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Oesophageal cancer is 7th most occurring cancer in men, 13th in women

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Dr Richard Turkington, Senior Clinical Lecturer, Queen’s University, Belfast in conversation with Tarannum Rana discusses the research that the university is conducting on personalised medicine approach, tailoring treatment for cancer and the new oesophageal cancer-detecting test that his team has developed in collaboration with Almac Diagnostic Services

Worldwide, what is the rate of oesophageal cancer and how is it being managed? Why is it so widespread in the UK?
Oesophageal cancer is the seventh most commonly occurring cancer in men and the 13th most commonly occurring cancer in women. There were over 500,000 new cases in 2018. Oesophageal cancer is classified into two main types: squamous cell carcinoma, which occurs in the upper part of the oesophagus, and adenocarcinoma, which develops at the junction of the oesophagus and stomach. Globally, squamous cell carcinoma is the most common type and accounts for the vast majority of cases; however, the proportion of adenocarcinomas is increasing dramatically in affluent nations. The UK has the highest incidence worldwide of oesophageal adenocarcinoma with 9000 cases per year but the causes of this are unknown. Increased rates of obesity causing persistent acid reflux are a factor but does not account for all of the increased incidences.

What is the significance of personalised medicine in oesophageal cancer care and why is there a need for such a device?
Tumours which are localised are treated with chemotherapy prior to being removed by an operation. However, at the time of surgical resection, only around 15 per cent of cases demonstrate a profound response to chemotherapy. A test to predict which tumours would respond to which type of chemotherapy would enable the most effective therapy to be selected for each patient.

How does this device function?
The DNA Damage Immune Response (DDIR) assay is a 44 gene expression signature which utilises routine clinical oesophageal cancer biopsies to generate an assay score.

What are the key indicators/ markers of this device that will determine that a specific amount of chemo is to be delivered to a patient?
Rather than determining the amount of chemotherapy to be delivered, the assay identifies those tumours with a higher likelihood of responding to DNA damaging chemotherapy. We hope that this will allow these patients to receive this treatment and those patients with a low likelihood of response could be offered alternative chemotherapy.

What is its accuracy rate?
At present, the DDIR assay has trialled on a retrospective cohort of 273 clinical samples and is able to be evaluated on 98 per cent of biopsies. Further testing is required in other retrospective and clinical trial datasets to assess the sensitivity and specificity of the assay.

Are there any clinical trials done on this? Can you elaborate on it?
This research used archival samples but, after further validation, we hope to move forward with prospective clinical trials.

Can this technology be utilised in other types of cancer treatments as well?
Yes, this assay was originally developed in breast cancer and can predict sensitivity to both neo-adjuvant and adjuvant chemotherapy in this cancer type. The presence of a sub-group of patients with a high likelihood of response to DNA-damaging chemotherapy is a common theme across a number of cancer types and this assay has the potential to be applied to a number of cancers.

Will the test be cost-effective? What will be its cost?
The test is available commercially for research use from Almac Diagnostics as part of their ClaraT platform and costs are available from the company.

Are there any other cancer study areas that the institution is currently working on?
The Centre for Cancer Research and Cell Biology at Queens University Belfast has a broad range of research programmes covering gastrointestinal, prostate, breast, ovarian and blood cancers.

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