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Hospital-level briefings on applications to the cancer drugs fund

These briefings on applications to the cancer drugs fund made by individual NHS acute trusts includes information on the number of applications between 1 September and 30 November 2011, as well as a breakdown of the cancer treatments requested where data has been provided.

Statins ‘may block cancer’

A daily dose of statins has “been shown to block the growth and spread of tumours,” according to the Daily Express. The newspaper reported that common cholesterol-lowering drugs “could be the key to beating cancer”.

The news is based on laboratory research into the role of a specific genetic mutation in the development of breast cancer. The research was mainly carried out in cell cultures, and did not test drugs on humans.

During their experiment researchers grew cells generated from breast cancer tumours carrying the mutation, which is often found in cancers. The researchers then interfered with the effects of this gene mutation, leading approximately half the cells to revert to a more normal structure.

Exploring this phenomenon further they then identified how this gene affects the cells, and tested drugs to interfere with this mechanism. Treating the breast cancer cells with simvastatin, a commonly used statin drug, reduced cancer cell growth and increased cancer cell death to an even greater extent than interfering with the gene mutation alone.

This study provides a potential new target for the treatment of breast cancer, and perhaps other cancers. However, significantly more research will be required before we know if statins or related new treatments can be used as treatments for breast or other cancers.

Does fruit and veg chemical fight cancer?

“A healthy fruit and vegetables diet could help guard against one of the deadliest cancers,” the Daily Express has today reported. The newspaper says this is due to “a potent super-nutrient” found in these foods.

This story is based on research into a chemical called luteolin that is found in a wide variety of plants. The substance has already been found to reduce the growth of bowel cancer cells in the laboratory, and this new study attempted to confirm how it disrupted these cancer cells. In particular, the researchers concentrated on a cellular process that blocks cells from dying naturally and causes cancers to form. After testing luteolin on bowel cancer cells the researchers found that it interfered with this process, which effectively helps to control a cell’s life and death.

The Daily Express has reported that a luteolin-rich diet prevents cancer, but this research was carried out in cells in the laboratory, and did not test the effect of the compound in humans. Also, the luteolin used in this research was in a highly concentrated pure dose, and not from dietary sources. The study demonstrates how pure luteolin reduces the growth of bowel cancer cells in the laboratory, but does not show that a diet high in luteolin-containing vegetables can prevent cancer.

However, there is a great deal of existing research supporting a link between fruit and vegetables and benefits such as a reduced risk of bowel cancer. On this basis, there is already enough evidence to recommend including fruit and vegetables as part of a balanced diet.

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Deodorant chemical ‘found in breast tumours’

“Chemical found in deodorants, face cream and food products is discovered in tumours of ALL breast cancer patients”, reported the Daily Mail. The newspaper said that the chemical, which is widely used as a preservative in cosmetics, has been found in tissue samples of 40 women with breast cancer.

The headline is based on a laboratory study that investigated how a group of chemicals called parabens are deposited in human tissue. It examined the distribution of five types of paraben at four different parts of the breast in tissue samples from 40 women who had undergone a mastectomy due to breast cancer. The researchers detected parabens in 99% of the samples. They also found differences in the concentrations of individual parabens and where they were predominantly located in the breast.

This analysis only looked at tissue taken from 40 women with breast cancer and did not compare them with tissue samples from women who had not had cancer. It does not prove that parabens caused these cancers, and it does not suggest that parabens have any association with breast cancer development. The study found that all 40 women with breast cancer had parabens in their breast tissue, but it is not known whether this would be the case in all women with breast cancer. It is also not known whether parabens would be found in the breast tissue of all women (including those with healthy breast tissue) and men.

The potential link between cosmetic chemicals and cancers will continue to be investigated. Many factors are known to increase the risk of breast cancer, and as the researchers conclude, it is unlikely that any single chemical would be a dominant risk factor.

Processed meat ‘linked to pancreas cancer’

BBC News has reported a possible link between eating processed meat, such as bacon or sausages, and pancreatic cancer. Apparently, consuming only an extra 50g a day – about one sausage – can raise your risk of this rare cancer by 19%.

The news is based on research that combined results from 11 earlier studies that included over 2 million people. It did not find a link between red meat consumption and cancer overall, but suggested that eating an extra 50g of processed meat a day increased the risk of pancreatic cancer by 19%. It is important to note that pancreatic cancer is rare, so even a 19% increase in risk would mean that a person’s lifetime risk of pancreatic cancer would still be very small.

