When Menopause Masks Ovarian Cancer, Vital Treatment Gets Delayed

Image Credit: The New Yorker

By Anubhuti Matta

Nine months — that’s how long Shradha Gupta, 51, waited for an ovarian cancer diagnosis.

“I had a terrible pain in the pelvic region, felt bloated all the time, but the gynecologist kept asking me to wait a few months, as my period had stopped as well, to confirm if it was because of menopause,” says Gupta. “If my doctors and I had been more aware of the symptoms, that something as simple as constantly being bloated could be a tell-tale sign of ovarian cancer, it could’ve been caught sooner.”

Ovarian cancer has the unfortunate reputation of being known as a ‘silent killer.’ Its symptoms are so subtle, they are often waved away as menopause, since both are most common among the same group: women over 50.

Both are characterized by bloating, pain in the pelvic or abdominal region, difficulty eating or feeling full quickly, and a frequent need to urinate. Occasionally there can be other symptoms of ovarian cancer, such as changes in bowel habits, extreme fatigue or unexplained weight loss or gain — again all menopause symptoms. Sometimes, Irritable Bowel Syndrome (IBS) is diagnosed.

By the time ovarian cancer is considered as a possible cause, it usually has already spread to nearby organs, making it more difficult to treat. 

According to the Indian Journal of Cancer, ovarian cancer — the third leading cancer among women — has the worst prognosis, with a 5-year survival rate of 45%, “primarily due to the late stage of diagnosis of the disease.”

Gupta, who has undergone a hysterectomy and ovariectomy, is currently undergoing chemotherapy, and is on her way to recovery, leads a women’s cancer support group called We Will Win. Misdiagnosis is one of the main reasons why three out of five women in her Mumbai-based group have ended up with late-stage ovarian cancers.

“It’s not unusual for a woman newly diagnosed with ovarian cancer to have been seen by a bowel or bladder specialist for her symptoms or for the symptoms to be passed off as menopause at least five to six times before doctors confirm it as ovarian cancer,” says Gupta.

“Irregularities or the presence of these symptoms do not give away ovarian cancer directly. The first diagnosis is always menopause,” says oncologist Dr Kedar Mugwe. “Therefore, often, the early signs are either ignored, attributed to other conditions, and misinterpreted by general practitioners resulting in delays in women being referred to gynecologists.”

Ovarian cancer, unlike other cancers, lacks viable diagnostic tests. Unlike cervical cancer, which can be detected by a Pap smear, or breast cancer, which can be confirmed by a mammography before a lump is even big enough to be felt, there’s no specific screening available for ovarian cancer.

The only tests available to doctors to detect the presence of ovarian cancer have their own shortcomings. Women can undergo a complete pelvic ultrasound or a Transvaginal Ultrasound (TVUS), but neither are highly reliable in detecting ovarian cancer. They may reveal a mass or tumor in the ovary, they can’t actually tell if it is malignant or benign. A TVUS, which is conducted by inserting an ultrasound wand into the vagina and probing, carries the added disadvantage of being invasive.

Doctors can also order a CA-125 blood test, which measures the amount of a protein (CA-125) in the blood; many women with ovarian cancer have high levels of this protein. However, there are two problems with this test: first, its results can be misleading — high levels of CA-125 can also be caused by conditions like endometriosis and pelvic inflammatory disease — and second, not all women who have ovarian cancer display have high levels of CA-125.

This leaves both doctors and women with one, rather unremarkable tool for the earlier detection and treatment of ovarian cancer: awareness.

“If you think you have any of these symptoms that have persisted long enough, please don’t hesitate in asking for tests or more time from the doctor to research and look into your case,” Dr Mugwe says. “Insist on getting tested for ovarian cancer that usually means an ultrasound or an exploratory surgery to examine the ovaries directly.”

“My advice to both doctors and patients is to not show a low threshold for considering ovarian cancer as a possibility,” he adds.

