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10th February 2020
Scientists forced cancer cells in the lab to evolve much more rapidly than usual using a molecule called APOBEC3B, which is often used by tumours to drive rapid genetic change and drug resistance.
They found that these highly mutated cancer cells could be used to create a vaccine for each individual cancer type, which amplified the effects of immunotherapy – and cured mice with a variety of otherwise treatment-resistant tumours.
The international study – carried out by scientists at The Institute of Cancer Research, London, the Mayo Clinic in Rochester, US, and the University of Leeds – is the first to show that APOBEC3B’s role in driving cancer evolution can be used to create vaccines that can boost the immune response.
The researchers want to take their new technique for creating personalised vaccines into the clinic as early as next year – starting with a trial in children with brain tumours.
The findings have been published in Nature Communications.
The researchers first showed they could drive rapid genetic changes in human cancer cells in the lab using high levels of APOBEC3B, which is able to edit the DNA code of cells, giving rise to genetic changes that can be seen as ‘signatures’ or ‘footprints’.
The genetic analysis revealed more than a million extra mutations in the cells expressing APOBEC3B, compared with control cells. Of these, around 68,000 contained the classical APOBEC signature. These genetic signatures made cancer cells vulnerable to treatment with immune checkpoint blockade, a major strategy in immunotherapy.
However, by generating new genetic changes, APOBEC3B can also drive cancer evolution and help cancer cells become resistant to chemotherapy. So rather than give APOBEC3B directly to tumours as a treatment, the researchers instead used the genetic signature it left behind to create individual cancer vaccines, each tailored to the particular genetic profile of a specific tumour.
They gave mice highly mutated cancer cell vaccines, in the form of mutant cancer proteins, and these elicited an immune attack against their tumours as they were immediately detected as ‘foreign’.
By combining the individualised tumour vaccines with checkpoint inhibitor immunotherapy, the researchers were able to cure melanoma and brain tumours in mice.
The next step is further preclinical research to translate these findings further into human cell systems, with the aim to take the vaccine technique into clinical trials for paediatric brain tumors within the next year.
The Institute of Cancer Research (ICR) has been focusing on increasing its understanding of APOBEC protein molecules, which are crucial to the ability of the immune system to adapt to different infectious diseases – but are also hijacked in many cancers to speed up evolution of drug resistance.
The potential of APOBEC inhibitors to slow down cancer evolution is enormous. This study now demonstrates that APOBEC3B could also be used to increase the effectiveness of new treatments that use immunotherapy to attack tumours.
The ICR – a charity and research institute – is creating a new £75 million Centre for Cancer Drug Discovery to study molecules like APOBEC3B, with the aim of creating new cancer treatments that can overcome the major challenge of cancer evolution and drug resistance. The ICR has less than £10 million left to raise to deliver the new building.
This study was supported by a variety of funders – the National Institute of Health, the European Research Council, the Richard M Schulze Family Foundation, the University of Minnesota and Mayo Clinic Partnership, Cancer Research UK, the Shannon O’Hara Foundation, Hyundai Hope On Wheels, and a research grant from Oncolytics Biotech.
Study author Alan Melcher, Professor of Translational Immunotherapy at The Institute of Cancer Research, London, said: “Our new study rather paradoxically takes advantage of a mechanism used by cancers to rapidly evolve and become resistant to chemotherapy, and instead makes them much more vulnerable to the effects of immunotherapy.
“We have supercharged genetic changes in cancer in order to create cancer vaccines, which are tailored to the genetic code of these tumours, and can boost the immune response against them.”
“By combining our vaccines with checkpoint inhibitor chemotherapy, we’ve shown in mice that it’s possible to cure tumours in a variety of locations, including the brain. Our new approach has the potential to be effective against cancers that do not currently respond to treatment, and we’re keen to take it into clinical trials as soon as possible.”
Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said: “Cancer’s ability to evolve and become drug resistant is the biggest challenge we face in treating the disease more effectively. But this exciting new study also suggests it is possible to use a key evolutionary mechanism against cancers, by forcing them to accumulate genetic mutations that are able to spark the immune system against them.
