings.
It is at the conference every year that cutting-edge therapies are announced, with many making dramatic front-page headlines.
This year I was lucky enough to attend the meeting, alongside scores of specialist medical writers who report on the latest innovations in the field.
The buzz-term at the event was precision medicine: bespoke protocols involving tests that help doctors understand the genetic make-up of a patient’s specific disease, helping them attack tumours with pinpoint accuracy while minimising side effects.
There has been much talk about this in theory, but now years of hard work and scientific study are producing breakthroughs that mean the outlook is truly one of optimism.
But what does it all mean for British cancer patients today, and how can the average person benefit?
I put that very question to the UK’s leading cancer specialists to find out…
NO MORE CHEMO FOR EARLY BREAST CANCER WHAT’S IT ALL ABOUT?
THE announcement that the majority of women with early-stage breast cancer, of the most common type, can safely forgo chemotherapy generated huge excitement.
All women will still be offered surgery to remove the cancer. However, after being given a genetic test, a decision can be made as to whether this is followed by chemotherapy and hormoneblocking drugs, or the latter alone, said researchers.
WHAT DOES IT MEAN FOR ME?
CONSULTANT oncologist Dr Hendrik-Tobias Arkenau, Medical Director at Sarah Cannon Research UK, said: ‘The type of breast cancer looked at in the study was hormonereceptor positive, HER2-negative, and node negative – if you have this, you’ll recognise the terms – which represents roughly half of all diagnoses.
‘About 70 per cent of these women may be able to avoid chemo, without any raised risk of their cancer returning.
‘The key is the genetic test, the Oncotype DX test, which is widely used in the NHS. This looks for genetic signatures on a tumour that indicate whether there is a low, medium or high risk of the cancer coming back.
‘We can now reassure postmenopausal women who score with a low or medium risk of recurrence that they do not need chemotherapy and they will have surgery and hormone drugs only.
‘Younger women with a low risk can also safely forgo chemo. The study authors indicated that this may further broaden to include even more patients. The way we treat women with early-stage breast cancer will change overnight thanks to this study.’
GREAT LEAPS FORWARD TO BEAT BIGGEST KILLER WHAT’S IT ALL ABOUT?
IT WAS good news, for once, for sufferers of lung cancer, which causes 100 deaths a day in Britain. First, immunotherapy drug pembrolizumab was shown to be more effective than chemotherapy for patients with advanced, incurable cases of the most common type of lung cancer. It gave the majority of them about four to eight months more life, with fewer side effects, when compared to chemo.
The surface of the cancer cells were studied for the presence of markers that indicate whether it will be sensitive to the drug.
And there was hope for better screening for those at high risk of lung cancer – such as smokers – as early-stage trials showed DNA blood tests could accurately detect the disease at an early stage, before it causes symptoms.
WHAT DOES IT MEAN FOR ME?
CONSULTANT oncologist Professor Siow-Ming Lee, an expert in lung cancer at University College Hospital London, said: ‘The immune system should attack anything that shouldn’t be in the body, such as a tumour.
‘But many cancers seem to evade detection by giving off signals that interfere with the way immune cells recognise an “invader”.
‘Pembrolizumab, which is a type of immunotherapy, works by blocking those signals. This allows the immune system to “see” it and attack it, clearing the cancer from the body.
‘Today, we can test tumour biopsies to find out whether pembrolizumab will have an effect. In about a third of cases it may do.
‘For those patients who we think it will benefit, we will apply to the Cancer Drugs Fund for them to be given the treatment. In those patients, we know it will extend life.
‘However, it won’t work for
everyone. Immunotherapy isn’trecommended for patients whosufferfromanautoimmunediseasesuchasCrohn’sorcolitis,becauseit can worsen those conditions,orwhohavetakenimmune-suppressingdrugssuchassteroids,becausethetwomedicationscanceleachotherout.’
ProfLeeadded:‘MoreresearchisneededbeforewecanrecommendDNAbloodteststoscreenforearlylungcancer.Itwillbeat leastfivemoreyearsbeforeweseeareliabletestlikethis.’
BACK FROM THE BRINK... THANKS TO ‘LAZARUS’ DRUG WHAT’S IT ALL ABOUT?
AS FIRST revealed in The Mailon Sunday last week, men withterminal prostate cancer couldbethrownalifelinethankstothe‘Lazarusdrug’pembrolizumab.Thepatientswerethosewhohadundergone chemotherapy and othertreatments to no avail. But theeffectofpembrolizumabinoneintenmenwasdramatic.Atthestartofthetrial,somewerebeing‘eatenalive’ by the disease – but thankstothetreatmenttheywereclearofcanceruptotwoyearslater.
