Personalised medicine approach to individuals could lead to patients having tumours successfully removed, improving their prognosis and quality of life
The researchers at Queen’s University Belfast and the University of Cambridge, in partnership with the stratified medicine company Almac Diagnostic Services, have validated a test that for the first time could enable clinicians to decide the most appropriate chemotherapy for early stage oesophageal cancer. This personalised medicine approach of tailoring treatment to the individual could lead to more patients having their tumours successfully removed, improving their prognosis and quality of life.
Current treatment for oesophageal cancer involves a course of standard chemotherapy aiming to reduce the tumour size before follow-up surgery can be carried out to remove it. Only around 20 per cent of tumours will reduce in size following the standard course of chemotherapy. For oncologists identifying the most effective chemotherapy to reduce the size of oesophageal tumours before they are operated on is a challenge.
Dr Richard Turkington, Senior Clinical Lecturer at Queen’s University Belfast, and lead author on the study explains: “The UK has the highest incidence in the world of a particular type of oesophageal cancer called oesophageal adenocarcinoma, with 16,000 cases each year. One-third of patients are diagnosed with tumours which have not spread and can be removed by surgery following a course of chemotherapy. However, less than one in five patients show evidence of shrinkage from the chemotherapy when their tumour is removed.”
“In order to cure more oesophageal cancers we need to identify the most effective treatment for each patient to give them the best chance of all of their cancer being removed. At present we apply a ‘one-size-fits-all’ approach where everyone gets the same type of chemotherapy before their surgery. But we know that different chemotherapies work better for different patients so we need to match the right treatment to the right patient. This test enables us to gain a molecular understanding of each patient’s cancer, which could then inform the decision to select the right chemotherapy to shrink the tumour.”
Queen’s has collaborated with Almac Diagnostic Services to bring personalised medicine to oesophageal cancer. Almac Diagnostic Services has previously developed the DNA Damage Immune Response (DDIR) Signature, previously known as DDRD, to personalise chemotherapy for breast cancer but further studies indicated that it may be applied to other cancer types. The DDIR Signature is a 44 gene signature which uses the expression of each gene present in each tumour to generate a score for each patient. A high score indicates that the tumour has a higher likelihood of responding to DNA damaging chemotherapies.
Professor Richard Kennedy, McClay Professor of Medical Oncology at Queen’s University Belfast and Global Vice-president of Biomarker Development at Almac Diagnostic Services commented: “This study highlights the benefits of close collaboration between academia and industry and the strong links between Queen’s and Almac in particular. It expands the indications for the DDIR signature to oesophageal adenocarcinoma and brings stratified medicine a step closer in this difficult to treat cancer.”
This research study is part of the Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium led by Professor Rebecca Fitzgerald from the Medical Research Council Cancer Unit at the University of Cambridge and funded by Cancer Research UK.
Professor Fitzgerald commented: “The OCCAMS collaboration is a UK wide network of centres for the collection of tissue samples and clinical information to study the biology and treatment of oesophageal cancer. A key aim of the consortium is to translate laboratory discoveries into clinical progress and this study is an example of using this knowledge to improve diagnosis and treatment for oesophageal cancer patients.”
The research has been published in the journal Gut. The research team is continuing to test the assay further in other sample collections and through clinical trials.