“This is a terrific example of the kind of exciting research into cancer evolution and drug resistance that will be the focus of our pioneering £75 million Centre for Cancer Drug Discovery, and which we hope will deliver entirely new types of cancer treatment.”
Co-author Dr Adel Samson, from the University of Leeds’ School of Medicine, said: “Adult cancers are caused by an accumulation of genetic mutations, which can provide resistance to conventional chemotherapy drugs. However, the same mutations make it possible for the immune system to detect and kill the cancer.
“This study demonstrates how we might apply this concept to future therapeutic cancer vaccines, by artificially mutating patient-derived cancerous cells in the laboratory, then injecting the mutated cell proteins back into the same patient. In doing so, this immunotherapy would be able to trigger an immune response against both the artificially mutated proteins, as well as the closely related cancerous cells originally present in a patient.”
But a recent survey carried out by the Association for Perioperative Practice has highlighted that these issues could extend far beyond nurses and in fact appear to be prevalent in an area where patient safety is equally as vital; the operating theatre.
According to the survey of just under 800 theatre practitioners, an alarming 86% feel concerned about staff wellbeing and the effect it is having on patient safety, with the results indicating that bullying is one of the major factors raising their concern.
Of those who took part, again 86% said they had witnessed bullying within the perioperative environment on more than one occasion, with 71% of these stating they had also been a victim of bullying themselves.
In addition, when asked whether they would feel able to speak up and report the instances of bullying towards them, whilst 73% said they felt they could, over a quarter of respondents said they felt they would be too scared to make a formal complaint.
Whilst bullying in the operating theatre was the biggest concern for respondents, the survey also indicated that an alarming number of theatre practitioners – 39% – are often asked to do things that fall outside of their scope of practice.
What’s more, 25% of these indicated that when asked to perform things they are not qualified to or allowed to do under their scope of practice, they felt too scared to say no.
Commenting on the results of the survey, Dawn Stott CEO of the association said: “We are all very aware of the concerns about poor mental health amongst perioperative professionals but it’s alarming to hear about the impact practitioners feel it’s having on patient safety.
“It’s more important than ever that we find ways to improve the negative culture within operating theatres and help practitioners maintain the high quality of patient care they expect and strive to provide.”
The independent, anonymous online survey was completed by 712 theatre practitioners from across the UK, all of who stated they were registered healthcare professionals and whose roles fell under the umbrella of operating department practitioners, theatre nurses, scrub nurses, anaesthetists or recovery nurses.
The results constitute phase one of AfPP’s survey analysis, which will be published in three phases as part of their Caring for those who Care campaign.
The campaign, which will look at how best to improve negative cultures within the operating theatre as well raising awareness of the impact on patient safety, will be a core focus for AfPP throughout 2020.
Edith Cowan University’s Melanoma Research Group, in collaboration with Harvard Medical School and clinicians at Western Australian hospitals, has pioneered a new technique to detect circulating tumour cells (CTCs) that could provide a new avenue for cancer diagnosis and therapies.
This work builds on the continued success of the Melanoma Research Group, who developed the world’s first blood test capable of detecting melanoma in its early stages.
Lead researcher Associate Professor Elin Gray said this new step was the first study to comprehensively describe the immense diversity found in melanoma CTCs.
“These preliminary findings are a first step towards a new way to stop melanoma from spreading around the body,” Professor Gray said.
“Cancer spreads around the body when CTCs shed from the primary tumour and travel through the blood to form secondary tumours (metastases) in other organs.
“If we can find a way to reliably detect these cells, then we have a chance to stop melanoma in its tracks with a powerful diagnostic tool and perhaps opportunities for therapies in the future.”
Like a needle in a haystack
Until now melanoma CTCs have proved to be incredibly elusive, with detection rates wildly varying from 40 to 87%.
Professor Gray said this ECU-led research has explained why CTCs have been so hard to find.
“We now understand that CTC detection cannot be resolved with a one-size-fits-all approach,” she said.
“There is a huge amount of variety in the shape and bioactivity of these CTCs and so they all look different and respond differently to assay tests.
“To complicate things further, melanoma CTCs are hidden among thousands of other cells and matter in blood. Within one millilitre of blood, there are often fewer than 10 cancer cells among one billion red cells and one million white blood cells.
