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̽��ֱ��women helping to change the story of ovarian cancer

lw355 — Mon, 24 Jan 2022 13:40:02 +0000

Every patient with cancer has a story to tell of their journey through diagnosis and treatment. We meet a group of women who are at the centre of pioneering research in Cambridge that’s changing the outcome of ovarian cancer – helping to create treatments that are as unique as their stories.

‘Virtual biopsies’ could replace tissue biopsies in future thanks to technique developed by Cambridge scientists

cjb250 — Wed, 06 Jan 2021 09:47:55 +0000

̽��ֱ��research published in European Radiology shows that combining computed tomography (CT) scans with ultrasound images creates a visual guide for doctors to ensure they sample the full complexity of a tumour with fewer targeted biopsies.

Capturing the patchwork of different types of cancer cell within a tumour – known as tumour heterogeneity – is critical for selecting the best treatment because genetically-different cells may respond differently to treatment.

Most cancer patients undergo one or several biopsies to confirm diagnosis and plan their treatment. But because this is an invasive clinical procedure, there is an urgent need to reduce the number of biopsies taken and to make sure biopsies accurately sample the genetically-different cells in the tumour, particularly for ovarian cancer patients.

High grade serous ovarian (HGSO) cancer, the most common type of ovarian cancer, is referred to as a ‘silent killer’ because early symptoms can be difficult to pick up. By the time the cancer is diagnosed, it is often at an advanced stage, and survival rates have not changed much over the last 20 years.

But late diagnosis isn’t the only problem. HGSO tumours tend to have a high level of tumour heterogeneity and patients with more genetically-different patches of cancer cells tend to have a poorer response to treatment.

Professor Evis Sala from the Department of Radiology, co-lead CRUK Cambridge Centre Advanced Cancer Imaging Programme, leads a multi-disciplinary team of radiologists, physicists, oncologists and computational scientists using innovative computing techniques to reveal tumour heterogeneity from standard medical images. This new study, led by Professor Sala, involved a small group of patients with advanced ovarian cancer who were due to have ultrasound-guided biopsies prior to starting chemotherapy.

For the study, the patients first had a standard-of-care CT scan. A CT scanner uses x-rays and computing to create a 3D image of the tumour from multiple image ‘slices’ through the body.

̽��ֱ��researchers then used a process called radiomics – using high-powered computing methods to analyse and extract additional information from the data-rich images created by the CT scanner – to identify and map distinct areas and features of the tumour. ̽��ֱ��tumour map was then superimposed on the ultrasound image of the tumour and the combined image used to guide the biopsy procedure.

By taking targeted biopsies using this method, the research team reported that the diversity of cancer cells within the tumour was successfully captured.

Co-first author Dr Lucian Beer, from the Department of Radiology and CRUK Cambridge Centre Ovarian Cancer Programme, said of the results: “Our study is a step forward to non-invasively unravel tumour heterogeneity by using standard-of-care CT-based radiomic tumour habitats for ultrasound-guided targeted biopsies.”

Co-first author Paula Martin-Gonzalez, from the Cancer Research UK Cambridge Institute and CRUK Cambridge Centre Ovarian Cancer Programme, added: “We will now be applying this method in a larger clinical study.”

Professor Sala said: “This study provides an important milestone towards precision tissue sampling. We are truly pushing the boundaries in translating cutting edge research to routine clinical care.”

Fiona Barve (56) is a science teacher who lives near Cambridge. She was diagnosed with ovarian cancer in 2017 after visiting her doctor with abdominal pain. She was diagnosed with stage 4 ovarian cancer and immediately underwent surgery and a course of chemotherapy. Since March 2019 she has been cancer free and is now back to teaching three days a week.

“I was diagnosed at a late stage and I was fortunate my surgery, which I received within four weeks of being diagnosed, and chemotherapy worked for me. I feel lucky to be around,” said Barve.

“When you are first undergoing the diagnosis of cancer, you feel as if you are on a conveyor belt, every part of the journey being extremely stressful. This new enhanced technique will reduce the need for several procedures and allow patients more time to adjust to their circumstances. It will enable more accurate diagnosis with less invasion of the body and mind. This can only be seen as positive progress.”

This feasibility study, involving researchers from the Department of Radiology, CRUK Cambridge Institute, Addenbrooke’s Hospital, Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust, and collaborators at Canon, was facilitated through the CRUK Cambridge Centre Integrated Cancer Medicine programme.

̽��ֱ��goal of Integrated Cancer Medicine is to revolutionise cancer treatment using complex data integration. Combining and integrating patient data from multiple sources – blood tests, biopsies, medical imaging, and genetic tests – can inform and predict the best treatment decisions for each individual patient.