While the review was well conducted, dietary research has inherent limitations. For example, it must rely on people to estimate what they eat, and researchers must account for the influence of other factors such as physical activity, smoking and drinking.

The causes of pancreatic cancer are not fully understood, although it is speculated that age, smoking, certain medical conditions such as diabetes, family history of cancer, excess weight and dietary factors and could all be involved. This study, which focused on meat intake, suggests that processed meats could be involved, although it cannot conclusively prove that this is the case. That said, there is evidence that red meat consumption can contribute to other types of cancer, particularly bowel cancer, so the public has been advised to limit daily intake of red and processed meat.

Fluorescent spray ‘detects oesophageal cancer’

“A throat spray has been developed to spot cancer of the oesophagus at an early stage,” according to the Daily Mail. The paper says that the test “offers hope” to the 8,000 Britons diagnosed with the cancer each year.

Contrary to what the media has suggested, scientists were not trying to develop a way to screen the general population routinely for cancer of the oesophagus (also known as our “food pipe”). Instead, doctors have looked at ways to check for abnormal cells in a very specific condition called Barrett’s oesophagus. People with Barrett’s oesophagus have abnormal cells along their oesophagus that have a a greater chance of becoming cancerous than normal cells.

In this study, scientists developed a fluorescent chemical that latched most strongly onto healthy cells and less strongly on abnormal cells that were becoming cancerous. This allowed them to identify potentially dangerous clumps of cells in the tissue taken from people with Barrett’s oesophagus.

This is early research and the detection technique has so far only been tested in sections of the oesophagus removed from four patients. It is also important to note that this technique is not being assessed as a way to screen the general population for oesophageal cancer, but to detect areas of tissue that are progressing in people who have a condition that predisposes them to this cancer.

The technique will need to be studied further to assess whether it would be feasible, effective and safe in clinical practice and whether it offers real advantages over existing techniques.

Study linking HRT to breast cancer ‘was wrong’

Several newspapers have today reported that HRT does not increase the risk of breast cancer. The reports said that the study that reported the link in 2002 was “fundamentally flawed”.

The original research found that women who had taken HRT were twice as likely to develop breast cancer and more likely to die. The Daily Telegraph and other newspapers reported that these 2002 findings “triggered a collapse in confidence in hormone replacement therapy and the number of women taking it halved”.

Today’s news reports are based on a new analysis of the data from the Million Women Study and two other studies. The researchers wanted to determine whether the association between HRT and breast cancer actually showed that HRT caused an increased risk in breast cancer. They appraised each study against nine criteria that would need to be met before it was possible for the study to say whether HRT caused breast cancer. For example, one criterion assessed was whether the women had taken HRT before they developed their breast cancer. This analysis did not suggest that the original studies were poorly performed but highlighted limitations to what the studies can tell us.

The new analysis found that all three studies failed to meet the majority of the criteria and therefore none of the studies was able to establish whether or not HRT increases the risk of breast cancer.

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Bone marrow cancer gene clues found

A gene defect increases the risk of a type of bone marrow cancer by 30%, the Daily Mail reported.

The news is based on an examination of people with multiple myeloma, a relatively rare type of cancer that starts in the bone marrow and can go on to damage the bones. By comparing the genetics of people with and without the disease, researchers found two genetic variations that were more common in people with multiple myeloma. These variations were associated with a 30% increase in the overall risk of a person developing multiple myeloma. Although it has long been known that relatives of multiple myeloma patients have a greater risk of the disease, this is reportedly the first study to identify genetic variations that are linked to it.

Although researchers identified these genetic variations, it is still unclear why they might increase the risk of multiple myeloma. Further work will be needed before these findings can help us understand more about the disease. It is likely to take considerable time before we know if the discovery can lead to new treatments. Also, not everyone carrying the genetic mutations will get myeloma, and not everyone with myeloma will carry these mutations.

Consultation on a revised version of the Cancer of Unknown Primary Measures

A draft version of the Cancer of Unknown Primary Measures for inclusion in the Manual for Cancer Services has been issued for a 12 week consultation period ending 14 March 2012. This consultation is aimed at interested stakeholders only.

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Charity launches major cancer genetics project

A new initiative to develop ‘personalised cancer treatment’ has today been launched. The experimental project has been designed to develop a screening program to test tumours for key genetic changes. It is hoped that in the future the results of such tests would influence treatment programmes, helping doctors choose the best drug for each person.