“It is much like finding a needle in a haystack.”
A new approach
Armed with a better understanding of the complexity of the task, the researchers tried a multifaceted approach to detecting melanoma CTCs.
“By combining three assays together, we raised detection rates to 72%, which was a significantly and consistently higher result than using one test,” Dr Gray said.
“We are confident this approach is a move towards the reliable detection of CTCs, but we now need to tweak the assay to include a better combination to capture the broadest range of CTCs.”
The ECU Melanoma Research Group is now working with artificial intelligence experts to fast-track the identification of CTCs.
The latest research was published in the British Journal of Cancer.
In the paper, published in the Journal of Investigative Dermatology, researchers found that 50% of skin rashes in patients with lupus contained an abnormally high presence of a common bacteria responsible for skin infections: Staphylococcus aureus, or more commonly known as staph.
“Fifty percent of the patients we investigated were colonised by staph, which means the person with the rash is a carrier for the bacteria and can spread it to others,” says J Michelle Kahlenberg, MD, PhD, associate professor of rheumatology at Michigan Medicine and senior author of the paper.
“In addition, we identified that a protein in the skin of patients with lupus, called interferon, increases the stickiness of staph aureus to their skin.”
Kahlenberg had already done previous studies into interferons of the skin of patients with lupus.
“Because our previous work has shown the importance of interferons for sensitivity to sunlight and inflammation in lupus, we then wanted to study whether the interferons and staph were linked,” she says.
Kahlenberg notes that while skin rashes are a common side effect of lupus, she and her team were surprised by the abnormally high presence of staph colonisation on the rashes.
“Using a University of Michigan lupus cohort, we found that patients with lupus had staph colonisation on their skin at a rate higher than that reported in healthy adults – 40% compared to 30%,” Kahlenberg says. “And when the patients with lupus had active skin rashes or lesions, that rate increased to 50%.“
Kahlenberg says the focus on staph bacteria began because it’s a leading cause of infection in patients with lupus.
“Others have shown it may be associated with disease flares and development of lupus nephritis, or inflammation of the kidney in patients with lupus,” Kahlenberg says.
She is currently enrolling patients in a clinical trial that is testing whether topical antibiotics can decrease inflammation and rashes in the skin of patients with lupus.
“This is important because if true, the addition of topical antibiotics may be a simple way to improve treatment response in lupus skin and reduce the ability for those rashes to be colonised by staph,” Kahlenberg says.
7th February 2020
If doctors see bleeding in patients with atrial fibrillation, they may assume that it is due to oral anticoagulant drugs and alter the treatment rather than check for bowel cancer; but the study of nearly 125,500 Danish patients with atrial fibrillation shows that those who experienced bleeding were between 11- and 24-times more likely to be diagnosed with bowel cancer, compared to patients who did not have gastrointestinal bleeding.
Dr Peter Vibe Rasmussen, from Herlev-Gentofte University Hospital, University of Copenhagen, Denmark, who led the research, said: “We found that between 4% and 8% of atrial fibrillation patients who experienced bleeding from their lower gastrointestinal tract were diagnosed with bowel cancer. Less than 1% of patients were diagnosed with bowel cancer if they did not have bleeding.
“These high absolute risks of bowel cancer associated with bleeding provide a strong argument that if blood is detected in the stools of patients being treated with oral anticoagulants, this is something doctors should worry about. Our findings underline the important point that patients with gastrointestinal bleeding should always be offered meticulous clinical examination, irrespective of whether or not they are taking anticoagulants. It should not be dismissed as a mere consequence of anticoagulant treatment.
“Our study is also a reminder that educating and informing our patients is of utmost importance. When patients start taking anticoagulants, we should tell them that if they see blood in their stools they should always consult their doctor. Timely examination could potentially provide early detection of bowel cancer.”
Patients with atrial fibrillation are often prescribed oral blood-thinning drugs, such as warfarin, dabigatran, rivaroxaban and apixaban, to prevent the formation of clots that can lead to stroke. However, bleeding from the gastrointestinal tract can be a side effect and is estimated to occur in about 1-2% of these patients each year.