This article was published by The Swaddle.

We Asked a Genetic Counselor About 23andMe’s New Cancer Test

By Dan Robitzski

“There’s that element of anxiety and stress and not necessarily having an educational resource to turn to.”

Over The Counter

23andMe is already allowed to screen customers for mutations associated with an increased risk of breast cancer. Now the FDA has granted the company approval to sell a direct-to-consumer test that screens for a colorectal-cancer associated mutation as well, according to Bloomberg.

A 23andMe Inc. DNA genetic testing kit. Photographer: Cayce Clifford/Bloomberg

The test could increase awareness and inform people of their previously-unknown cancer risks. But it also carries risks, a genetic counselor told Futurism — in this case, increased access to medical information that comes without the expert counseling that would help people understand what it means and what to do with it.

“When I think about bringing awareness to hereditary cancer risk, which adding some of these genes to this type of test certainly does — it brings it into the general population’s focus, I think that can be a good thing,” said Rachelle Chambers, the manager for genetic counseling at the High-Risk Cancer Genetics Program at the NYU Langone Perlmutter Cancer Center. “It’s bringing awareness. But I also think that it’s really important to understand the limitations to this type of test and the follow-up that needs to be done with this type of testing.”

Peering Through A Keyhole

Let’s talk about the actual test. There’s a very specific variant to the MUTYH gene which, if a person carries the mutation on both of their copies of the gene, is associated with an increased lifetime risk of developing colorectal cancer. About one in 20,000 people carry both mutations, explained Chambers, and something like one or two percent of people might have just one mutated gene.

Those carrying the cancer-linked MUTYH gene variant are not by any means guaranteed to develop cancer — it’s just one potential indication that they might.

23andMe’s newly-approved cancer test will detect the presence of that gene variant and clarify whether someone has one or two mutated MUTYH genes.

“But we don’t have as much data on what it means to have one mutation,” says Chambers. “The risks associated with one mutation are not as clear.”

Basically, people who take the 23andMe colorectal cancer screening will get a very limited glimpse into their cancer risk factors.

“This doesn’t take into account some of the still-rare-but-more-common genetic predispositions to colon cancer, and it certainly can’t take into account family history,” says Chambers, who added that genetic predispositions only account for 5 percent of colorectal cancer cases.

What that means is that a negative result on 23andMe’s new test doesn’t indicate that someone is in the clear, and a positive result doesn’t mean that they’re going to get cancer. What either result ­does mean is that the person who took the test will have a little bit more information about their own genetic information — though genetic screenings can yield complex information that Chambers says even trained geneticists can struggle to interpret.

“Within the MUTYH report (which isn’t yet available), we will clearly state that a negative result does not mean people are not at risk of developing colorectal cancer; rather, we will highlight that this is just one risk factor for colorectal cancer,” a 23andMe spokesperson told Futurism in response to concerns about the test. “These reports do not diagnose any conditions, rather they tell you, based on certain genetic variants, what your risk may be for developing a condition.”

Get Help

“Increasing accessibility is a good thing. But some of the limitations of genetics is that there aren’t a whole ton of people that really specialize in genetics,” Chambers said.

Logistically, direct-to-consumer tests can increase accessibility to cancer screenings. But even then any findings must be verified by a clinically-validated lab’s own tests before making any actual medical decisions, she explained.

“If you receive a negative result, 23andMe highlights that it is important to continue with any cancer screenings your healthcare provider recommends,” said the 23andMe spokesperson. “Additionally, if you receive an increased risk result, it is important to confirm the result in a clinical setting.”

Screenshots of the reports that come back from 23andMe’s breast cancer screening test reviewed by Futurism do clearly include several key points: that the test doesn’t test for a great deal of cancer-linked gene variants, that all results are meant to be verified in a clinical setting, and that a 23andMe test cannot replace an official diagnosis.