The new initiative, called the Stratified Medicine Programme, is being led by Cancer Research UK, the UK Technology Strategy Board and the pharmaceutical companies AstraZeneca and Pfizer. It is hoped that the work will lay the foundations for genetic testing of both patients and tumours to become standard practice, allowing the use of specialised drugs that target specific genes and mutations that can cause or influence the development of cancer.

In addition to laying the foundations for a genetic testing service, the information collected during the programme may be useful for research into new treatments; for example, by identifying new targets and by seeing how genetics affect people’s responses to various cancer drugs. Although people taking part in the early stages of this programme are unlikely to directly benefit, it is hoped that in the long-term, patients will be provided with individually tailored treatments that ultimately prove more effective.

Improving outcomes and experiences for older women with breast cancer

This briefing focuses on the key issues for older women affected by breast cancer and presents recommendations for service improvements in three main areas: early diagnosis; treatment and assessment; and information and support.

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Cancer cases projected to rise 45% in next two decades

The number of new cancer cases in the UK could rise by 45% by 2030 to more than 430,000 a year, research suggests.

The rise is explained almost entirely by the expected increase in the number of people living in the UK and the ageing population.

Cancer Research UK, which funded the study published in the British Journal of Cancer, says the NHS must act now to avoid being “overwhelmed”.

The Department of Health said it was already responding to the challenge.

The research presents projections for 23 different types of cancer. The results are based on taking figures from cancer registries going back to 1975, and then projected forwards to 2030, taking into account expected changes in population.

The study suggests that the number of new cases could rise from about 298,000 in 2007 to 432,000 by 2030 – an increase of 45%. The increase in men is forecast to be 55%, and 35% in women.

Light ‘promising’ in cancer fight

Light is a “promising” tool in the fight against cancer, say researchers in the US.

A study, published in Nature Medicine, showed how a drug could be created which sticks to tumours, but is then only activated when hit by specific waves of light.

It means a treatment can be highly targeted and not damage the surrounding tissue.

A cancer charity said the treatment showed early promise.

Currently, treatments for cancer can be separated into three categories: blasting it with radiation, surgically removing a tumour or using drugs to kill the cancerous cells. All have side effects and scientists are trying to come up with more precise therapies.

In this study, researchers at the National Cancer Institute, Maryland, used an antibody which targets proteins on the surface of cancerous cells.

They then attached a chemical, IR700, to the antibody. IR700 is activated when it is hit by near infrared light. This wavelength of light can penetrate several centimetres into the skin.

To test the antibody-chemical combination, researchers implanted tumours, squamous cell carcinoma, into the backs of mice. They were given the drug and exposed to near infrared light.

2011 thoracic surgical blue book

This audit found that the number of lung cancer patients benefiting from life-saving surgery has risen by 60 percent while the operative mortality rate has halved in recent years as a new generation of specialist lung surgeons start to come through into the NHS. In the last year alone the number of lung cancer operations has increased by more than 17 per cent.

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Aspirin cuts genetic bowel cancer risk

Aspirin cuts the risk of bowel cancer in people with inherited susceptibility to the disease, The Guardian has today reported. The newspaper said that a study of long-term aspirin use found it cut the risk of bowel cancer by more than 60% in these individuals.

The news is based on research that examined how effectively aspirin prevented bowel cancer in over 800 patients with Lynch syndrome, a rare genetic condition that raises the risk of several types of cancer.

The researchers gave half the participants aspirin and the other half a dummy placebo for two years, looking at how many people from each group had developed bowel cancer in the years that followed. When the researchers analysed data on those participants that had completed the full two years of treatment, they found that the group taking aspirin had 63% lower rate of the disease in the 5-10 years that participants were followed.

This well conducted trial was the first to look at aspirin preventing cancer in this way. It suggested yet another use for the humble aspirin pill, which already has proven benefits in fighting heart disease and preventing blood clots. However, it should be remembered that the results apply only to people with this specific genetic condition, which is behind around 2-7% of bowel cancers. Also, regular aspirin is not suitable for everyone as it can cause side effects such as ulcers and stomach bleeds.

Do statins cut breast cancer recurrence?

“A daily dose of drugs designed to lower cholesterol could also slash the risk of breast cancer recurring,” the Daily Mail reported today.

