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Ground-breaking trial pilots new tests to detect lung cancer earlier

Science blog

The first participants have taken part in a new research trial that aims to save lives by detecting lung cancer at an earlier stage when it is more treatable.

People attending the NHS Targeted Lung Health Checks in Southampton are being invited to take part in the iDx Lung trial, which will offer new types of tests to 10,000 people over the next 3 years.

Part-funded by Cancer Research UK, iDx Lung is a collaboration between the Cancer Research UK Southampton Clinical Trials Unit at the University of Southampton, the University of Leeds and healthcare and diagnostic companies.

The trial is currently taking place at the Royal South Hants Hospital, but in the autumn it will move to a mobile unit which can travel around the county with the NHS Targeted Lung Health Check vans.

Michelle Mitchell, chief executive of Cancer Research UK, said that lung cancer is a priority for the charity, as survival has improved very little over the last 40 years despite continuous research efforts.

“Trials have shown that CT scanning people at increased risk of developing the disease can reduce lung cancer deaths and combining CT screening with biomarker tests and using blood and nasal samples, it may help to catch more cases at an early stage of the disease, which can be easier to treat. We hope this will lead to more people surviving their lung cancer.”

Detecting lung cancer earlier

Every year in the UK, 25,000 people are diagnosed with advanced, inoperable lung cancer, making it the biggest cause of cancer death in the UK and worldwide.

Professor Peter Johnson, Director of the CRUK Southampton Centre and Chief Investigator of trial, said: “We know that lung cancer can be treated successfully if we catch it early, but too often it can go unnoticed and is then picked up at a late stage when treatment options are limited.”

Screening with CT scanning is already being tested by the NHS, but the iDx Lung team hope that they will be able to not only increase the number of people diagnosed earlier, but find more cost-effective ways to do so.

Harnessing the latest technology

The trial team are working alongside NHS England’s Targeted Lung Health Checks programme and Leeds Lung Health Check, where people at high risk of lung cancer are being invited to attend a CT scanning unit.

The iDx Lung trial will ask 10,000 people who attend the scans to also give a nasal swab and a blood sample.

Victoria Goss, Programme Manager for iDx Lung at the Cancer Research UK Southampton Clinical Trials Unit, said that these samples will then be analysed for changes that could indicate the early signs of cancer developing.

“The aim is to determine whether using simple biological tests alongside the Targeted Lung Health Check programme can help increase diagnosis rates in people with the very early signs of lung cancer, so they can begin treatment quickly when it is far more likely to be successful.”

The samples will be analysed by a number of companies testing out some of their latest technologies to find the best way to detect lung cancer at an early stage.

Collaborators for the trial include Roche Diagnostics, Oncimmune, Inivata, BC Platforms, the Lung Cancer Initiative at Johnson & Johnson, and the Southampton Experimental Cancer Medicine Centre (ECMC).

“By bringing some of the latest molecular technology to this problem, we hope that we can find better ways to detect lung cancer in its early stages and make sure people have the best chance of a cure,” said Johnson.

The post Ground-breaking trial pilots new tests to detect lung cancer earlier first appeared on Cancer Research UK - Cancer news.

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Combination immunotherapy for advanced bowel cancer approved for NHS in England

Science blog

People who have previously been treated for a type of bowel cancer that has spread to other parts of their body will now have another treatment option in England, following the approval of the combined use of nivolumab (Opdivo) and ipilimumab (Yervoy) for these patients.

The National Institute of Health and Care Excellence (NICE) has approved this combination of immunotherapy drugs for use in adults with bowel cancer that has spread to other parts of the body (metastatic bowel cancer) and has a lot of errors (mutations) in its DNA.

Ben Chiu, policy manager at Cancer Research UK, said that this decision is “excellent news” for people with this type of cancer. “Even though some uncertainty remains, clinical evidence suggests that nivolumab plus ipilimumab can improve patients’ survival and help maintain their quality of life.”

An unmet need

Around 4 in 100 metastatic bowel cancers have a lot more DNA mutations than others, as they’re unable to repair any mistakes that are made in their DNA.

These cancers are said to have high ‘microsatellite instability’ (MSI) or ‘mismatch repair (MMR) deficiency’, which can make them more aggressive, and are associated with a poorer outlook and greater risk of death.

Despite this, there aren’t specific treatments for this type of bowel cancer, so people are offered the same treatment whether or not their cancer has this inability to fix mistakes in its DNA.

