Can a simple breath test detect cancer?
The PAN cancer trial will ask people to breathe into a mask for 10 minutes. Researchers will then try and detect molecules called ‘volatile organic compounds’ (VOCs) to see if they can signal cancer.
The clinical trial will involve both healthy volunteers, to better understand ‘normal’ VOC levels, and patients with a suspected cancer diagnosis to look at whether the level of VOCs in their breath is different. The trial, which began in January 2019, is currently recruiting patients with oesophageal and stomach cancers but will expand to include patients with liver, prostate, kidney, bladder and pancreatic cancers.
Professor Rebecca Fitzgerald (right), Chief investigator of the trial, and co-lead for the Early Detection Programme, Cancer Research UK Cambridge Centre, said: “We urgently need to develop new tools, like this breath test, which could help to detect and diagnose cancer earlier, giving patients the best chance of surviving their disease. Through this clinical trial we hope to find signatures in breath needed to detect cancers earlier – it’s the crucial next step in developing this technology. Owlstone Medical’s Breath Biopsy® technology is the first to test across multiple cancer types, potentially paving the way for a universal breath test.”
If the trial is successful, researchers hope they can identify cancer sooner, reduce the need for invasive testing and roll this simple test out to GP’s surgeries.
The Cancer Research UK Cambridge Centre is running the PAN Cancer trial for Early Detection of Cancer in Breath in collaboration with Owlstone Medical to test their Breath Biopsy® technology.
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Cancer treatment could save millions
The 2.6m PERSEPHONE trial, the largest of its kind and led by Professor Helena Earl (right), Cambridge researchers found 89.4 per cent of women taking six months treatment were free of breast cancer after four years compared with 89.8 per cent of patients taking treatment for twelve months.
In addition, just three per cent of women in the six month study had to stop taking the drug – also called Herceptin – because of heart problems compared with eight per cent of those who took it for 12 months.
The cost saving of a six month, rather than 12 month, treatment is estimated at £9,699 per patient and potential global savings could be in the millions annually.
The study and data from a parallel French trial will be used to explore whether there are subgroups of higher risk women for whom 12 months therapy would remain the most appropriate course.
This new evidence could change practice and will be considered by NICE and NHS England. Women currently taking the medication should not change their treatment without seeking the advice of their doctor.
World-leading genome study spells hope for sick babies
The largest study of its kind in the world, the Next Generation Children’s Project, uses whole genome sequencing that delivers results within a two to three week window in the NHS.
The study found that one in four babies had an underlying genetic condition and that in the majority of the cases, the diagnosis changed their treatment plan.
The advanced genome sequencing will help doctors identify genetic conditions in neonatal and paediatric intensive care units and enable doctors to intervene earlier, manage conditions more effectively, potentially improve outcomes and even save lives.
Importantly, parents who lose a child are more likely to be spared the agony of not knowing the full reasons why, and will be able to make more informed decisions about trying for a family again.
Proving that genomic tests are possible will have an impact on early diagnosis and treatment plans. This study will pave the way for this kind of testing to be offered nationally.
Screening and Treatment for Abdominal Aortic Aneurysm
Abdominal aortic aneurysm (AAA) is an enlargement of the abdominal aorta. It is predominantly found in men over the age of 65, and when it increases in size it can be dangerous and in some cases deadly.
Cambridge researchers led a randomised trial to see whether performing ultrasound screening would identify men likely to develop a dangerous AAA, and investigate if early screening can provide long-term benefits. This was then followed up by a further health economic assessment of AAA screening.
After inviting more than 33,000 men to ultrasound screening and analysing their results against a comparable group not invited, researchers were able to show that population screening of men over 65 could halve the number of deaths from AAA over a 10-year period.
In 2013, the Department of Health in England introduced a national screening programme for men over 65, based on the data from Cambridge researchers which helped shape their policy. A year later Wales, Scotland and Northern Ireland introduced AAA screening for men, and other countries have also adopted the programme.
This national AAA screening programme has saved many lives via early detection and treatment of AAA.
Using nutritional biomarkers to show that not all fats are the same
One way of adding objective information to this picture is to use ‘nutritional biomarkers’ – molecules found in the body that reflect the foods we eat. These can be measured in body tissues such as blood or urine, and can provide helpful additional information.
To improve their understanding of the link between dietary saturated fat consumption and the risk of developing type 2 diabetes, researchers in Cambridge studied saturated fatty acid blood biomarkers as a way to help distinguish between different types of saturated fat.
They developed a sophisticated method of high-speed blood analysis to study biomarkers from thousands of people across eight European countries. They found that saturated fatty acids can be associated with both an increased and decreased risk of developing type 2 diabetes, depending on the type of fatty acids present in the blood.
These findings provide evidence that individual saturated fatty acids are not all the same. And they could partially explain recent other evidence that suggests some foods high in saturated fats, such as dairy products, could actually lower the risk of type 2 diabetes, while other high fat foods, such as red and processed meat, raise its risk.