Dr Vibe Rasmussen said: “Cancer in the lower part of the digestive system develops over extended periods of time often without showing any symptoms. These tumours are called occult cancers. As a consequence, the cancer is most often not diagnosed until the patient experiences symptoms. Treatment with blood thinning medication, as often recommended in patients with heart disease, increases the risk of bleeding from the gastrointestinal tract. In this study we wanted to test the hypothesis that bleeding induced by oral anticoagulants could be due to the unmasking of an undiagnosed occult cancer.”
The researchers identified all patients aged between 18 and 100 years with a diagnosis of atrial fibrillation between 1 January 1996 and 31 December 2014 from the Danish national registers. Patients who took any oral anticoagulant were included in the study and were followed until the end of 2015. After excluding some patients for reasons such as not living in Denmark, already having a bowel cancer diagnosis, or having recently had hip or knee surgery, there was a total of 125,418 patients eligible for inclusion in the study.
During a maximum of three years of treatment, the researchers identified 2576 patients with bleeding from the lower gastrointestinal tract. Of these, 140 were diagnosed with bowel cancer within the first year after the bleeding was detected.
The risk of bowel cancer being diagnosed in the first year after bleeding depended on the patients’ age. Patients aged 65 or younger with bleeding were 24-times more likely to have bowel cancer detected than those of the same age without bleeding, while older patients (aged 71 to 75 years) with bleeding were 11-times more likely to have bowel cancer than those without bleeding.
Dr Vibe Rasmussen said: “We found the highest absolute risk of bowel cancer after bleeding among patients aged 76-80 years; 8% of patients in this age group were diagnosed with bowel cancer within the first year after bleeding.”
The researchers point out that with an aging population in many countries, the prevalence of atrial fibrillation is increasing, more people are treated with blood-thinning drugs and so gastrointestinal bleeding is likely to occur more frequently.
There is no suggestion that oral anticoagulants cause bowel cancer.
The main strength of the study is its large size and the fact that it included everyone in Denmark diagnosed with atrial fibrillation. Limitations of the study include: it is an observational study; there were no data available about risk factors such as alcohol consumption, dietary habits and obesity; adherence to oral anticoagulant therapy was assumed on the basis that patients were collecting their prescriptions; and selection bias may have occurred due to the fact that patients with more severe bleeding, combined with other, potentially cancer-related symptoms, are more likely to be referred for further investigation than patients with light bleeding and without any other symptoms.
The study, conducted at Trinity’s Centre for Health Policy and Management and The Irish Longitudinal study on Ageing (TILDA), estimated how many people will die from a serious disease such as cancer, heart disease, organ failure and dementia to 2046. The estimated 84% increase compares to 43% for England and Wales in a similar period.
Projected increases are underpinned by two factors of population ageing: increasing absolute numbers of people dying, and increasing proportion of people who experience a serious illness prior to death. Increases are most observable in the 85+ age group, which is growing rapidly. The difference with England primarily reflects Ireland’s population, which is now younger than the EU average and so will have faster-growing needs in the 21st century.
Palliative care is a type of specialist supportive care that aims to improve quality of life for people living and dying with serious illness. It is provided in Ireland in hospitals, by homecare teams and at inpatient hospices.
Professor Karen Ryan, Consultant in Palliative Medicine at the Mater and St Francis Hospice, and Clinical Professor in the School of Medicine at UCD, said that the results indicate an urgent need to address funding and workforce in palliative care: “Ireland is recognised to have a high standard of palliative care provision. Our data show that capacity must increase significantly if we are to maintain that.
People are living longer with more serious illnesses. This is a success story for society but also brings challenges.
Sláintecare priorities include a revised national palliative care policy in 2020 and we hope that our results will inform this review, so that people dying with serious illness and their families receive the care and support they need during this unique life event.”
The study also estimated numbers of people who will live with serious illnesses requiring expert support in the years prior to death. They found that the number of people living with a serious disease outnumber those in the last year of life with a serious disease by about 12:1.
Dr Peter May, Research Assistant Professor in Health Economics at Trinity and lead author of the study, said that this has important implications also:
“Population ageing means not only more people dying with serious medical conditions but many more people living with them also.
The highest average illness burden and health care need is of course among those near the end of life. But total population needs will be driven by all people experiencing these conditions.
