The Christie School of Oncology: Christie Research Publications Repository
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What Is the impact of novel systemic anticancer therapy on acute oncology education and service delivery?
No full textOBJECTIVES: To discuss the importance of educating healthcare professionals about oncological emergencies linked to novel systemic anticancer therapy (SACT) and the impact on acute oncology (AO) services. METHODS: This discussion is based on clinical expertise and informed by current literature. RESULTS: Novel SACT, such as immune-checkpoint inhibitors, have more complex toxicity profiles and can be challenging to recognize and treat. An increasing prevalence of toxicity is expected as new drugs are developed and the numbers of patients living with and beyond cancer expand; more data are required to capture the full extent of this. There are knowledge gaps within the healthcare workforce, particularly outside oncology-specialist settings. Focused research in this area will provide direction for targeted educational interventions. CONCLUSIONS: Insufficient SACT education is a safety issue; severe toxicities can be fatal but initial symptoms can be subtle and may be missed. We argue that emergency care pathways can help to streamline the appropriate management of patients with SACT toxicity, but awareness of AO issues remains 'everyone's business.' Continuing clinical education is key to maintaining awareness of newly developed SACT. AO service models may vary, but AO competence assessment passports can provide a standardized method of evidencing AO knowledge and skills. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses, as a highly specialized and knowledgeable part of the healthcare workforce, are key in supporting interprofessional education. By using existing cancer nursing frameworks, this can support the implementation of the AO Passports. The learning and development of AO services in the UK can be transferred internationally
Selecting first-line immunotherapy in advanced melanoma: current evidence on efficacy across diverse patient populations
No full textImmunotherapy has dramatically changed the outcome for patients with advanced melanoma, with significant improvements in overall survival and potential cure for some. The recent approval of nivolumab in combination with relatlimab (nivolumab-relatlimab) added a third immunotherapy option for first-line treatment for advanced melanoma. Nivolumab-relatlimab has shown greater efficacy compared to single-agent nivolumab and has fewer unacceptable side effects compared to the combination of ipilimumab and nivolumab (ipilimumab-nivolumab). However, the lack of both long-term follow-up data and direct comparison with ipilimumab-nivolumab raises uncertainty about where to position nivolumab-relatlimab in clinical practice. Since most patients who respond to combination ipilimumab-nivolumab also respond to nivolumab-relatlimab, and many to single-agent anti-programmed death-1 (PD-1) monotherapy, the challenge is to identify the subgroup of patients who need ipilimumab-nivolumab and would not achieve similar benefits from less toxic alternatives. This review discusses the available data on efficacy of the three approved first-line immunotherapies (single-agent anti-PD-1, nivolumab-relatlimab or ipilimumab-nivolumab) and their value in distinct population groups to help guide clinical decisions
Development and evaluation of a remote monitoring regional adjuvant abemaciclib service for patients with high-risk early breast cancer
No full textINTRODUCTION: Adjuvant abemaciclib was recently approved in high-risk early breast cancer, leading to an increase in oncology resource utilisation. We thus developed a regional, remote monitoring clinical service. The set-up, delivery processes and outcomes from the first 6 months' consecutive patients are presented. METHODS: A regional delivery model with remote monitoring using optional electronic patient outcome measures (ePROMs) and bloods closer to home (BCTH) was implemented. Electronic patient records of patients entering the service (October 31, 2022 to May 31, 2023) were reviewed. Time-in-motion and on-line patient satisfaction surveys were conducted with questions adapted from prior questionnaires used by our cancer center. An independent t-test was used to assess differences in creatinine levels whilst on abemaciclib and a Mann-Whitney test to determine whether the time taken to complete follow-up appointments differed with and without ePROMs. RESULTS: The first 103 patients to commence abemaciclib (median age 58 [range, 27-85], 66.0% White) had completed a median of 6 cycles (range, 0-9). 51.5% had treatment interruption, 52.4% a dose reduction and 15.5% discontinued therapy. Diarrhoea (90.3%), fatigue (84.9%) and anorexia (73.1%) were the most commonly reported toxicities on ePROMs. 10.8% of patients reported grade 3-4 toxicities. Neutropenia was also common and low grade. 89.5% of patients would recommend ePROMs and 98.0% found the BCTH service easy to use. Review appointments with ePROMs were a similar length to those without (P = .138). CONCLUSIONS: We have successfully implemented a remote, regional adjuvant clinical service which could serve as a blueprint for other NHS trusts for this and other cancer drugs