The company also warns customers that the information they receive as part of a medical screening may be troubling when they opt into the tests, and 23andMe encourages customers to set an appointment with a doctor and genetic counselor.

But recent findings that direct-to-consumer genetic tests can be inaccurate complicate the matter, according to Chambers.

“You have to balance that with wanting people to get quality information that’s accurate — and that’s not always the case with direct-to-consumer testing,” Chambers said.

In an ideal world, Chambers said she would rather people have access to what she called a “facilitated track” to genetic screening — educational resources combined with trained professionals to interpret and provide counseling about accurate test results. With direct-to-consumer tests like 23andMe’s, much of that is missing.

“This is not a comprehensive test,” Chambers said. “It’s not testing all predispositions for cancer. It’s only testing a fraction of the mutations in those genes. This is going to be a very incomplete place to start.”

Read more: DNA Company 23andMe Gets FDA Approval for Consumer Cancer Test [Bloomberg]

This article was published by Futurism.

Palliative Care May Improve Survival, Quality of Life in Advanced Cancer

By Brielle Benyon

Recent research found that outpatient palliative care improved survival and quality of life in patients with advanced cancer.

Palliative care may boost survival in patients with advanced cancer, according to recent research conducted at Tulane University.

“If people got palliative care, they had better quality of life. That’s great, because that’s what palliative care is made for,” study author Michael Hoerger, Ph.D., MSCR, assistant professor of psychology, psychiatry and oncology at Tulane University, said in an interview with CURE.

The researchers examined 2,307 patient records from nine different studies, and then compared survival and quality of life outcomes between those who were given outpatient specialty palliative care and those who were not. All patients involved had advanced cancer, and the majority of them had either lung cancer or a gastrointestinal cancer.

The palliative care group showed survival advantages at six, nine, 15 and 18 months, with a 14 percent absolute increase in one-year survival (56 percent versus 42 percent in the palliative care versus non-palliative groups, respectively). Average survival for patients given palliative care was more than 4.5 months longer.

“In general, patients who received palliative care lived a little longer. This doesn’t mean palliative care cures people of their cancer, it just means that they might live a little bit longer or for a longer time frame.”

The reasons for palliative care extending life are still unknown. Some believe that palliative care may help patients decide to stop treatments such as chemotherapy, which may be harmful toward the end of life. Another school of thought explains that palliative care helps patients have a more positive outlook on their diagnosis, explained Hoerger. 

Palliative care is sometimes confused with hospice, or end-of-life care. Palliative care can be prescribed at any time – during any prognosis – of treatment or the survivorship process, and is focused on improving comfort and quality of life. A typical palliative care session might include interventions that can help patients cope with symptoms and side effects, as well as decisions regarding treatment options and planning. If a patient is near the end of life, they might also discuss this, but only if they want to.

“Palliative care is not going to push people to talk about those tough end-of-life issues if the patient does not want to do that,” Hoerger said. “Somebody could have some really bad symptoms or side effects, and that could lead them to palliative care, too.”

This was not the first study to outline the benefit of palliative care for patients with advanced cancer. Other research found that it may reduce the risk of suicide in veterans with stage 3b or 4 lung cancer.

Moving forward, Hoerger hopes that his findings will expand the use of palliative care in health systems across the country, while also enlightening patients and their families to the benefits that it could provide.

“What I hope this research will do is help decision-makers to realize that they need to grow their palliative care programs,” Hoerger said. “This is also a tremendous opportunity for patients and families to know what palliative care is and speak up and ask for it.”

This article was published by CURE.

Energizing the Immune System to Eat Cancer

Immune cells called macrophages are supposed to serve and protect, but cancer has found ways to put them to sleep. Now researchers at the Abramson Cancer Center of the University of Pennsylvania say they’ve identified how to fuel macrophages with the energy needed to attack and eat cancer cells. It is well established that macrophages can either support cancer cell growth and spread or hinder it. But most tumors also express a signal called CD47, which can lull macrophages into a deep sleep and prevent them from eating. Researchers have found that rewiring macrophage metabolism can overcome this signal and act like an alarm clock to rouse and prepare macrophages to go to work. Their findings were published in Nature Immunology today.

