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

Science blog

Ovarian cancer blood test ‘better thanpreviouslythought’ 

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 andBBC 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  cancerresearch, services and care, writes Matt Sample, policy advisor at Cancer Research UK in hislatest 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 druggets approvalfor 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,theNationalInstitute of Health and CareExcellence said around 950 people whose cancer has either spread or returned could benefit.Pembrolizumab was initially rejected in January, but additional data helpedNICE to fully evaluate its benefits, as detailed inour report. 

Immunotherapy – longer term side effects are emerging 

Anew piece in theDaily 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 evidencesuggestsstatin’s cancer benefits  

Statins drugs that lower cholesterol and improve heart health may also havea 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 betweenadherence to statins and cancer mortality.While the study points to some potential benefits of statins, researchers cautioned thatthey cannot definitely say that statinswere responsible for this effect and the results must be confirmed with clinical trials.TheNew York Times has the full story. 

Diet advice could be helpful forbowel 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

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

Science blog

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…..”

https://scienceblog.cancerresearchuk.org/wp-content/uploads/2020/10/summaryofwork.mp3

“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

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Annette and Nick Razey: “Even since my diagnosis, the development of treatments has been astounding”

Philanthropy and partnerships

Image of Annette and Nick Razey, supporters of Cancer Research UK

Thanks to the visionary philanthropy of three of our closest supporters, we're now able to match pound for pound every £100k+ gift we receive through a special £1.6m challenge fund. Here, long-term friends of Cancer Research UK, Annette and Nick Razey, tell us why they were inspired to double the impact of their support by taking advantage of this exciting opportunity.

What does philanthropy mean to you?

ANNETTE: I think we have a duty of care to use our resources to help others. That resource can be time, effort or expertise, as well as money. My philosophy is that we should aim to enable future generations who encounter diseases like cancer to have a better life experience.

Why did you choose to support our work?

ANNETTE: We’ve had people we love experience and die from various types of cancer. And as Cancer Research UK supports research into all cancers, our donation is used where the need is greatest.

NICK: The thing about cancer is that it’s everywhere and everyone knows someone who’s been affected by it. But medical research is astonishing and it’s progressing so quickly. I’ve had cancer for several years and even in that time, medicine has moved forward. So I really do have hope that things are going to change – and change quickly. For example, life expectancy is often given as a percentage chance of living for five years or more, but that’s based on backwards-looking statistics and in five years those numbers will sometimes improve dramatically. I just feel that, with cancer, it’s going somewhere. We’re getting there slowly, but we’re winning the battle.

What are your hopes for the future of cancer research?

ANNETTE: My mother died from breast cancer when she was 44 – and there was no chemotherapy in those days. The therapies we have today seem to have been around forever, but they just weren’t there in the 1960s and it’s astonishing to see the difference they’ve made. But having seen Nick go through chemo, one of my hopes would be to see a reduction in the nasty side effects that come hand in hand with new and effective drugs.

I’m also interested in how different fields of research can now be applied to cancer, such as genetics, and the development in cancer vaccines and simpler diagnostic tests that can be done in a GP surgery, as some people are a bit squeamish about hospitals and tests.

How has your personal experience of cancer motivated you?

NICK: I’ve been going to the Royal Marsden Hospital in Sutton for a couple of years and the place is amazing. The nurses are so positive that it’s actually quite a happy place. You think it’s going to be doom and gloom, but I come out of there in a good mood. There’s no such thing as a good cancer experience, but I feel I’ve been lucky. And even since my diagnosis, the development of treatments has been astounding. I’m going to have to live with fear in the back of my mind for the rest of my life, but science is constantly progressing, which means my chances get better and better every year. So I’m relatively optimistic.

What was it about our Challenge Fund that inspired you to give?

NICK: Knowing that our money would be matched is just a great way of doubling the impact of our gift. It’s a clever way of getting good bang for your buck.

To find out more about our Challenge Fund, email philanthropy@cancer.org.uk

Interview by Edward Bowers, philanthropy communications executive

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Immunotherapy drug approved for head and neck cancer

News report

An illustration of T cells (white) attacking a tumour (purple)

Some people with head and neck cancer will now have access to the immunotherapy drug pembrolizumab (Keytruda) on the NHS in England.   

The drug was initially rejected in January due to uncertainties in the clinical trial data, but has now been approved by the National Institute of Health and Care Excellence (NICE) based on additional data. Pembrolizumab will now be an option for some adults whose cancer has either spread to other parts of the body or come back and cannot be removed surgically. 

NICE estimates that around 950 people will be eligible for the treatment.  

Who will the decision affect?  