Multi-institution longitudinal apparent diffusion coefficient measurements in a diffusion weighted imaging phantom at room temperature
No full textBACKGROUND AND PURPOSE: This work contributes to technical validation of apparent diffusion coefficient (ADC) as a biomarker of cancer. The aim was to evaluate ADC accuracy, random error, short-term and long-term repeatability and reproducibility, across multiple institutions using a room temperature phantom. MATERIALS AND METHODS: ADC measurements were made in a travelling room temperature diffusion weighted imaging (DWI) phantom on six scanners at four UK institutions over 18 months at six-month intervals. ADC bias measurements were calculated as the difference between measured and temperature corrected ground-truth ADC values and used to calculate mean ADC bias, isocentre ADC error estimate, short- and long-term intra-scanner repeatability as per the Quantitative Imaging Biomarkers Alliance (QIBA) DWI profiles, and inter-scanner reproducibility by calculating the 95 % limits of agreement for all ADC bias measurements. RESULTS: The use of a room-temperature phantom with a magnetic resonance (MR) readable thermometer enabled ADC measurements without ice-water setup, considerably simplifying logistics with respect to multi-institution ADC quality assurance. Mean ADC bias across all scanners and sessions was <0.01 × 10(-3) mm(2) s(-1) (0.81 %); mean isocentre ADC error estimate was 1.43 %; average scanner short-term repeatability was <0.01 × 10(-3) mm(2) s(-1) (1 %). Reproducibility was 0.07 × 10(-3) mm(2) s(-1) (9 %). CONCLUSION: Results indicated good ADC accuracy, repeatability and reproducibility; demonstrating the feasibility of transferring diagnostic DWI sequences between scanners from the same manufacturer, for use in multi-institution longitudinal studies, and assessing ADC with minimal quality control and harmonisation steps required
Assessment and treatment of frail patients living with multiple myeloma. A guideline on behalf of the UK Myeloma Research Alliance Frailty Group
No full textCancer in a drop: Advances in liquid biopsy in 2024
No full textOver the past decade, liquid biopsy (LB) has emerged as a key tool in oncology. Its utility in non-invasive sampling and real-time monitoring has made it a cornerstone in precision medicine. Since 2020, publications on LB in solid tumors have doubled, underscoring its pivotal role in advancing cancer care. Notably, 2024 marked a peak in scientific papers on this topic. Blood remained the most studied biofluid, with circulating tumor DNA (ctDNA) as the most frequently analyzed analyte, followed by circulating tumor cells, extracellular vesicles, and microRNAs. Among tumor types, gastrointestinal, lung, breast, and genitourinary cancers were the most investigated, collectively accounting for more than half of the studies. Early cancer and minimal residual disease detection are critical areas of interest, emphasizing the expanding potential of fragmentomics and methylation profiling, as well as the prognostic significance of ctDNA across various cancer types. Moreover, serial ctDNA monitoring demonstrated the ability to predict relapse and guide treatment (de)-escalation strategies. In metastatic setting, ctDNA profiling plays a crucial role in capturing tumor heterogeneity, detecting resistance mechanisms, and informing treatment selection. Non-blood biofluids gained interest for their potential to enhance the detection of clinically relevant alterations in different cancer types such as central nervous system and head and neck cancers. Other than biomarkers selection, the technological advancements and artificial intelligence significantly improved the sensitivity and specificity of LB assays. This evidence in combination with the rapid advancement of machine learning and other computational approaches, are paving the way for a new chapter of LB research
Early-onset colorectal cancer: linking clinical outcomes to socio-economic challenges across three tertiary cancer centres
No full textMaximum tumor diameter is associated with relapse risk in limited-stage Hodgkin lymphoma: an international study