Macrophages are immune cells just like T and B cells, but differ in that they can eat cells that are not supposed to be in the body. Credit: Penn Medicine

Macrophages are immune cells just like T and B cells, but differ in that they can eat cells that are not supposed to be in the body. In fact, they are the most prominent immune cell found in cancer, but unfortunately, most are often convinced to help cancer grow and spread. Cancer cells frequently stop macrophages from attacking them by expressing CD47, a “don’t eat me” signal. Researchers now say that merely blocking inhibitory signals like CD47 is not always sufficient to convince macrophages to attack cancer. Instead, two signals are required. First, they need a signal to activate them—such as a toll-like receptor agonist. After that, a second signal—such as a CD47 inhibitor—can lower the threshold needed to wage battle on the cancer.

“It turns out macrophages need to be primed before they can go to work, which explains why solid tumors may resist treatment with CD47 inhibitors alone,” said the study’s senior author Gregory L. Beatty, MD, Ph.D., an assistant professor of Hematology-Oncology at Penn’s Perelman School of Medicine. Jason Mingen Liu, an MD and Ph.D. graduate student in Beatty’s lab, is the study’s lead author.

The team used this approach by activating macrophages with CpG, a toll-like receptor agonist that sends the first signal, and found that it rapidly induced shrinkage of tumors and prolonged survival of mice even without the requirement of T cells. Unexpectedly, they also found that the activated macrophages were able to eat cancer cells even in the presence of high levels of CD47.

To understand the molecular basis of this phenomenon, the team traced the metabolic activity of macrophages and determined that activated macrophages began to utilize both glutamine and glucose as fuel to support the energy requirements needed for them to eat cancer cells. This rewiring of the macrophages metabolism was necessary for CpG to be effective, and the researchers say these findings point to the importance of macrophage metabolism in determining the outcome of an immune response.

“Cancer does not shrink without the help of macrophages and macrophages need the right fuel to eat cancer cells and shrink tumors,” Liu said. “To do this, a shift in metabolism is needed to steer the energy in the right direction. It is the metabolism that ultimately allows macrophages to override signals telling them not to do their job.”

Beatty points out that patients with diabetes, cardiovascular disease, and other conditions are routinely treated with drugs that could affect macrophage metabolism, but virtually nothing is known about how these drugs might impact immunotherapy responses in cancer, meaning the team’s discovery has implications even for existing treatments.

Provided by Perelman School of Medicine at the University of Pennsylvania

This article was published by Medical Xpress.

Alisertib-Based Combo Improves Survival Outcomes in Ovarian, Breast Cancer

By Jessica Skarzynski

For some time now, paclitaxel has been considered standard of care in the treatment of patients with platinum-resistant ovarian cancer; however, recent research has shown the addition of the investigational drug alisertib to a paclitaxel regimen demonstrated promising activity in patients with recurrent ovarian cancer or advanced breast cancer.

In the JAMA Oncology study, the researchers noted that alisertib has shown modest single-agent activity in patients with platinum-resistant ovarian and breast cancer, and is generally well tolerated. Given that, and the fact that the combination of alisertib and paclitaxel showed promise in preclinical trials, Falchook and his colleagues conducted a multicenter, open-label phase 1/2 study to evaluate the drug combination in both patient populations.  

Phase 1, which ran from May 2010 to August 2012, included 49 patients with either recurrent ovarian or breast cancer from 33 sites in the US, France and Poland. In addition to determining the tolerability and recommended dosage of the drug combination for phase 2, the researchers also evaluated overall response rate, duration of response, time to progression and overall survival as secondary endpoints.