The news is based on the findings of a large Danish study that looked for an association between the use of statins and the recurrence of breast cancer. Researchers followed 18,769 women, for an average of 6.8 years, who had previously been diagnosed with invasive breast cancer. Of these, 17% had been prescribed statins at some point. Compared to women who did not use statins, women who took simvastatin and other “lipophilic” (fat-soluble) statins were less likely to have breast cancer that reoccurred. Those who took “hydrophilic” (water-soluble) statins did not have a reduced risk. However, this type of statin was used by only 6% of the statin users, which limits the strength of this finding.

This type of study can only find associations, and further studies would need to confirm that the lower risk of recurrent breast cancer is caused by lipophilic statins. The findings do not mean that taking a statin provides any protection against developing breast cancer in the first place. Without further study, women who have had breast cancer but who have no medical reason to use statins should not be encouraged to take the medication to try to prevent their cancer from coming back.

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New Evidence Updates from NHS Evidence

‘Improving outcomes for people with skin tumours including melanoma’:

www.evidence.nhs.uk/evidence-update-1 focuses on a summary of selected new evidence relevant to the NICE cancer services guidance manual 2006 (partially updated 2010).

In producing the Evidence Update, almost 3,000 pieces of evidence were searched of which 20 have been chosen for publication. An Evidence Update Advisory Group, comprised of subject experts, has reviewed the prioritised evidence and provided a commentary.

Pill ‘lowers ovarian cancer risk’

Women who take the Pill for 10 years almost halve their risk of ovarian cancer, according to a study.

But experts say this must be balanced against the risk of breast cancer, which is higher in women on the Pill.

For every 100,000 women on the Pill for 10 years there are 50 extra breast cancers and 12 fewer ovarian cancers, data shows.

The study is published in the British Journal of Cancer.

It adds weight to previous research suggesting factors like the Pill and pregnancy can impact on cancer risk by changing the level of hormones in the body.

Dr Richard Edmondson of the Northern Institute for Cancer Research at the University of Newcastle, said: “Women may be reassured to know that the oral contraceptive is not only an effective contraceptive but can have the added benefit of reducing their risk of ovarian cancer.

These results are important because most women don’t know that taking the Pill or getting pregnant can help reduce their risk of ovarian cancer later on in life”

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“This is however balanced against a slightly increased risk of developing breast cancer.

“To put this in context, it is estimated that if 100,000 women use the Pill for 10 years or more, there will be 50 more breast cancers than would have otherwise occurred, but 12 fewer ovarian cancers.

“This may be particularly important for women with an increased risk of ovarian cancer in their family.”

New way to predict breast cancer returning?

Researchers have developed a new breast cancer test “that predicts whether or not their breast cancer will return after surgery”, The Daily Telegraph has today reported. The newspaper says the test may mean that thousands of women with a low risk of recurrence could be spared unnecessary chemotherapy.

The story is based on new research that compared an existing method for predicting cancer recurrence, the Oncotype DX recurrence score (RS), and an adapted version that also took other clinical data into account. To test this new method, called the “recurrence score-pathology-clinical assessment” (RSPC), researchers examined long-term study data on 1,444 women with early-stage, hormone-sensitive cancer that had not spread beyond the breast.

The researchers found that under the RSPC model, more patients were classified as being at low risk for disease recurrence compared to the original test. It did not, however, improve the ability to predict which patients would benefit from receiving chemotherapy. As such, the test should be considered “still in development” and not yet ready for use in practice. Its accuracy and ability to guide treatment choices will now need testing prospectively by applying the model to women with breast cancer before treatment and waiting to see if its results later prove to be accurate.

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Do eggs raise prostate cancer risk?

“Eating just three eggs a week increases chance of men getting prostate cancer,” reported the Daily Mail. The story went on to say: “Experts in theUSclaimed that men who consume more than two-and-a-half eggs on a weekly basis were up to 81% more likely to be killed by the disease.”

This research examined the association between eating red meat, poultry and eggs and the risk of developing lethal prostate cancer (which the researchers defined as either dying from the disease or having metastatic disease that had spread to other organs). The study was in a large group of 27,607 healthy men, of whom 199 developed lethal prostate cancer over 14 years of follow-up. The researchers calculated that the men who ate the most eggs were at a significantly higher risk than those who ate fewer eggs. No significant association was found with any other food item.