Patient experts explained to the NICE committee that this kind of diagnosis affects the quality of life both physically and psychologically, and that new treatments like the newly approved immunotherapy drugs are needed.

Living longer and with fewer side effects

People with previously treated metastatic bowel cancer are currently offered combination chemotherapy as their second-line treatment.

But following the NICE decision, patients with bowel cancer that has high MSI or an MMR deficiency will now have an option of a combination of immunotherapies.

Why does immunotherapy work better for these patients?

Immunotherapies harness the body’s immune system to fight cancer. Researchers have found that bowel cancer tumours with high MSI or MMR deficiency have a lot of immune cells within them, but the cancer stops them from working. Nivolumab and ipilimumab block the cancer’s ability to do this, allowing the immune cells to attack the tumours.

Experts commented that having the immunotherapy combo rather than combination chemotherapy may mean less debilitating side effects. The absence of side effects like nausea, stomach pain and fatigue could give people a better quality of life.

The clinical evidence for the effectiveness of this treatment came from the single-arm, phase 2 CheckMate 142 study. The trial included 119 people with metastatic colorectal cancer with high MSI or MMR deficiency, previously treated with combination therapies.

As a single-arm trial, the study did not directly compare the use of nivolumab plus ipilimumab with other treatments, so the data had to be compared indirectly with data about current treatments.

The NICE committee concluded that despite this uncertainty, the trial showed that the benefits of the treatment, measured by overall survival for patients and the amount of time where their cancer didn’t get worse, was likely to be greater than current standard care.

Overall, the treatment was considered cost-effective for use in the NHS by NICE and will now be an option on the NHS in England. NICE decisions are usually adopted in Wales and Northern Ireland as well, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing drugs.

The post Combination immunotherapy for advanced bowel cancer approved for NHS in England first appeared on Cancer Research UK - Cancer news.

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Let’s talk about HPV: 6 common questions answered

Science blog

Talking about a virus is all a lot of us seem to be doing at the moment. We’re happy enough chatting away about COVID-19 and other common viruses like the cold or flu, so why is there so little conversation about HPV?

You may have heard about HPV,human papillomavirus, as the virus linked to cancer.Cervical cancer is the type most strongly linked to HPV infection, but HPV can also cause cancer of theanus,penis,vagina andvulva, and some types ofmouth and throat cancers. But although HPV can cause cancer, having HPV doesn’t mean you have or will definitely get cancer.

Although not everyone will be comfortable talking to their friends or partners about HPV, our Cancer Research UK nurses have received lots of questions from people worried about what HPV is, and what having HPV means for their health, their partner’s health and very often, their sex life.

You’ve asked and we’ve answered.

Is HPV a sexually transmitted infection?

HPV is a really common virus – most of us will have HPV at some point in our lifetime without it causing any harm and a lot of the time without us knowing.

HPV lives in the skin and the cells lining the inside of our body, so it can pass between people through close skin to skin contact, often during sex. This includes penetrative vaginal and anal sex, oral sex, touching and using sex toys with a partner, such as vibrators or butt plugs.

Labelling HPV as an STI isn’t particularly helpful in a lot of cases. It prompts questions like ‘where did I get it?’ or ‘who gave it to me?’, which in reality is not how it works and only adds to the reasons why we don’t want to talk about it.

Having HPV is not something to be ashamed of, and it’s not a sign that you or your partner have been unfaithful. Having HPV is just a totally normal part of life.

How did I get HPV and can I get rid of it?

Now we know how HPV can be passed between people, let’s talk a bit more about how the virus works.

HPV has a ‘dormancy’ period, which means that the virus spends some time in our body without causing any harm, this is usually a couple of years but can stretch to decades.

When HPV is dormant it can’t be detected by a test, but it can become active later which is when it would be picked up in cervical screening. This is also why you might not have had HPV show up in your previous screening but it has in your most recent one – it’s not necessarily that you have had a new HPV infection between screens, but that it has been dormant in your cells.

It’s hard to know how long an infection has been there for if it’s been dormant, so there’s usually no point trying to work out where you ‘got’ HPV.

There’s no cure for HPV but most of the time our body’s immune system does the job and clears up the infection by itself before it’s done any harm. It’s only when certain types, or strains, of HPV can’t be cleared up by our body that damage can happen to our cells. Regular cervical screening monitors HPV infection, it sees if the infection has cleared from your last screen or whether the infection has caused thecells in the cervix to change and need treating.

If I’ve had HPV once can I get it again?

There are over a hundred different types, or strains, of HPV and around 13 of these are linked to cancer. So it’s possible to have multiple infections and you might have different strains of HPV over the years that are picked up at cervical screening.