̽��ֱ��study was funded by Cancer Research UK and ̽��ֱ��Mark Foundation for Cancer Research.

Reference
Lucian Beer, Paula Martin-Gonzalez et al. Ultrasound-guided targeted biopsies of distinct CT based radiomic tumour habitats: proof of concept. European Radiology; 14 Dec 2020; DOI: 10.1007/s00330-020-07560-8

A new advanced computing technique using routine medical scans to enable doctors to take fewer, more accurate tumour biopsies, has been developed by cancer researchers at the ̽��ֱ�� of Cambridge. This is an important step towards precision tissue sampling for cancer patients to help select the best treatment. In future the technique could even replace clinical biopsies with ‘virtual biopsies’, sparing patients invasive procedures.

This study provides an important milestone towards precision tissue sampling. We are truly pushing the boundaries in translating cutting edge research to routine clinical care

Evis Sala

Image showing individual and combined scans

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Leading European cancer centres share guidance on making their operations ‘pandemic proof’

cjb250 — Thu, 16 Apr 2020 16:44:27 +0000

̽��ֱ��centres, which include the Cancer Research UK Cambridge Cancer Centre, form an alliance known as Cancer Core Europe (CCE), and together represent around 60,000 newly diagnosed cancer patients each year and conduct more than 1,500 clinical trials.

In a Perspective published in Nature Medicine, CCE researchers describe how their centres have been forced by the current pandemic to drastically revise and reorganise their patient care and scientific research, while maintaining the same high quality of care.

̽��ֱ��specialist centres not only want to prevent the spread of the virus in general, but also to protect patients with cancer whose disease and treatment make them especially vulnerable to complications if infected.

“COVID-19 has created a unique challenge: how to adjust cancer management to minimise the disruption caused to cancer care by the pandemic,” said Professor Carlos Caldas, co-lead author of the article, member of the senior management team of the Cancer Research UK Cambridge Centre, and Group Leader at the Cancer Research UK Cambridge Institute.

“Our medical staff across all disciplines have been truly amazing at very quickly producing COVID-19-adjusted treatment guidelines.”

̽��ֱ��researchers have identified several factors that medical institutions need to consider to ensure continuity in cancer care as the COVID-19 pandemic unfolds. These include:

Clinical activities
Given the high transmissibility rate of SARS-Cov2, it is the responsibility of all health care professionals to make sure patients are not exposed to COVID-19. For CCE centres, this means that face-to-face consultations are now, whenever possible, taking place via web consulting or by telephone calls, and non-urgent appointments are postponed.
Adaptation of standard-of-care treatment regimens
Across all centres, standard-of-care treatment regimens have been adapted to minimize the number of hospital visits and hospitalizations, and to prevent complications of COVID-19 caused by anticancer treatments.
Patient information and psychosocial care
Addressing patients’ concerns relating to their treatment and how it may be affected by COVID-19 poses a challenge to CCE centres and has required urgent attention.
Support of qualified personnel
In order to ensure the continuity of cancer care, the presence of sufficient qualified personnel to treat cancer patients is essential. This involves the whole chain of hospital caregivers, from the operating theatre, to the ward, day clinic, and intensive care unit (ICU). Every CCE has faced a similar problem: the absence of a rapid diagnostic system for COVID-19 for caregivers. This frequently leads to unnecessary self-isolation of health professionals, further reducing the health workforce in a time when demand is peaking.
Capacity of cancer care facilities
In many hospitals, the COVID-19 pandemic is a major stress test for the capacity of the various treatment or support units: radiation, medical oncology, imaging, surgery and ICUs. With increasing severity of the pandemic, health care systems will become overwhelmed and prioritization will be necessary. To prepare for this, CCE centres have established decision rules to categorize and prioritize patients for anticancer therapies or surgery.
Research activities
CCE centres have large research facilities and together employ thousands of preclinical scientists. One of the first measures taken was to downscale these preclinical research activities to a minimum in accordance with social distancing guidelines and the ‘lockdown’ local policy. Clinically trained scientists and research fellows are frequently going back to clinical work to support their healthcare system.

̽��ֱ��authors acknowledge that the current crisis will have major ramifications to the progress of cancer research. However, public health measures in place to curtail the COVID-19 pandemic have to be prioritized at the moment, and the damage to the scientific enterprise will be repairable in time if safeguards and resources are put in place.

̽��ֱ��team outline a set of practical measures that have been implemented in their respective centres and could be considered by other medical centres. These range from instructing patients where possible not to visit the hospital if they have possible symptoms of COVID-19 to reducing preclinical research activities to a bare minimum, and from informing patients about a possibly increased risk associated with anticancer therapy during the pandemic through to considering non-surgery-based treatments, such as radiation for prostate cancer.