Work remains to understand more about the precise relationship between what people eat and the chemicals found in their blood. However, in time, these types of findings could be used to help refine dietary guidance for everyone, and even as part of identifying groups of patients who could benefit from personalised lifestyle recommendations.
Alemtuzumab in Multiple Sclerosis
T and B white blood cells normally attack bacteria, but in patients with MS, these white blood cells attack the nerves in the brain and spinal cord. In trials done from 1991 to 2012, researchers found that alemtuzumab stopped the immune system from attacking these nerves. As a result, patients with multiple sclerosis did not get worse, and indeed often noticed an improvement in their disability; this has never been achieved before.
Alemtuzumab was licensed in Europe in 2013 and approved by NICE in 2014. It is now been licenced in over 50 countries, and administered to tens of thousands of people with multiple sclerosis.
Artificial pancreas an international success
Cambridge researchers from the Metabolic, Endocrinology and Bone research theme collaborated with our Women’s Health and Paediatrics theme to develop a world-leading artificial pancreas system (a continuous glucose monitoring device) for people with type 1 diabetes. The system uses smartphone technology to communicate with an insulin pump and a continuous glucose monitor.
The system calculates and delivers the correct amount of insulin needed at any particular time, therefore cutting out the need for injections, improving glucose control and reducing the risk of hypoglycaemia (low blood sugar). The continuous glucose monitor is worn 24/7 meaning that blood sugar levels are continuously measured including through the night leading to less disturbed sleep patterns.
More than 150 children and adults have trialled the device and compared it with the best available therapy in diabetes clinics internationally, including the UK, Germany and Austria. Longer-term trials are ongoing, testing the artificial pancreas in newly diagnosed children and adolescents and young children aged 1 to 7 years old.
Families have their questions answered
These genes were either not previously identified or more commonly changes in the DNA of these genes have been identified as causing a specific rare disease.
More than 400 patients and families have directly benefitted from this research as individual mutations or change in these genes have been identified in the participating families. However, the research contribution has been wider as these gene tests are now available to all clinicians across the NHS who can now offer patients a test for these known genes, if appropriate. Cambridge researchers continue to work with partners to understand rare diseases.
Prostate Cancer Diagnostic Pathways
Clinicians at Cambridge University Hospitals have been working with imaging researchers to carry out Magnetic Resonance Imaging (MRI) targeted prostate biopsies (needles into the prostate to retrieve samples), using MRI-Ultrasound image fusion software.
In 2011, Cambridge was the first centre in the UK to use this technique routinely in the clinical setting, for repeat biopsy in high-risk patients. This practice was subsequently adopted in the 2014 update of the NICE guidelines for prostate cancer. Cambridge researchers developed the Ginsburg group guidelines on how to perform targeted ‘transperineal biopsy’ to allow standardisation of the technique.
The traditional diagnostic pathway of prostate cancer has been changed since 2015; prior to intervention, men now have the MR imaging before undergoing a biopsy.
This pathway has provided clinicians an improved way to identify cancerous tumours in the prostate and has reduced the number of invasive samples being taken and in some cases avoiding a biopsy altogether.
This has allowed clinicians to “get it right first time” and is helping men to be diagnosed faster and start treatment earlier. The Anglian Network Cancer Group has adopted this practice as its Prostate Best Practice Pathway, and NICE have suggested that this practice will form part of their updated 2018 guidelines for prostate cancer diagnosis and management.
Genetic variants found that determine severity of Crohn’s disease
One of the biggest challenges that doctors face in treating Crohn’s disease is that the behaviour of the disease can vary considerably between people, with some experiencing very aggressive disease and others having a much milder form. It was previously thought that the more variants people had, the more likely they would be to have a more aggressive form of Crohn’s disease, but Cambridge researchers have shown that this is not the case.
By comparing the genomes (the complete set of all the genes) of more than 2,700 people who have either mild or aggressive Crohn’s disease, the researchers showed that while there were variants that influenced prognosis, these were different from the variants that caused the disease to develop in the first place.
Finding that the genes involved in determining disease course differ from those that cause Crohn’s disease to develop has wide-ranging and important implications. It suggests, for example, that the best targets for new therapies might not be the pathways that have previously been thought to be important in Crohn’s disease, but rather new pathways in which the prognosis-associated genes are involved. This work – to better understand how these genes might alter prognosis – is ongoing and should provide better ways of treating Crohn’s disease in the future.
New ways to manage vasculitis
B-cells are a type of white blood cells that can produce harmful auto-antibodies which attack the body tissue. This can lead to conditions such as vasculitis, when the immune system attacks blood vessels and it can be serious in some people.
Cambridge researchers have looked at the effect of depletion of B cells with a drug called Rituximab.
Through pilot and controlled studies, researchers have looked at the long-term benefit of Rituximab and how this drug would suit patients with vasculitis. This has led to rituximab being accepted into the NHS commission guidance and national guidelines.
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