“Health care provision has to change to reflect those needs. We need better anticipatory and supportive care to lower avoidable hospital admissions and keep people living at home and in their communities for as long possible.”
6th February 2020
Vitamin D has been termed the sunshine vitamin because the majority of body stores comes from exposure to UV radiation.1 Vitamin D plays an important role in facilitating absorption of dietary calcium and phosphorus,2 calcium homeostasis and the stimulation of bone resorption. Calcium also has a vital role in bone health and virtually all of the body’s calcium is found in bones, where it is required for the normal growth, development and maintenance of the skeleton.3 Sufficient dietary intake of calcium can be achieved through foods such as dairy products including milk, cheese and yoghurt and some green vegetables.
One of the biggest risks of reduced bone mass is osteoporosis which represents a significant cause of both morbidity and mortality. The condition is characterised by an impairment of bone mass, strength and microarchitecture that increases the risk of a fracture.4 In the UK there are approximately 536,000 new fragility fractures each year with an estimated cost to the NHS of over £4.4 billion in 2010.5 The role of both calcium and vitamin D in bone health was deemed sufficiently important to be incorporated into a UK clinical guideline as a lifestyle measure recommended for the prevention of fractures.5 The guideline suggested that an adequate intake of calcium and vitamin D were 700 to 1200mg/day and 400IU, respectively.
However, the available evidence does not appear to support this recommendation and in a US preventative services task force report, it was concluded that there was insufficient evidence to assess the benefits and harms of vitamin D and calcium supplementation for the primary prevention of fractures.6 This position statement was strengthened by a systematic review of fracture incidence in 33 randomised trials in over 51,000 patients supplemented with vitamin D and calcium, which concluded that supplementation was not associated with a lower risk of fractures in older adults.7 In a systematic review focusing solely on vitamin D supplementation in musculoskeletal health, the authors concluded that “our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density.”8 A network meta-analysis published in the BMJ in 2019 also confirmed no benefit from the routine supplementing of vitamin D and calcium in reducing the risk of fractures.9
With a lack of good evidence, it would seem that supplementing with either vitamin D or calcium is not worthwhile. Yet another systematic review on the topic was published in JAMA in December 2019, which this time reached a different conclusion.10 Although the analysis confirmed the earlier finding that vitamin D alone was not beneficial, this new analysis found that the combination was effective. The authors found that combining calcium (in the range 800 to 1200mg/day) and vitamin D (400 or 800IU/day) resulted in a 6% reduced risk of any fracture (95% confidence intervals, 0.89–0.99) and a 16% (95% confidence intervals, 0.72–0.97) reduction in hip fracture. This new analysis was based on a total of six controlled trials which included over 49,000 patients, with an average age of 66 years, treated for approximately 6 years. Though the analysis suggested that combined supplementation was an effective strategy to reduce fracture risk, the authors note that five of the trials had a high risk of bias and that the upper limit of the 95% confidence intervals were very close to 1.0 (that is, indicating that there was no effect), signifying some uncertainty in these estimates.
Should clinicians continue to prescribe these supplements to all patients?
This question is particularly relevant given the potential for calcium supplements to increase cardiovascular risk in the elderly.11 Evidence from studies in the very elderly (mean age 85 years) indicates that supplementing does reduce the risk of hip fractures,12 especially when patients are deficient in these supplements. It remains uncertain if other patient groups would derive the same benefit from supplementing but, based on the evidence, it seems any likely advantages would be marginal.
With several ongoing trials exploring the value of supplementing with high dose vitamin D on fracture risk, any additional benefits from this approach remain to be seen.
References
1. Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther 2010;23(1):48–60.
2. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357(3):266–81.
3. Flynn A. The role of dietary calcium in bone health. Proc Nutr Soc 2003;62(4):851–8.
4. Rachner T, Khosla S, Hofbauer L. Osteoporosis: now and the future. Lancet 2011;377:1276–87.
5. Compston J et al. UK Clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2017;12(1):43–68.
6. US Preventative Services Task Force. Vitamin D, Calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults. JAMA 2018;319:1592–9.
7. Zhao JG et al. Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults. A systematic review and meta-analysis. JAMA 2017;318:2466–82.