Patients received the two drugs concurrently, which included 10 mg of alisertib orally mg twice daily on days 1 through 3, 8 through 10 and 15 through 17 in 28-day cycles; and while researchers monitored the effects in the first cycle, the alisertib doses were increased twice daily in 10-mg increments until the maximum tolerated dose was reached.

Additionally, patients received 80 mg of paclitaxel intravenously on days 1, 8 and 15, in 28-day cycles. This was reduced to 60 mg, and in the second 28-day cycle, the alisertib doses were withheld on days 1 through 3 to determine how the paclitaxel worked alone compared with the addition of alisertib. Throughout phase 1, patients received a median of six treatment cycles.

In phase 1, the recommended dosage of alisertib was 40 mg plus 60 mg/m2 of paclitaxel weekly. Phase 2, which ran from March 2012 through August 2013, included 142 patients with recurrent ovarian cancer who were randomized to two groups: one that received the recommended phase 1 regimen and another that received weekly paclitaxel alone. Patients in the alisertib plus paclitaxel arm received a median of 6 cycles, while the paclitaxel-alone arm received 5 cycles.

All 49 patients involved in phase 1 experienced a drug-related side effect, including 38 (78 percent) with grade 3 or 4 side effects. The most common side effects were neutropenia (59 percent) and leukopenia (35 percent), as well as anemia, febrile neutropenia and stomatitis. Serious side effects occurred in nine patients (18 percent), most frequently with febrile neutropenia (12 percent). This led to eleven patients (22 percent) requiring a dose reduction of alisertib and ten patients (20 percent) requiring a dose reduction of paclitaxel. Two patients dropped out of the study as a result of the side effects they experienced in phase 1.

In phase 2, all 73 patients in the alisertib plus paclitaxel arm experienced side effects compared to 66 patients (96 percent) in the paclitaxel-alone arm. In the arm that received both drugs, grade 3 or 4 side effects occurred in 67 patients (92 percent), leading to dose reductions in 54 patients (74 percent) and drug discontinuation in 12 patients (16 percent). Of those who received paclitaxel alone, 35 patients (51 percent) experienced grade 3 or 4 side effects. Side effect-related dose reductions occurred in 17 patients (25 percent) and four patients (6 percent) discontinued the study drug.

While one patient in each arm died during the study, neither death was considered related to the drugs being studied.

Overall, researchers noted an increase in progression-free survival of two months between the two arms: 6.7 months in the patients that received alisertib plus paclitaxel versus 4.7 months in patients who took paclitaxel alone.

Given that the combination shows promising results – and that its safety profile has been found to be generally manageable in patients with recurrent ovarian cancer – the researchers concluded that future studies of alisertib in combination with paclitaxel and other taxanes are warranted.

This article was published by CURE.

Antibody That Targets a Protein on the Surface of Stem Cells Also Targets Same Protein on Cancer Cells

An antibody that targets and is taken up only by certain types of cancer cells has been developed by A*STAR researchers. Combining this antibody with an anticancer drug could lead to a new treatment for some types of breast and ovarian cancers.

A team of researchers from the A*STAR Bioprocessing Technology Institute wanted to develop monoclonal antibodies that could specifically target and kill cancer cells through one of a variety of potential mechanisms. Pluripotent stem cells and many cancer cells share some of the same proteins, called oncofetal antigens, on their surfaces. The researchers utilized this to develop monoclonal antibodies by injecting human embryonic stem cells (hESCs) into mice, spurring their immune system into producing antibodies.

The team found that A19, one of the monoclonal antibodies produced, bound to Erbb-2, which is a receptor present on certain breast and ovarian cancer cells. During experiments with these cancer cells, they found that A19 not only bound to their Erbb-2 receptors, but was also consumed by them. The team wanted to test whether this process could be used for the targeted introduction of anticancer drugs into tumor cells.

They developed antibody-drug conjugates that were successfully taken up by ovarian cancer cells. The drugs were released inside the cells, killing them, and reducing their overall numbers.