What the science is less clear on is reinfection – this means getting the same strain of HPV again.

Our immune system generally works by recognising something that’s not right and building an immunity that means we can’t get the same infection again. But studies show our natural immunity against HPV isn’t very good so it can be possible to have the same infection again.

There’s still lots of research to be done to understand this properly and how reinfection could happen between partners.

Does my partner have it and how can I protect them?

There isn’t testing for HPV apart from as part of the nationalcervical screening programme. Cervical screening is for anyone with acervix aged between 25 and 64. This can include women,transgender men and people who are non-binary. Invitations to cervical screening start at 25 because in younger people, the changes to the cells in the cervix more often return to normal and are less likely to develop into cancer.Screening at a younger age would lead to unnecessary worry and treatment, and overall does moreharm than good.

There are some ways to reduce the risk of getting or passing on HPV, but it’s important to remember it is a very common virus and it’s normal to have it at points in your life.

As HPV is passed between people during close skin to skin contact, barrier methods like condoms and dental dams can reduce risk, but they don’t work perfectly. Having HPV doesn’t mean you need to stop having sex with your partnerbut sexual health and consent is always important to talk about with any sexual partners.

But try not to worry about it too much. Even though HPV infection itself is common, it leading to cancer isn’t. Around 80% people will have an HPV infection at some point in their life but only a small percentage of people will develop a cancer linked to HPV.

There aren’t screening programmes for all cancer types related to HPV as screening is only set up when there’s an effective test, and when saving lives can be balanced with not adding health risk. It’s important to remember that screening is for people without symptoms. If you are worried about a symptom or have noticed a change that is not normal for you or not going away, tell your doctor – whatever your age and regardless of whether you have been for screening recently or not.

Can I give HPV to my kids?

HPV can be passed between mother and child during pregnancy or delivery, but it’s not very likely. And if it does happen, usually the infection clears up by itself and there are no issues for the child.

There is more research needed to understand the transmission between mother and child. HPV can also be passed through breast feeding but this is very rare and shouldn’t be a reason not to breastfeed. If it’s something you are concerned about – talk to your doctor or midwife.

Should I get the HPV vaccine?

HPV vaccination is an important part of reducing the number of people withhigh risk HPV and in turn, the number of people who develop HPV related cancers. In the UK, all children between 11 and 13 are offered the HPV vaccine.

Vaccines work by reducing the risk of getting an infection, they’re not designed to get rid of an infection that is already there. The vaccine programme includes children of this age as it is likely to be before any exposure to HPV which makes it work better. Once a person has been exposed to HPV, the vaccine becomes less effective.

You can request a vaccine for free up to the age for 25 if you didn’t have one when you were offered it at school. The vaccine is also available to men who have sex with men up to 45 through sexual health clinics. You can pay to have the vaccine privately if don’t meet these criteria, but the vaccine may not be effective if you’ve already been exposed to the virus, which most of us have been when we’re adults.

The best way to protect yourself against cervical cancer is to attend your regular cervical screening. The vaccine isn’t 100% effective at protecting against HPV so cervical screening is still important whether you have had the HPV vaccine or not.

Though sometimes some of the science is complicated, what having HPV means shouldn’t be – it’s normal! It’s hard to just ‘not worry’, but there’s not much you can do about your HPV status and having regular cervical screening is a really effective way of preventing cervical cancer.

While many of us may have hang ups about sex, don’t let HPV be one of them.

Karis

The post Let’s talk about HPV: 6 common questions answered first appeared on Cancer Research UK - Cancer news.

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Fears breast cancer progress could stall due to COVID-19 backlog

Science blog

Around 10,600 fewer breast cancer patients have started treatment in the last year in England.

Breast cancer deaths reached an all-time low before the pandemic, but experts fear these new stats show that this hard-won progress could slow.

The charity estimates around 38,000 fewer people started treatment for all cancer types in England. And breast cancer represents more than a quarter of these ‘missing cancers’ during the pandemic – almost double what might be expected.

These are most likely people who have cancer but haven’t been diagnosed yet.

Considering the huge disruption to cancer services, sadly, these figures are not surprising.

– Professor Charles Swanton, Cancer Research UK’s chief clinician

Impact on screening

The majority of these ‘missing’ breast cancers are early stage disease, based on provisional data from Public Health England’s Rapid Cancer Registration data. Of the breast cancers with a known stage that are missing, almost 95% (93%) were early stage (stage 1 and 2), which are usually more treatable.