8. Bolland MJ, Grey, A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol 2018;6(11):847–58.
9. Hu ZC et al. Comparison of fracture risk using different supplemental doses of vitamin D, calcium or their combination: a network meta-analysis of randomised controlled trials. BMJ Open 2019;9:e024595.
10. Yao P et al. Vitamin D and calcium for the prevention of fracture. A systematic review and meta-analysis. JAMA Netw Open 2019;2(12):e1917789.
11. Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk: 5 years on. Ther Adv Saf 2013:4(5):199–210.
12. Chapuy MC et al. Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: The Decalyos II study. Osteoporosis Int 2002;13:257–64.
4th February 2020
To mark the 20th anniversary of World Cancer Day, UICC commissioned a global survey to form an up-to-date picture of the public’s experiences, views, and behaviours around cancer. Conducted by Ipsos, the survey includes more than 15,000 adults across 20 countries in the first multi-country public survey on cancer perceptions in a decade.
The survey’s results, detailed in UICC’s report released today, International Public Opinion Survey on Cancer 2020: What people feel, think and believe about cancer today, indicate a clear divide between higher and lower socioeconomic groups when it comes to knowledge and awareness of cancer risks and, as a result, the practice of behaviours to limit such risk.
Chief Executive Officer, Union for International Cancer Control, Dr Cary Adams said: “It is unacceptable that millions of people have a greater chance of developing cancer in their lifetime, because they are simply not aware of the cancer risks to avoid and the healthy behaviours to adopt – information that many of us take for granted. And this is true around the world.”
Awareness of cancer risks
The survey’s results show that there is generally a high level of cancer awareness among the surveyed population globally. Tobacco use (63%), exposure to harmful UV rays (54%) and exposure to tobacco smoke from others (50%) appear to be the most recognised factors that can increase a person’s risk of cancer. Meanwhile, a lack of exercise (28%), exposure to certain viruses or bacteria (28%) and being overweight (29%) appear to be the least recognised cancer risk factors.
However, individuals from a lower-income household bracket in the countries surveyed are less likely to recognise cancer risk factors than those from higher-income households. In all areas except tobacco use, this trend can also be seen when comparing people surveyed who have not completed a university education to those with university educations.
Practicing cancer prevention
Irrespective of where people live in the world, those surveyed with a lower education and those on lower incomes appear less aware of the main risk factors associated with cancer and appear less likely to proactively take the steps needed to reduce their cancer risk than those from a high income household or with a university education.
What should be done: Prioritising awareness raising to support health-promoting behaviours
An overwhelming 84% of individuals surveyed felt that governments should be taking action in relation to cancer whilst nearly a third of individuals surveyed believed that it is most important for governments to improve the affordability of cancer services – a measure notably emphasised by people surveyed in lower middle-income countries.
UICC President HRH Princess Dina Mired of Jordan said: “To tackle the global cancer burden now and for the future, governments and decision makers across the international cancer community must come together to ensure that everyone is afforded every opportunity to take control over their cancer risk – no matter their education or income level.”
To help raise greater awareness around cancer and to support health-promoting behaviours so that no one gets left behind, UICC is calling for all governments to:
Prioritise cancer awareness raising and prevention through progressive health policies and education to support healthy decisions and health-promoting behaviour, with a focus on engaging lower socioeconomic populations
Ensure the public is provided with up-to-date information on cancer risks and cancer prevention, and importantly that the information is presented and delivered in a way that is accessible by individuals from lower socioeconomic backgrounds
Implement policy to help reduce the consumption of known cancer-causing products (for example, tobacco, sugary food and beverages), to encourage health-promoting behaviours, particularly among lower socioeconomic groups
Invest proactively in national cancer control planning and the establishment of population-based registries to ensure the most effective resource allocation that benefits all groups
Continue to raise awareness with each new generation to help ensure that up-to-date information on cancer risks and cancer prevention is not taken for granted
As part of World Cancer Day’s ‘I Am and I Will’ campaign, which calls on each person to make a commitment – big or small – UICC recommends that everyone:
Use World Cancer Day as an opportunity to improve your understanding of cancer risk factors and share your knowledge with others
Make a personal commitment to reduce your cancer risks like quitting smoking, eating healthily, exercising regularly, and using sunscreen
Take advantage of what your health system can provide, including getting a check-up, getting screened, and getting vaccinated
3rd February 2020
Attended by over 40 people representing patients, the medical community, and the pharmaceutical industry as well as political advisers and Members of the Scottish Parliament, the Group agreed to write to the First Minister of Scotland, Nicola Sturgeon and Cabinet Secretary for Health & Sport, Jeanne Freeman to request urgent consideration of a screening programme in Scotland for people at risk of developing lung cancer.