The team then implanted ovarian cancer cells under the skin of mice and injected the antibody-drug conjugates into their abdominal cavities. The tumor sizes were reduced by 60 per cent in the treated mice compared to a control group.

Herceptin, another monoclonal antibody, is currently the gold standard for treating a specific type of breast and stomach cancer, called HER2 positive, and also binds to Erbb-2. The researchers found that A19 binds to a different form of Erbb-2 than Herceptin.

“A19 could possibly be developed as an alternative or complementary treatment to Herceptin,” says stem cell researcher, Heng Liang Tan, the first author of this study. He noted that the drug would still need to go through toxicology testing and clinical trials.

Tan says the team hopes to collaborate with biotechnology companies to develop A19 into a clinically approved drug. They will also continue to use the same approach applied in this study to generate more antibodies that can be used as targeted therapies, or for diagnosing a variety of diseases.

Provided by Agency for Science, Technology and Research (A*STAR), Singapore

This article was published by Medical Xpress.

Antihypertension Drug Losartan May Improve Treatment of Ovarian Cancer

A new study from a Massachusetts General Hospital (MGH) research team has found that the hypertension drug losartan, which targets the angiotensin signaling pathway, may improve the effectiveness of chemotherapy agents used to treat ovarian cancer. Previous research from the same team identified a similar effect for losartan in animal models of breast and pancreatic cancer, leading to a phase 2 clinical trial that had promising results against pancreatic cancer.

“We know that solid stress imposed by growing cancer cells and the extracellular matrix molecules they produce can compress blood vessels, reducing delivery of drugs and oxygen to tumors,” says Lei Xu, PhD, of the Steele Laboratories for Tumor Biology in the MGH Department of Radiation Oncology, co-senior author of the report published online in PNAS. “The extracellular matrix itself can keep high-molecular-weight drugs from penetrating tumors, and angiotensin signaling contributes to matrix formation. Since levels of an important enzyme in the angiotensin pathway are elevated and associated with poor outcomes in ovarian cancer, we investigated whether use of losartan to decrease fibrosis could improve outcomes in animal models of ovarian cancer.”

In a series of experiments in two mouse models the investigators found the following:

• Losartan treatment reduced extracellular matrix content and solid stress in ovarian tumors, increasing blood supply, oxygen levels and drug delivery;
• A mathematical model based on tumor physiology predicts that adding losartan to both low- and high-molecular-weight cancer therapies, delivered either intravenously or intraperitoneally, could improve outcomes;
• Adding losartan to treatment with the chemotherapy drug paclitaxel enhanced the antitumor effect of intraperitoneal paclitaxel and also reduced the development of ascites, accumulations of fluid in the abdomen that significantly reduce patients’ quality of life;
• Losartan depleted the extracellular matrix by inducing the expression of antifibrotic miRNA molecules, which could be used as biomarkers for response or resistance to chemotherapy;

An analysis of records of patients who received standard treatment for ovarian cancer at MGH or Brigham and Women’s Hospital while also also being treated for hypertension found that those patients taking losartan or other angiotensin-targeting drugs at the time of diagnosis lived an average of 30 months longer than did those taking other hypertension drugs.

“The entire class of angiotensin-targeting drugs that includes losartan has been shown to reduce collagen accumulation in cardiac and renal fibrotic disease,” says Xu, who is an assistant professor of Radiation Oncology at Harvard Medical School (HMS). “Losartan is a safe, and inexpensive drug that would cost less than $1/day while making a significant difference for patients with ovarian cancer.”

Rakesh K. Jain, PhD, director of the Steele Labs, A.W. Cook Professor of Radiation Oncology at HMS and co-senior author of the PNAS report, adds, “Our findings – on top of the the beneficial results of the recent phase 2 trial for pancreatic cancer – should provide information and tools to explore a new therapeutic target for ovarian cancer, which leads to the death of around 14,000 women in the U.S. each year.”