Professor Caldas added: “We hope that our collective experiences will help guide others and will also reassure cancer patients that we are doing everything we can to avoid compromising their care.

“This COVID-19 crisis is making us rethink care, and some of the changes might in the long run have positive effects, for example minimising hospital visits and face-to-face consultations or delivering care using telemedicine.”

̽��ֱ��Cancer Core Europe (CCE) alliance of seven leading European cancer centres was founded in 2014 to accelerate the development of innovative cancer therapies through close collaboration in translational and clinical research. Its seven member centres collectively treat approximately 350,000 patients annually.

̽��ֱ��Cancer Research UK Cambridge Centre acknowledges funding from Cancer Research UK, the National Institute for Health Research Cambridge Biomedical Research Centre, and ̽��ֱ��Mark Foundation for Cancer Research. Its clinical cancer services are provided by Cambridge ̽��ֱ�� Hospitals (CUH) and Royal Papworth Hospital.

Reference
Caring for patients with cancer in the COVID-19 era. Nat Med; 16 Apr 202; DOI: 10.1038/s41591-020-0874-8

Seven of Europe’s leading cancer centres have today published a report detailing how they have organized their healthcare systems at an unprecedented scale and pace to make their operations ‘pandemic proof’ during the COVID-19 pandemic.

COVID-19 has created a unique challenge: how to adjust cancer management to minimise the disruption caused to cancer care by the pandemic

Carlos Caldas

CRUK Cambridge Institute

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Making sense of cancer’s ‘big data’ problem to revolutionise patient care

cjb250 — Tue, 10 Jul 2018 11:12:10 +0000

̽��ֱ��Mark Foundation Institute for Integrated Cancer Medicine, announced today, will be funded by an £8.6 million award to the ̽��ֱ�� of Cambridge from ̽��ֱ��Mark Foundation for Cancer Research – the first time that the New York-based philanthropic organisation has made an award to a UK institution.

̽��ֱ��virtual institute aims to exploit recent advances in big data processing and machine learning to capture and integrate clinical, genomic, and image data collated from hundreds of cancer patients in real-time. Laboratory and clinic-based researchers and data experts will work together to determine whether sophisticated computational integration of all these diverse data types into a single platform can inform and predict the best treatment decisions for each individual patient.

Blood tests, biopsies, medical imaging, and genetic tests are a routine part of current cancer care; however, it is not always clear which of these increasingly large datasets are most important in guiding treatment at specific points in the patient journey.

“Doctors have long dreamed of an objective system that can integrate all the results generated from their cancer patients, guiding comprehensive treatment decisions both for current treatment and to predict how a particular disease will behave in the future,” explains Professor Richard Gilbertson, Director of the Cancer Research UK Cambridge Centre where the new institute will be based.

“This is essentially an enormous mathematical problem that requires state-of-the art computational and machine learning approaches to solve. It is this problem that our new institute, funded by a visionary award from ̽��ֱ��Mark Foundation for Cancer Research, will seek to address.”

With the help of artificial intelligence and machine learning approaches, the new institute will build and interrogate common data platforms and translate insights gained into principles for guiding timely clinical decision making.

“Integrated cancer medicine offers the promise of turning the tsunami of data generated in medical practice into an extraordinarily powerful but practical tool for patient benefit. This should enable us to deliver conventional and novel cancer treatments more effectively, and learn constantly from each patient through iterative analysis, as we refine and improve care for the future,” adds Professor Gilbertson.

̽��ֱ��researchers involved in these studies plan to use existing breast cancer clinical trials to test the concept of synthesising different types of data to produce results that improve clinical decisions for patients during the course of their treatment. If successful, this approach will be extended to other disease types.

Dr Michele Cleary, CEO of ̽��ֱ��Mark Foundation for Cancer Research said: “We are delighted to support this bold and innovative research at the ̽��ֱ�� of Cambridge. ̽��ֱ��maximal use of patient data holds tremendous promise to offer better outcomes to patients and their families. Cambridge scientists are at the forefront of the field in this regard and are well positioned to accelerate optimal approaches for personalised cancer medicine.”

A new institute at the ̽��ֱ�� of Cambridge aims to revolutionise cancer care by using cutting edge analytics to maximize the use of big data sets collected from patients.

Integrated cancer medicine offers the promise of turning the tsunami of data generated in medical practice into an extraordinarily powerful but practical tool for patient benefit

Richard Gilbertson

NASA's Marshall Space Flight Center

Mutants in Microgravity

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