Survival rates from lung cancer by patients diagnosed in Scotland is among the lowest in Europe and lung cancer is the biggest killer of all cancers.
“Many more lives could be saved if lung cancer was diagnosed earlier through a screening programme” said Dr Adam M Hill, Chief Executive of Oncimmune who was a guest speaker at the Cross Party Group meeting. Dr Hill presented the findings of a recent trial in Scotland among 12,000 high risk people using a simple blood test, called EarlyCDT® Lung, in conjunction with CT scanning, to detect lung cancer.
The trial, known as Early Detection of Lung Cancer in Scotland (ECLS), showed that the blood test can improve the likelihood of early detection by 14% thereby potentially saving thousands of lives across the UK.
Lung cancer survivor, Rebecca Allison from Glasgow was one of the participants in the trial and she told her story to the Cross Party Group. “I was one of the lucky ones, my lung cancer was detected early with the blood test, despite it not showing up on scans and I had no symptoms. We need this blood test across the UK – it would save so many lives.”
Lung cancer is one of the most prevalent forms of cancer and kills more women than both breast and ovarian cancers. Five year survival rates for breast and bowel cancer patients are 86% and 59% respectively. Both these cancers have screening programmes. Five year survival for lung cancer, which has no screening programme, is less than 10%.
Professor Bob Steele, Director of the UK National Screening Committee attended the meeting and admitted during the questions that a recommendation on screening for lung cancer should be prioritised and that the blood test could have a role in this, particularly if it “reduced the number of people having unnecessary CT scans”.
“The positive CHMP opinion for this new indication in chronic lymphocytic leukaemia is an important step forward for patients and underscores the growing utility of Venclyxto in treating this common blood cancer,” said Neil Gallagher, MD, PhD, chief medical officer and vice president of development. “If approved by the EC, the venetoclax and obinutuzumab combination would be the first chemotherapy-free option for treatment-naïve patients with chronic lymphocytic leukaemia where dosing can be completed in one year.“
The CHMP positive opinion is based on results from the Phase III CLL14 clinical trial, which evaluated the efficacy and safety of Venclyxto in combination with obinutuzumab compared with chlorambucil in combination with obinutuzumab. The primary endpoint was progression-free survival (PFS; the time on treatment without disease progression or death) as assessed by an investigator. At the time of analysis, investigator-assessed results demonstrated that patients treated with Venclyxto plus obinutuzumab achieved superior PFS compared to patients treated with obinutuzumab plus chlorambucil. Adverse events were consistent with the known safety profiles of venetoclax and obinutuzumab alone. At least one AE of any grade occurred in 94.3% of patients in the venetoclax combination arm, with the most common Grade 3/4 AEs in patients being febrile neutropenia and infections. Tumour lysis syndrome (TLS) was reported in three patients in the venetoclax plus obinutuzumab group (all during treatment with obinutuzumab and before venetoclax). Results from the CLL14 trial were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting and published in the New England Journal of Medicine.
“Chemotherapy has historically been the first treatment for patients with chronic lymphocytic leukemia. If the venetoclax plus obinutuzumab combination is approved in the EU, previously-untreated patients will, for the first time, have a chemotherapy-free, fixed-duration treatment option,” said Michael Hallek, MD, lead investigator of the CLL14 study, Director of the Department of Internal Medicine and Center of Integrated Oncology Cologne-Bonn at the University Hospital Cologne in Germany, and Head of the German CLL Study Group. “The early use of venetoclax plus obinutuzumab combination has the potential to change the treatment paradigm for chronic lymphocytic leukemia as it has been demonstrated to improve outcomes, allowing patients to live longer without disease progression.”
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