Study co-authors Olapado Yeku, MD, PhD, and David Spriggs, MD, of the MGH Gynecologic Cancer Program, hope to initiate a clinical trial of losartan in ovarian cancer patients later this year to test this strategy.

This article was published by EurekAlert.

AI Tool Scans Tumour Shape to Detect Aggressive Ovarian Cancer

Researchers at The Institute of Cancer Research, London (ICR) have developed an artificial intelligence (AI) test that analyses the shape of tumour cells to identify patients with aggressive ovarian cancer.

The test is intended to enable tailored treatment based on the patient requirements.

It scans for clusters of cells within tumours having misshapen nuclei. Patients with clusters of shapeshifting cells were found to have extremely aggressive disease.

Approximately 15% of women with this type of cancer are known to survive for five years or more, compared to 53% in other cases with the disease.

The researchers found that tumours with misshapen nuclei had impaired ability for DNA repair, making them susceptible to potential treatment with drugs such as PARP inhibitors or platinum chemotherapy.

In addition, it was observed that immune cells could not move into the clusters of such cancer cells.

The team used the new AI tool to automatically examine tissue samples from 514 ovarian cancer patients, analysing the shape and spatial distribution of the tumours and their surroundings.

Findings showed that tumours with misshapen cell nuclei had lower key DNA repair genes activity.

The researchers said that the test could identify tumours with the lower DNA repair activity, even when the genetic code of the BRCA gene remains intact.

They added that the hidden DNA repair defects would be overlooked only during tests for faults in DNA repair genes.

ICR Computational Pathology team leader Yinyin Yuan said: “We have developed a simple new computer test that can identify women with very aggressive ovarian cancer so treatment can be tailored for their needs.

“Using this new test gives us a way of detecting tumours with hidden weaknesses in their ability to repair DNA that wouldn’t be identified through genetic testing. It could be used alongside gene testing to identify women who could benefit from alternative treatment options that target DNA repair defects, such as PARP inhibitors.”

Furthermore, the study revealed higher levels of galectin-3 protein, which leads to the death of immune cells, in the clusters of shapeshifting cells.

The team believes that the protein could be a potential target for new immunotherapies to treat ovarian cancer.

This article was published by Verdict Medical Devices.

New Breath Test for Cancer Currently Under Trial

By Maria Cohut

A clinical trial has just launched to assess the effectiveness of a newly developed breath test that could help diagnose multiple forms of cancer.

Clinical trials assessing Owlstone Medical’s Breath Biopsy are currently under way.
Image credit: Owlstone Medical Ltd, 2019

Researchers from the Cancer Research United Kingdom Cambridge Institute have recently developed an innovative breath test.

They say that it will assist in the diagnosis of several types of cancer.

The new noninvasive test, created with the support of Owlstone Medical, screens for the presence of volatile organic compounds (VOCs).

These are signature molecules in a person’s breath that could help identify cancer at any stage.

This approach could help identify the presence of cancer early on, thus allowing people to access treatment immediately and enhancing the probability of positive health outcomes.

The new breath test, called Owlstone Medical’s Breath Biopsy, is being assessed in a clinical trial called the PAN Cancer Trial for Early Detection of Cancer in Breath.

According to lead investigator Prof. Rebecca Fitzgerald, “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,” she adds.

“Owlstone Medical’s Breath Biopsy technology is the first to test across multiple cancer types, potentially paving the way for a universal breath test,” explains Prof. Fitzgerald.

‘Providing a whole-body snapshot’

The authors explain that, during their natural processes, cells release a range of VOCs — but if they undergo mutations, this will alter the kinds of molecules they produce.

Owlstone Medical’s Breath Biopsy is aiming to detect the VOC changes that indicate the presence of different types of cancer.

In the clinical trial, the investigators are looking to collect and analyze samples from around 1,500 participants.

