Research being performed across the UK in early detection, personalised treatment, and targeted therapy of cancer show promising steps forward in testing and treatment.
Every two years, worldwide cancer deaths exceed those of combatants in the First World War. The story of cancer is rarely one of hope, rather one of difficult journeys, generally punctuating charity bake-offs in the best case and resulting in personal tragedy at worst.
Though it continues to pervade society, recent developments in testing, categorisation of treatment and new methods have provided some hope in how science tackles the disease.
“There is no magic bullet, but there’s room for optimism,” noted Devi Sridhar, chair of global public health at the University of Edinburgh, in The Guardian this week.
Spotting lung cancer
Lung cancer is the UK’s most common form of cancer death, yet recent advances have proven effective in catching the disease in its earliest stage – in which it has a five-year survival rate almost 13 times that of if it were caught late.
Local health teams in England have begun performing comprehensive lung health checks on current and past smokers as part of the NHS lung cancer screening programme, using mobile scanning units parked on England’s high streets and supermarket car parks to check those deemed at risk.
The NHS is attempting a nationwide rollout of this programme, aiming for more than six million across England to be invited for a checkup.
“The Lung Cancer Screening Programme has been designed around where people already are… [making] it easier for people to get checked” said Peter Johnston, NHS England national clinical director for cancer.
Furthermore, a team of Cambridge scientists have discovered a urine test capable of detecting early signs of lung cancer months before symptoms appear. The researchers developed an injectable sensor which monitors the rate of harmful senescent cells, also called Zombie cells, within the lungs. Upon discovery, the sensor triggers the release of a detectable compound in urine, displaying biological signs of both early cancer and treatment resistance.
The urine test shows promise as a leap forward in precise testing and treatment of lung cancer. Although the treatment has not been tested on humans, Ljiljana Fruk, professor of BioNano Engineering at the University of Cambridge, is confident that “it could one day be used easily in GP surgeries and hospitals to help detect recurrence in this hard-to-treat cancer much earlier”.
These breakthroughs demonstrate a much-needed sign of confidence in how we deal with various prevalent cancers. “We’re living in a golden age of research, which is powerfully underlined by this innovative new urine test to detect early lung cancer,” said Patrick Keely, spokesperson for independent cancer research organisation Cancer Research UK.
Gene genie
Within the field of treatment categorisation, an international clinical trial, the OPTIMA trial (Optimal Personalised Treatment of early breast cancer using Multi-parameter Analysis), at University College London, has designed a gene test to help breast cancer patients safely avoid chemotherapy.
Worldwide, chemotherapy is regularly given to people with early-stage breast cancer.
While this is effective overall, it leads to sometimes dangerous side effects, therefore, the use of the genomic test Prosigna, which measures the activity of genes involved in breast cancer growth and identifies the likelihood that this cancer may return over the next 10 years, could lead to a more tailored treatment. This represents a potential breakthrough in terms of effective use of treatment.
“For patients, this means many may be spared the physical and emotional burden of chemotherapy and its potential long-term side effects. For health systems, it represents a more efficient and evidence-based use of resources,” said Rob Stein, professor of breast oncology at the UCL Cancer Institute
In the study of 4,429 people, the control group faced standard treatment while the test group was given hormone-based therapy guided by the Prosigna test. It saw only marginal differences in five-year outcomes. These findings indicate that using Prosigna to guide treatment decisions could help a substantial number of patients avoid unnecessary chemotherapy without compromising their outcomes.
“These findings represent a major step forward in delivering more personalised, precise care, ensuring that treatment decisions are driven by what will genuinely improve outcomes for patients, while avoiding unnecessary toxicity,” said Iain MacPherson, professor of breast oncology at the University of Glasgow.
Tumour shrinkage
Targeted antibody therapy research at the Institute of Cancer Research in London and the Royal Marsden NHS Foundation Trust has shown early signs of tumour shrinkage when combined with advanced chemotherapy in patients suffering from bowel cancer.
The ongoing ozekibart INBRX-109 clinical trial, still in the early stages of human study, has delivered a 20% tumour shrinkage rate in patients with advanced colorectal cancer who had seen poor results from traditional chemotherapy, including one case of complete response.
Of the 45 patients studied, disease control was achieved in 39 – with side effects being largely comparable to those of chemotherapy alone.
The ongoing perspective of researchers is one of optimism, with Hazel Lote, consultant medical oncologist at The Royal Marsden NHS Foundation, calling it “a promising new treatment option”, particularly in those for whom traditional treatments have failed.
Further research into providing treatment to chemotherapy-resistant cancers has been seen in an international trial of the Amivantamab injection, intended for patients with head and neck cancers. The injection targets cancers by blocking growth receptors responsible for tumour development, as well as activating the immune system in order to attack cancer cells.
This has seen success; among 102 patients, 43 experienced significant tumour shrinkage, while 15 saw their tumour disappear entirely.
“These are unprecedentedly strong responses in patients whose disease has become resistant to both chemotherapy and immunotherapy,” said Kevin Harrington, professor in biological cancer therapies at The Institute of Cancer Research, noting the benefits for patients for whom treatment options are incredibly limited.
In addition to the effectiveness of the jab, its injectable nature makes it far easier to take and less intrusive. This makes outpatient care simpler and leads to meaningful quality-of-life improvements. Recent tests on the Johnston & Johnston-developed Amivantamab have proved effective in tackling lung cancer, with encouraging results in colorectal, brain and gastric cancers as well.
Naturally, triumphalism must be avoided with these results, as researchers so readily caution. Despite this, sustained cutting-edge research being performed across the UK in early detection, personalised treatment and targeted therapy makes the government’s plan of a 75% five-year survival rate by 2030 less of an aspiration, and more like a target.