These are likely to be cancers that haven’t been picked up in breast screening, which was effectively paused for several months and only started sending out routine invitations again after the first wave.

“We’re seeing the impact of effectively pausing breast screening which detects almost a third of breast cancer cases,” said Swanton.

“But it’s important to remember that cancer screening is for people without symptoms, so it’s vital that if people notice anything usual for them, please don’t wait for screening – get in touch with your GP. In most cases it won’t be cancer, but if it is, catching it early gives the best chance of survival.”

Many people also stayed at home, putting off seeking help for symptoms during the peaks of the pandemic, for fear of catching COVID-19 or not wanting to overwhelm the NHS.

Risking vital progress

The charity fears that progress in reducing breast cancer deaths, which had made huge strides in the last decade, could slow.

Since records began in the 70s, death rates for breast cancer have fallen by almost 40%. This progress is thanks to huge developments in understanding breast cancer and its treatment.

From Cancer Research UK scientists laying the groundwork for the drug Herceptin, to the discovery of the BRCA1 and BRCA2 genes, to the development of a new family of targeted drugs known as PARP inhibitors through Cancer Research UK funded studies, research has played a large role.

But this progress is in jeopardy. It’s important that women come forward with symptoms, and consider screening when invited, but the NHS also needs the capacity to treat these women when they do finally enter the system.

Michelle Mitchell, Cancer Research UK’s chief executive, said: “Science is the route to beating cancer and from cell biology in the lab, to patient trials in hospitals, Cancer Research UK has helped to reduce breast cancer deaths. But these figures are worrying, and we could see progress slow over the coming years as the true effect of the pandemic is revealed.

“The NHS is showing signs of recovery, but a huge effort is still needed to clear the cancer backlog as quickly as possible to help avoid preventable cancer deaths as a consequence of the pandemic.”

Mitchell added that Government must make sure there is enough funding for staff, diagnostic equipment and the research needed to improve cancer care across the UK in the long term, so “cancer patients are given the best chance of surviving their disease”.

“It was such an emotionally charged time”

Charly and her daughter.

Charly, pictured with one of her daughters, was diagnosed with breast cancer during the COVID-19 outbreak.

Army veteran, Charly McNelis, 37, was diagnosed with breast cancer in March 2020, at the beginning of the pandemic. The mother-of-two scheduled an appointment with her GP after finding a lump, and was referred to the breast clinic. “I was in a state of panic, I was reading about everything.”

Her biopsy was in early March. “COVID-19 wasn’t really a concern at that point,” she says, but things changed rapidly over the next few weeks.

“I went back for the results on the 10th March and it was confirmed as having cancer. They said I would have chemo first, then radiotherapy and surgery.” Charly asked if the treatment plan might be affected by COVID-19, but the doctors didn’t know enough at that point.

But the situation evolved with the outbreak, with Charly’s appointment being followed by a flurry of calls. “By now the pandemic levels were rising and they explained it didn’t feel safe to go down the chemotherapy route so I would have surgery first, and it should still be a lumpectomy. But by the time I went to meet the surgeon the week after, this changed to a full mastectomy.”

Because of COVID-19, Charly’s doctors changed the chemotherapy drugs to minimise infection risk. She started chemotherapy after surgery, at the beginning of May, which lasted 18 weeks in total.

“It’s such an emotionally charged time and it’s draining – COVID-19 has been a significant factor.”
But while her treatment has been complicated and challenging so far, Charly is positive. “I am lucky in many ways – my cancer is treatable. COVID-19 has impacted my treatment options but has not stopped it, and for that I am grateful. I got my diagnosis, and I got to have treatment, when there’s people out there who haven’t started treatment and are undiagnosed.”

The post Fears breast cancer progress could stall due to COVID-19 backlog first appeared on Cancer Research UK - Cancer news.

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David Dangoor: “Education is a treasure that you give someone and they carry with them all their life”

Science blog

At first glance, Cancer Research UK might not seem the obvious charity of choice for a family of philanthropists historically committed to supporting education. Until recently, their many beneficiaries chiefly comprised universities, libraries and schools. But for David Dangoor CBE DL and his family, there was something so compelling about the way our researchers spoke about their work at an event that it prompted them to learn more about our charity – which led to a gift of £1.1m. In-keeping with their philanthropic objective of promoting education, the donation was to support our About Cancer webpages, a resource accessed by 19 million people seeking reliable and accurate information about cancer in 2019/20.