These include both those potentially living with cancer and healthy controls.

To begin with, the researchers will work with people with suspected cancer of the stomach and esophagus. They will later collect samples from people who may have prostate cancer, kidney cancer, bladder cancer, liver cancer, or pancreatic cancer.

For this trial, the investigators are recruiting people at Addenbrooke’s Hospital in Cambridge to be tested for one of these forms of cancer.

The participants will receive the innovative breath test first, and then they will undergo traditional diagnostic methods. This will allow the researchers to confirm the accuracy and effectiveness of Owlstone Medical’s Breath Biopsy.

“There is increasing potential for breath-based tests to aid diagnosis, sitting alongside blood and urine tests in an effort to help doctors detect and treat disease,” says Billy Boyle, co-founder and CEO at Owlstone Medical.

“The concept of providing a whole-body snapshot in a completely noninvasive way is very powerful and could reduce harm by sparing patients from more invasive tests that they don’t need.”

Billy Boyle

‘Potential to revolutionize’

So far, those who have registered for this trial seem to have had no difficulty while undergoing this new test.

Rebecca Coldrick, a 54-year-old woman participating in the trial, has Barrett’s esophagus. This is a condition in which cells lining the oesophagus have undergone mutations.

Barrett’s esophagus places her at a higher risk of developing a form of cancer called esophageal adenocarcinoma, so she needs to keep on screening for developments.

“Every 2 years I have an endoscopy to monitor my condition,” explains Coldrick. She chose to join the PAN trial, and she notes that her experience with the new breath test was a positive one.

“Initially,” she says, “I thought I might feel a bit claustrophobic wearing the mask, but I didn’t at all. I found watching the display on the computer during the test interesting and soon we were done, without any discomfort.”

“I think the more research done to monitor conditions like mine and the kinder the detection tests developed, the better,” Coldrick adds.

The Cancer Research UK investigators are very hopeful about this clinical trial and believe that the new technology will improve diagnostic processes.

“Technologies such as this breath test have the potential to revolutionize the way we detect and diagnose cancer in the future,” emphasizes Dr. David Crosby, head of early detection research at Cancer Research UK.

This article was published by Medical News Today.

Avelumab Fails to Extend PFS in Ovarian Cancer

A randomized phase 3 trial designed to evaluate avelumab for women with previously untreated advanced ovarian cancer failed to achieve its primary endpoint of PFS.

The JAVELIN Ovarian 100 study has been terminated based on the finding, reported as part of a planned interim analysis.

Avelumab (Bavencio; EMD Serono, Pfizer) — a human anti-PD-L1 antibody — is approved for adults and children aged 12 years or older with metastatic Merkel cell carcinoma, as well as certain patients with locally advanced or metastatic urothelial carcinoma.

The JAVELIN Ovarian 100 study evaluated avelumab in combination with or after platinum-based chemotherapy among women with treatment-naive ovarian cancer. Eighty percent of ovarian cancer cases are diagnosed at advanced stages, and most women with advanced disease die within 5 years.

The multicenter study included 998 women with previously untreated, locally advanced or metastatic epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer.

Researchers randomly assigned women to one of three treatment regimens: carboplatin/paclitaxel followed by observation; carboplatin/paclitaxel followed by avelumab maintenance; or avelumab plus carboplatin/paclitaxel followed by avelumab maintenance.

Topline results showed no PFS benefit in either of the avelumab groups, prompting the decision to discontinue the trial.

Data are still being analyzed, and more detailed results will be released in the future.

The safety profile of avelumab appeared consistent with that observed in other studies. No new safety signals were reported.

The JAVELIN clinical development program is assessing avelumab for more than 15 tumor types, including ovarian cancer, breast cancer, head and neck cancer, gastric and gastroesophageal junction cancers, Merkel cell carcinoma, non-small cell lung cancer, renal cell carcinoma and urothelial carcinoma.

This article was published by Healio.