This large cohort study has some strengths, such as its large size and the fact that information on the participants’ diet was continually updated over the course of the study. However it also has several limitations, and only a small number of lethal cancers actually occurred, which could suggest that this association is due to chance. Furthermore, these results are inconsistent with previous research, which found no significant association between eggs and prostate cancer. The findings will need to be confirmed in more robust studies before any firm conclusions can be drawn.

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New radiation drug for cancer tested

Several newspapers reported today on a new cancer treatment. The reports said that trials of the new radioactive treatment have been so successful they have been stopped early as it would have been unethical not to offer all the patients the treatment.

The news stories are based on a phase three trial, the results of which have been presented at a conference in Stockholm. The results show that giving a drug called alpharadin to patients with advanced prostate cancer that had spread to their bones, increased the average survival (median) from 11.2 months to 14 months.

Alpharadin is made of a substance called radium 223-chloride and emits alpha particles of radiation – an extremely damaging type of radiation. Alpharadin travels to areas of high bone growth: in this case, the cancer growing in bones.

The increase in survival of the patients treated with alpharadin is significant. This was a phase 3 trial, a stage at which researchers test the safety and efficacy (how well it works) of a drug in a large population.

Importantly, these results are yet to be published in a peer-reviewed journal, and the treatment has not yet been approved by any regulatory authority so it is difficult to say when alpharadin might be available.

Cost of cancer treatment questioned

The Daily Mail has reported that doctors do not support giving life-extending drugs to patients with terminal cancer. The newspaper says that a new report has said the treatments “give false hope and are too costly for the public purse”.

The news story is based on an extensive international report that examined the cost and value of cancer care in developed countries. In the report doctors, health economists and patient advocates voice their opinions and suggest potential policy changes that could make cancer care more affordable for both patients and society. However, the report does not actually suggest that life-extending drugs should be withheld from terminal cancer patients, rather that there is a greater need to understand whether treatments at this stage will actually extend life, and whether resources would be better directed at improving patients’ quality of life through options such as palliative care. The report also suggests several policy areas that could be targeted to improve quality of care while reducing its cost.

This report is likely to stimulate discussions on policy relating to cancer care, but it is not policy itself. The report is of great interest but a broad agreement within the health service would be needed if it were to change the manner in which care is provided in the UK.

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Glowing dye ‘boosts cancer surgery’

Special fluorescent dyes may be able to improve survival after cancer surgery, The Guardian reported. In tests using the dyes, surgeons were able to identify and remove very small areas of cancerous cells in women with advanced ovarian cancer.

In their study, doctors examined 10 women with suspected ovarian cancer and injected them with a fluorescent “tagging” dye that would make cancerous ovarian cells glow under special lights, but leave healthy cells untagged. In photos taken from one woman’s surgery, the fluorescent images helped surgeons identify more areas of cancerous tissue than they could identify by looking at colour photos of the tissue alone. It is hoped that better identification of cancerous tissue would lead to improved staging (telling how advanced the cancer is) and may help surgeons remove a higher proportion of cancerous cells in later surgery aimed at treating the cancer. As with current therapies, women could then be given chemotherapy to try to kill any remaining cancer cells.

This technique is promising, but will need to be tested in larger numbers of women with different stages of ovarian cancer. Longer-term studies will also be needed to test whether using this technique (either as an aid to diagnosis and staging, or to guide therapeutic surgery) reduces the chance of relapse and improves women’s survival.

Important clues to chemo resistance found

“Fish oils block chemotherapy drug,” BBC news has reported. The broadcaster said that tumours could become immune to treatment due to processes involving two fatty acids that are also produced by stem cells in the blood.

This news story is based on research carried out in the Netherlands that examined the role of a specific type of cell, called mesenchymal stem cells (MSCs), in the development of resistance to chemotherapy. Although these non-cancerous cells occur naturally in the body, some research has indicated that they can play a role in tumours growing and spreading. This latest research involved a series of experiments in mice to determine whether these cells were also involved in tumours developing drug resistance. It looked at whether they produced resistance against a variety of chemotherapy drugs. The researchers found that MSCs brought about chemotherapy resistance by producing two specific fatty acids.

This was not a study that looked primarily at dietary consumption of fish oils, and the link between dietary intake of selected fatty acids in humans and mice with resistance to drugs will need further study. However, the study was well-designed and offers detailed insight into the development of chemotherapy resistance. Further research is needed to confirm that the mechanism and results from mice holds true in people. Healthy people who already take fish oil supplements or consume oily fish are safe to continue, and people receiving chemotherapy should always inform their doctor of any drugs or supplements they use.