The family still support those webpages today, over a decade later, and have heaped on further donations since. For example, in 2015, they gave £5m to support the building of the Francis Crick Institute, one of the four research institutes we help to fund and Europe’s largest biomedical research facility under one roof. Recent developments at the Crick include a first-in-human clinical trial of a new drug to treat leukaemia and insights that tell doctors who is most likely – and importantly, who is unlikely – to benefit from immunotherapy. Keen-eyed visitors to the institute might just spot a road running alongside it renamed ‘Dangoor Walk’ to acknowledge the family’s remarkable support.

An enduring relationship

Of their 12-year partnership with our charity, David says, “Our preference in philanthropy is to have a long relationship with an organisation. Once you believe in something, that belief continues.” It’s an attitude that has led to the family being actively involved in around 100 charitable organisations. And now they’re supporting us once again with a £1.2m gift to promote public understanding of and support for the Crick’s work. Plans involve developing new public-focused website content as well as accessible and far-reaching digital communications, including a very large LED screen outside the Crick to engage passers-by. Once again, education features at the heart of their giving. “By sharing knowledge, you can help people help themselves,” confirms David. “It empowers people beyond their own expectation.”

But now that the family are so involved with Cancer Research UK, and given the renewed public appreciation of biomedical research in light of COVID-19, has their focus shifted? With backgrounds in science, David, who studied physics, and wife Judy, who has a PhD in photosynthesis, have always followed scientific advances with great interest, and the global clinical response to the pandemic has of course been no exception. “When biomedicine put its mind to it, it was able to provide not one but several effective vaccines,” he says. “But it didn’t happen in just a year, it was the result of many years of research into human biology at places like the Crick. You need to understand the fundamentals of biomedicine to be ready to deal with threats like COVID-19.”

David allegorically describes this effect as like “groups of people from all over the world, going into a dark cave with nuggets of knowledge and then switching on the light”. More literally he explains, “When someone makes a discovery or contributes new insight, it illuminates the field and connections can be made. You make the whole field more amenable to future discoveries.” And for David, perhaps nowhere does this better than the Crick, to which Cancer Research UK supporters, including the Dangoor family, collectively donated £100 million. The institute celebrates its fifth anniversary this year.

One plus one equals three

“When Cancer Research UK told us that they wanted to bring all these different specialisms into one building in London, which has a unique diversity of people and skills, it sounded really exciting,” David recalls. “Concentrating brilliant people together in a collaborative space allows for the exchange of ideas. In those situations, one plus one equals three. And now that we’ve seen some of the advances they’ve already made, which will help people for generations all over the world, we feel very pleased that we’re part of it.”

But while cutting-edge research into biology and new treatments is vital, David also places a high value on cancer prevention – and education’s invaluable role in that. “We have hardly begun to take advantage of the huge potential of prevention and early detection,” he says, simultaneously acknowledging that nudging people into quitting smoking is “not as sexy” for scientists, politicians or the public as a new treatment for lung cancer. “You may not win a Nobel Prize or discover a new drug, but I feel the goal is wide open in prevention,” he says. “Because preventing someone from getting lung cancer and curing someone of lung cancer results in the same outcome, and the former is easier in all respects.”

A visceral choice

The family’s philanthropic objectives are clearly macro, with a focus on reaching as many people as possible, but their motivations stem from highly personal experiences. David’s mother, Renée Dangoor, died of breast cancer in 2008. And it was his father, Sir Naim Dangoor, who instilled the importance of education and, latterly, philanthropy in David and his siblings. Naim fled Iraq with his family in 1963 after the situation for Jews worsened to the point where their lives were under threat. He had to leave behind a hard-won portfolio of successful businesses. “All he took with him was his family and his education,” says David. Once in the UK, Naim built a property business and when that became successful, he started giving back. And so began a vocation in philanthropy.

“My father had developed a different perspective on the transience of wealth, and he wanted to show thanks to the UK for having taken us in by helping others,” says David. “So, education was a very visceral choice for our family. It’s a treasure that you give someone, and they carry with them all their life.” And for David himself, a chance encounter with a roadside altruist left its own indelible impression. “Shortly after I passed my driving test, I found myself stranded with no petrol or money,” he recalls. “A man stopped and poured half of his own can of petrol into my car. When I told him that I didn’t know how to thank him, he said I should buy a can myself and help someone else. I realised then that helping others is the best way to show gratitude.”

The post David Dangoor: “Education is a treasure that you give someone and they carry with them all their life” first appeared on Cancer Research UK - Cancer news.

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In primo piano