Pembrolizumab is an immunotherapy that aims to boost the immune system’s ability to recognise and kill cancer cells. It works by blocking a molecule found on immune cells – called PD-1 – from talking to cancer cells.    

What are 'checkpoint' immunotherapy drugs?

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Currently, treatment for head and neck cancer in the NHS in England will depend on where the cancer started growing:  

  • If the cancer started inside the mouth, it’s typically treated with a combination of a targeted cancer drug (cetuximab) and chemotherapy.drugs.  
  • If the cancer started outside the mouth, treatment usually includes a combination of chemotherapy drugs.   

Pembrolizumab will now provide a new treatment option for both groups, but only if their cancer has spread to other parts of the body and they have not received any treatment, or if their cancer has returned and cannot be removed surgically. It would only be an option for patients whose tumours test positive for PD-L1.   

Those taking pembrolizumab will also have to stop treatment after 2 years or earlier if their cancer progresses, according to the latest decision. 

How do you know if a tumour is PD-L1 positive?  

For head and neck cancer, researchers can calculate the percentage of PD-L1 positive cells within the tumour, which is reported as a combined positive score (CPS). A tumour is considered to be PD-L1 positive if it has a CPS score of more than 1.  

NICE decisions are usually adopted in Wales and Northern Ireland as well as England, so pembrolizumab should now be available to patients in all 3 nations. Scotland has a separate process for reviewing drugs.  

Clinical trial results and additional data 

Results from clinical trials found that for people whose cancer started inside the mouth, pembrolizumab is at least as effective and has lower overall costs than the current cetuximab combination therapy. In people whose cancer started outside the mouth, pembrolizumab works better than chemotherapy on its own. While it has higher overall costs, the price is considered to be a cost-effective use of NHS resources. 

Clinical trials also tested the benefits of using pembrolizumab in combination with chemotherapy drugs. But the cost-effectiveness estimates for pembrolizumab in combination with these drugs, which are currently the standard of care, are higher than NICE normally considers acceptable. 

Therefore, following the submission of new data, NICE has recommended pembrolizumab as a solo treatment for these patients. It will not be available as a combination therapy. 

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GPs say elderly are not seeking help for potential cancer symptoms

Press release

Older woman and doctor

53% of GPs say they are concerned that fewer older adults are contacting them with symptoms compared to before the pandemic, according to new findings from Cancer Research UK*.

Other groups they were worried about hearing less from included patients with learning difficulties (40%), those whose first language is not English (35%), people from poorer backgrounds (23%), ethnic minorities (22%) and those with existing health conditions (21%).

The findings come from a September survey of 1,000 UK GPs who were asked to compare their experience to before the pandemic.

While some progress has been made since the first monthly survey in June, with fewer GPs reporting reductions in the number of patients contacting them (62% in June compared to 29% in September), it’s worrying some groups may not be coming forward to get the help they need.

And while some patients have told us about difficulties they’ve had making an appointment, we’re hearing from GPs they are very much open for business and are keen to see as many patients as they can.

Age is the biggest risk factor for cancer and every year more than a third (36%) of all cancer cases in the UK are diagnosed in people aged 75 and over **, so it’s particularly concerning doctors are hearing less from this vulnerable group.

Diagnosing cancer at an early stage means it can be treated more easily and gives the best chance of survival. Covid-19 is making cancer diagnosis more challenging, and progress to see fewer patients diagnosed late is likely to be held up, according to the recently published Cancer Research UK Early Detection and Diagnosis of Cancer Roadmap. ***

Dr Richard Roope, Cancer Research UK’s GP advisor, said: “I’m really concerned that less of my older patients are contacting the surgery and it’s worrying that colleagues across the UK are reporting this too. GP surgeries and hospitals are changing the way they do things to help keep patients and staff safe and people should be reassured that it’s safe to visit them. The first contact is likely to be by phone, and where appropriate a face to face will follow.

 “If you’ve noticed an unusual or persistent symptom like a lump, bleeding, weight loss or pain you can’t explain, tell your doctor, we do want to hear from you. In most cases it won’t be cancer, but if it is, catching it early gives the best chance of successful treatment.  For those who’ve been unable to get through to your surgery, although it might be frustrating, I would encourage you to keep trying.”

Michelle Mitchell, Cancer Research UK’s chief executive, said: “People need to feel reassured that it’s safe to use the health services as we approach a second wave of the pandemic. Diagnosing cancer at an early stage, when treatment is more likely to be successful, is vital to ensure more people survive the disease.

“With a backlog of patients to get through, the NHS needs the support of government now more than ever, so that people can get the care they need. The upcoming spending review is the perfect opportunity for the government to act and provide the equipment and staff required.” 

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