WHAT DOES IT MEAN FOR ME?
CONSULTANToncologistDrPeterHarper, of Guy’s and St Thomas’ Hospital NHS Foundation Trustand co-founder of the LondonOncology Clinic, said: ‘A largenumberofmenwithprostatecancerarediagnosedatalatestage.Oncethediseasehasspreadoutsideoftheprostate,it’slikelytokeep coming back – and the problemreally isn’t the gland itselfanymore.Sotheymaywellnotbeofferedsurgery.
‘Instead,menaregivenhormonedrugs and chemotherapy and thisdoesusuallyhelpkeepthingsatbay. But some men don’t respondandwe’vehadfewoptionsforthem.Itisthisgroupwhowouldbeidealcandidatesforpembrolizumab.
‘However, it is not licensed inEuropefortreatingprostatecancer,sowecan’tofferitevenprivately.Evenifwecould,it’sveryexpensive–justunder£8,000perinjection,anditneedstobegiveneverythreeweeks.Ifyouliveforas long as some on this trial, itcouldgetquitecostly.
‘Thebestbetisgettinginvolvedinaclinicaltrial.VisittheNationalClinical Trials Gateway website[ukctg.nihr.ac.uk], and search formetastatic castrate resistantprostatecancer.’
KIDNEY PATIENTS MAY NOT NEED SURGERY WHAT’S IT ALL ABOUT?
UNTIL now, for all kidney cancerpatients,removaloftheaffected organ was standard treatment.ButresearchcarriedoutinFrancehas demonstrated that the operationdoes not boost survivalin those with advanced, incurablecancer.
A key factor is that surgerydelaysthepatientreceivingothertreatments, including medication,for weeks – by which timethecancercouldhaveworsened.
Surgeryisstillthegold-standardtreatment for patients who donot have advanced disease,noted the researchers from theHopitalEuropeenGeorges-PompidouinParis.
WHAT DOES IT MEAN FOR ME?
DRPETERHarpersaid:‘Althoughwecan’tcuremanypatientswithadvanced kidney cancer, wenow have quite an armamentofdrugs–includingsunitinib,orSutent,andnewtargetedantibodytreatments – that help us controlthedisease.
‘Kidneycancertypicallyspreadsto the bones, liver and lungs, andalsothebrain.
‘When it does pop up, thesemedicinesaregoodatzappingit.
‘Patients can survive for fiveyearsormore,andstayrelativelywell, living a normal life forthattime.
‘Nowweknowit’snotnecessarytoputthemthroughabigoperation–evenifitisakeyholeprocedurethese days, there are still risksand it means recovery time thatcould be far better spent doingotherthings.’
LOWERING THE RISK – WITH A DAILY ASPIRIN WHAT’S IT ALL ABOUT?
A DAILY dose of aspirin lowersthe risk of oesophageal cancer inpatients with a common digestivecondition, according to a majorBritishstudy.The2,500volunteersinvolved in the trial also took theover-the-counter medication omeprazole,which reduces stomachacid.AllthepatientsinvolvedhadBarrett’soesophagus,a‘pre-cancerous’conditioninwhichlow-levelacid reflux causes cell changes inthelowerpartofthegullet.
Sufferersare50timesmorelikelythanthosewithouttheconditiontodevelopoesophagealcancer.
Those who took the two dailypillsincombinationwerefoundtohavea20percentlowerchanceofdeveloping oesophageal cancerthaniftheyhadbeenuntreated.
Whiletheanti-aciddrugsreducethe damage caused by stomachacid,theaspirinisthoughttohavea dampening effect on the celldivisionthatleadstocancer.
About9,000Britonsdevelopoesophagealcancer and the diseasecauses7,900deathseachyear.
WHAT DOES IT MEAN FOR ME?
DR HENDRIK-Tobias Arkenausaid: ‘I would encourage anyonewithBarrett’soesophagustoseetheirGPorgastroenterologistanddiscusstheresultsofthistrial.
‘Thesedrugscostpenniesandwillhelp prevent oesophageal cancer.It’simportantnottoself-prescribe,even though the medicines areavailableoverthecounter.
‘Aspirin in particular can causestomach upsets, so the regimeneedstobeproperlymonitored.
‘The peak age for developingoesophageal cancer is in the mid60s,so starting on this course ofmedication as early as possibleisadvisable.’