No full textTumor bulk is an established prognostic factor in Hodgkin lymphoma (HL), but most patients with limited-stage (LS) HL do not have 'bulk' by standard definitions. In the RAPID trial, maximum tumor diameter (MTD) was associated with relapse risk in LS-HL patients achieving positron emission tomography negativity (PET-) after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). We aimed to externally validate these findings in the H10 trial. Stage I/IIA HL patients, without mediastinal bulk, who achieved PET- with ABVD were included. Patients received 3 ABVD plus radiotherapy (n = 208) or 3 ABVD alone (n = 211) in RAPID, and 3 to 4 ABVD plus radiotherapy (n = 556) or 4 to 6 ABVD alone (n = 303) in H10. MTD was strongly associated with event-free survival (relapse or HL-related death) in H10 (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.07-1.38; P = .003), a similar effect to that seen in RAPID (HR, 1.19; 95% CI, 1.02-1.39; P = .02), giving an estimated 21% risk increase per centimeter MTD (HRpooled, 1.21; 95% CI, 1.09-1.33; P < .001). Effect sizes were similar for patients treated with ABVD alone and ABVD plus radiotherapy, with no differential effect (pinteraction = 0.97). Treatment modality and MTD were independent risk factors; patients with higher MTD receiving chemotherapy alone had the greatest relapse risk. This international validation study confirms MTD is strongly associated with relapse risk in patients with LS-HL achieving PET- and informs decision-making around risk-adapted application of radiotherapy. The trials were registered at www.clinicaltrials.gov as #NCT00943423 and #NCT00433433
CA125 and age-based models for ovarian cancer detection in primary care: a population-based external validation study
No full textBACKGROUND: Cancer antigen-125 (CA125) is widely used to investigate symptoms of possible ovarian cancer (OC) in primary care. However, OC risk varies with age and CA125 level. We externally validated the Ovatools models, which provide CA125- and age-specific OC risk. METHODS: The performance of Ovatools in predicting OC diagnosis within 12 months of primary care CA125 was examined using English healthcare data for women <50 and ≥50 years. Discrimination and calibration were examined, accuracy was calculated at varying risk thresholds and compared to CA125 ≥ 35U/ml. We estimated OCs missed/detected by Ovatools in hypothetical diagnostic pathways, including a two-threshold pathway where moderate risk (1-2.9%) triggered primary care ultrasound, and higher risk (≥3%) triggered urgent cancer referral. RESULTS: 342,278 women were included, 0.63% had OC. The AUC was 0.95 in women ≥50 and 0.89 in women <50. When sensitivity/specificity were matched to CA125 ≥ 35U/ml, Ovatools showed marginally improved performance across other accuracy metrics in women ≥50 years. In a two-threshold pathway (≥50 years), 18.3% identified for urgent referral and 1% identified for ultrasound had OC. DISCUSSION: Ovatools performed well on external validation. Ovatools could be used to support informed decision-making and to triage women for further investigation based on cancer risk
UK association of supportive care in cancer (UKASCC) enhanced supportive care (ESC) national collaborative: building a community of practice
No full textBACKGROUND: Enhanced Supportive Care (ESC) delivers multi-professional and proactive support for people with treatable but not curable cancer by addressing physical, psychological and social needs throughout the disease trajectory from the point of diagnosis. Since the dissolution of the national NHS England Commissioning for Quality and Innovation funding, ESC services in the UK have lacked standardisation, financial backing and strategic oversight. OBJECTIVES: To create a national collaborative ESC framework by identifying evidence-based care models, mapping existing national services and informing future commissioning and research. METHODS: The ESC Steering Group was established in 2022 under the UK Association for Supportive Care in Cancer (UKASCC) and developed two workstreams in collaboration with patient and public involvement: (1) an international scoping review to define components of effective ESC models and (2) a national survey to evaluate current ESC service provision, barriers, facilitators and measurable outcomes. RESULTS: The UKASCC ESC National Collaborative involves over 40 professionals from 27 organisations and found considerable variation in ESC service delivery, therefore supporting the need for a standardised, evidence-informed model. The scoping review and survey distribution are in progress. SUMMARY: The UKASCC ESC National Collaborative demonstrates the power of collaborative working in supportive oncology. Despite challenges, this network guides national ESC development and aims to support a future research portfolio and commissioning strategy